Cancer medicine prices in 30 european countries

Author: Neda Zare, Naheem Shazad, Umar Ali, Sheikh Malik, Besime Ozbek, Nancy Dike, Zaheer-Ud-Din Babar Scientific Coordinator: Professor Zaheer-Ud-Din-Babar Institution: Department of Pharmacy , University of Huddersfield, HD1 3DH, United Kingdom

INTRODUCTION: Cancer is one of the leading causes of death worldwide, and it accounted for almost 10 million deaths around the globe in 2020. The number of deaths attributed to cancer is increasing across the world. High pharmaceutical product prices constitute a significant challenge both in high and low-income countries. AIM: We aimed to survey the prices of cancer medicines in 30 European countries. MATERIALS AND METHODS: Based on our previous experience we exUsing the Wilhelmy plate tensiometric method, the interfacial tension between oil and water was measured with the addition of different concentrations of selected emulsifiers. Emulsifiers were prepared based on the required HLB value, namely Tween 40 HLB=15.6; mixtures of Tween 40 and Span 85 with HLB=7 and 12, and Solutol HS15 HLB=14-16. With the selected concentrations of emulsifiers, emulsions with different proportions of oil and water were prepared (1:3 oil:water, 1:3 water:oil, and 1:1). Emulsions were prepared using a rotor-stator homogenizer under the same conditions of 15000 rpm for 10min. Droplet size was monitored by an optical microscope, and viscosity by a cylindrical viscometer. The stability itself was determined organoleptically. RESULTS: Austria, Germany, Sweden, and Spain ranked high priced countries, while Bulgaria and the UK were at the lower end. The difference between the highest-priced country (Germany) and the lowest-priced countries (Czech Republic & Sweden) varies between 24.98% and 170% for the same medicine. Inferential statistics revealed that location and GDP per capita were significantly associated with ex-factory unit price at the 5% significance level for Ibrance (p=0.001 for location; p<0.001 for GDP per capita). Medicine strength was significantly associated with the ex-factory unit price at the 5% significance level for several drugs: Afinitor, Caprelsa, Keytruda, and Zytiga (p<0.001 in all cases). CONCLUSION: Our results suggest variation in ex-factory price per unit of cancer medicines in 30 surveyed countries. The price data were not available for all drugs in all surveyed countries. Our findings may help policymakers to develop appropriate policy interventions to promote price transparency and equity. factory prices per unit indexed 80 800 Log ex -

8 Alecensa 150 mg hard capsuleZytiga 250 mg tablet Afinitor 2.5 mg tablet Zytiga 500 mg film coated tabletImbruvica 140 mg hard capsuleCaprelsa 100 mg film coated tabletAfinitor 5 mg tabletAfinitor 10 mg tablet Caprelsa 300 mg film coated tabletTagrisso 40 mg film coated tabletTagrisso 80 mg film coated tabletIbrance 75 mg hard capsuleIbrance 100 mg hard capsuleIbrance 125 mg hard capsuleKeytruda 50 mg powderKeytruda 25mg/ml 4ml Drugs Figure 1. Boxplot of drug prices (ex-factory price per unit) indexed (price in the lowest priced country=€10), as of May 2017

to April 2019, in 30 European countries. The box displays the interquartile range (IQR); the bottom and top of the box are

the 25th and 75th percentiles (the 1st and 3rd quartiles, respectively), and the band near the middle of the box is the

Questions & answers

Please, tell us a little bit more about yourself. I am a fourth-year pharmacy student at the University of Huddersfield. My passion is healthcare and anything that can relieve people from worrying about accessing treatment when they’re ill. I migrated to England in 2015, and after two years of college, I succeeded to earn a place at Huddersfield University. It was my dream to be a pharmacist, and since I started my course, the more I know, the more I fell in love with it. I studied nursing in Iran, and I witnessed how people can struggle to access medicines that are already there, but the price is the main burden to them. This applies to many countries worldwide.

Tell us a bit more about your research and its significance. My dissertation was on cancer medicine prices in 30 European countries. You might be surprised to know the same cancer medicine with the same brand from the same company has a price difference between countries up to 170%. In conclusion, this massive variation and the high price of cancer medicines are a burden to access treatment in some countries. As the number of cancer incidences increases, this issue can get more severe and affect more people. We tried to show this based on evidence and data available to inform policymakers of the significance of their decision about pricing cancer medicines. from May 2017 to April 2019 inclusive; equalizing these currencies was a challenge. Also, for some medicines, data were not available in all 30 countries, such as Malta. This was resolved by consulting various studies and methodological approaches, and the best way to go about it.

In your opinion, what is the benefit of joining ESSP and what advice do you have for students undertaking research in the future? Each research that you conduct is a voice that you want to be heard. ESSP is an excellent platform for students to make this happen and this is an excellent opportunity to represent their university. For me getting my abstract published with ESSP is like hard work paid back, and it’s a fantastic experience to have. For those who are researching the future, I would say first: - Conduct an extensive literature review. - Listen to the expert advice and trust your supervisor’s guidance. - Make your voice to be heard and your hard work to be seen and use all the supports and opportunities you have

What was the biggest challenge while carrying out the research and how did you overcome that? Our data were from 30 European countries in their original currency from different periods