Comparator Report on Patient
Access to Cancer Medicines in
Europe – Netherlands
Bengt Jönsson, Professor emeritus
Stockholm School of Economics
2016-10-18
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IHE comparator report 2016:4
1. Published in June 2016
2. Includes EU28,
Switzerland, Norway and
Iceland
3. Retrospective analysis
over two decades
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BURDEN OF CANCER
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Cancer incidence is increasing in NL, just
as in Europe as a whole
Cancer incidence cases per 100,000 inhabitants (crude rates, both sexes)
Notes: Hatched bars indicate that national estimates are based on regional data or based on neighboring countries.
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At the same time cancer patients live
longer
5-year age-adjusted relative survival rates for all cancers in patients aged ≥15 years, 1990–2007
Notes: Hatched bars indicate that national estimates are based on regional data.
Source: EUROCARE-3 to EUROCARE-5
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Number of cancer mortality cases have been
increasing in NL (crude rates, both sexes)
60000
50000
40000
30000
20000
10000
0
NL
•
•
Number of cancer mortality cases have been increasing in NL
This may be explained by the large increase of cancer incidences
and demographic factors
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Once demographic factors are accounted for,
cancer mortality case decreased in NL over the
past decades
300
250
200
150
100
50
0
NL
Cancer mortality cases per 100,000 inhabitants (age-standardized rates) both sexes, Netherlands
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Cancer has overtaken CVD in NL during the
period 2000-2012
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SPENDING ON CANCER CARE
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Changes in the composition of total cancer
costs
Components of the total cost of cancer in the EU (in billion €; 2014 prices), 1995–2014. Notes: Cancer is defined as ICD-10C00D48 for health expenditure and ICD-10 C00-97, B21 for production loss due to premature mortality. EU = European Union; h-exp
= health expenditure on cancer; m-loss = production loss due to premature mortality from cancer during working age.
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References: Jönsson B et al. Eur J Cancer 2016; 66: 162–170.
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The Netherlands
€ 5,000
4507
4405
(M€; unadjusted 2014 prices)
€ 4,000
€ 3,000
2,877
2801
2,405
2,480
3,853
3,826
2,049
€ 2,000
2,785
2,844
1,780
2,465
€ 1,000
€0
direct
m-loss
1995
direct
m-loss
direct
2000
cost of cancer drugs
654
579
336
m-loss
2005
direct
m-loss
2010
direct
m-loss
2014
other direct health costs
Notes: “direct” = direct health cost of cancer; “m-loss” = productivity loss due to premature mortality from cancer.
2014 prices. Cost of cancer drugs not reported separately in 1995 and 2000 – the cost of drugs is included in direct
costs for these years.
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Hospital costs for cancer have been reduced
over time: Will this trend continue?
NL hospital budget for secondary care (billion €)
•
25
24.5
•
24
23.5
23.10
23.11
23.03
22.99
22.95
2016
2017
2018
2019
2020
23
22.5
The budget is increasing until 2017
and then slowly decreasing during
the following years
Hospitals have made an agreement
to cap the hospital budget in 2016
by a growth percentage of 1%
22.25
22
21.5
21
20.5
20
2015
Note: Budget determined by the state for secondary care
Source: Rijksbegroting 2016 (2015)
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The proportion of spending on cancer
doesn’t reflect the burden of disease
HEALTH EXPENDITURE (NL)
Cancer
Other
DALYS (‘000)
Cancer
Other
Cardiovascular
5.7%
698.9
1041.8
94.3%
2734
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USE OF CANCER MEDICINES
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NL performs well but could still improve its
outcomes
100
88
89
90
80
83
80
79
86
85
84
83
86
89
88
89
83
90
70
58
59
%
65
48
31
31
32
40
15
13
16
15
17
22
20
20
64
65
53
44
40
40
42
50
30
60
63
54
52
60
61
59
60
63
61
58
62
62
70
9
10
0
Stomach
cancer
Colon cancer Rectal cancer Lung cancer
Belgium*
Germany
Skin
Breast cancer
melanoma (woman only)
Ovarian
cancer
Netherlands
Prostate
cancer
Sweden
Kidney
cancer
Non-Hodgkin
lymphoma
United Kingdom
5-year age-standardised relative survival for adult patients with cancer, diagnosed 2000–07
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Launch delay: nine-fold difference in Europe
Netherlands has the 2nd shortest launch delays
for in-patient oncology drugs
Short launch delays is important for patients
access to new oncology drugs
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Uptake of Trastuzumab (Breast)
8
7
6
g per case
5
4
3
2
1
0
2005
2006
Belgium
2007
EU Total
2008
2009
Germany
2010
2011
Netherlands
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2012
Sweden
2013
UK
2014
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Fastest launch times <> widespread use or uptake – the
case of drugs in HER2+ breast cancer
Use of HER2+ breast cancer drugs in 2014
• DDD usage of HER2+
breast cancer drugs is
lowest among
wealthier countries.
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Fastest launch times <> widespread use or uptake –
the case of drugs in HER2+ breast cancer
400
350
300
DDD per case
250
200
150
100
50
0
Lower GDP/capita tier
Mid GDP/capita tier
Upper GDP/capita tier
Lower GDP/capita tier
Mid GDP/capita tier
2005
trastuzumab
2014
lapatinib
pertuzumab
trastuzumab emtansine
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Upper GDP/capita tier
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Uptake of Erlotinib (Lung)
3.5
3
g per case
2.5
2
1.5
1
0.5
0
2005
2006
Belgium
2007
EU Total
2008
2009
Germany
2010
2011
Netherlands
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Sweden
2013
UK
2014
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Fastest launch times <> widespread use or uptake – the
case of drugs in lung cancer
Use of lung cancer drugs in 2014
• DDD usage of lung
cancer drugs is in the
middle of wealthier
countries.
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Uptake of Lenalidomide (Myeloma)
4.5
4
3.5
g per case
3
2.5
2
1.5
1
0.5
0
2005
2006
Belgium
2007
EU Total
2008
2009
Germany
2010
2011
Netherlands
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Sweden
2013
UK
2014
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Fastest launch times <> widespread use or uptake – the
case of drugs in myeloma cancer
Use of myeloma drugs in 2014
• DDD usage myeloma
drugs is in the middle
of wealthier countries.
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Conclusions
• Survival rates have increased all over Europe (up 56% in Netherlands
between 2000 and 2007).
• Health care expenditures on cancer are low in relation to the burden of
the disease which continue to increase
• Health care expenditures on cancer has been stable as a share of total
health care expenditures
• Innovation in cancer diagnosis and treatment challenges existing
patterns of care
• Despite having among the fastest launch times in Europe, uptake of
cancer medicines varies significantly in the Netherlands
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Thank you!
[email protected]
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Uptake of Imatinib (CML)
250
200
g per case
150
100
50
0
2005
2006
Belgium
2007
EU Total
2008
2009
Germany
2010
2011
Netherlands
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Sweden
2013
UK
2014
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Uptake of Bevacizumab (Colorectal)
7
6
g per case
5
4
3
2
1
0
2005
2006
Belgium
2007
EU Total
2008
2009
Germany
2010
2011
Netherlands
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Sweden
2013
UK
2014
