title: ESMO European Consortium Study on the availability, out-of-pocket costs and accessibility of antineoplastic medicines in Europe.
abstract: The management of cancer is predicated on the availability and affordability of anticancer therapies, which may be either curative or noncurative.
  
  
  
  The primary aims of the study were to evaluate (i) the formulary availability of licensed antineoplastic medicines across Europe; (ii) patient out-of-pocket costs for the medications and (iii) the actual availability of the medication for a patient with a valid prescription.
  
  
  
  The survey tool was based on the previous ESMO studies that addressed the availability and accessibility of opioids for the management of cancer pain. A total of 185 field reporters from 49 countries were invited to participate. The preliminary set of data was posted on the ESMO website for open peer-review, and amendments have been incorporated into the final report.
  
  
  
  There are substantial differences in the formulary availability, out-of-pocket costs and actual availability for many anticancer medicines. The most profound lack of availability is in countries with lower levels of economic development, particularly in Eastern Europe, and these are largely related to the cost of targeted agents approved in the last 10 years. Discrepancies are less profound among medications on the WHO model essential medicines list (EML) for cancer and in curative settings. However, medicine shortages also affect WHO EML medicines, with relevant therapeutic implications for many patients.
  
  
  
  The cost and affordability of anticancer treatments with recent market approval is the major factor contributing to inequity of access to anticancer medications. This is especially true with regards to new medications used in the management of EGFR- or ALK-mutated non-small-cell lung cancer, metastatic melanoma, metastatic renal cell cancer, RAS/RAF wild-type metastatic colorectal cancer, HER2 overexpressed breast cancer and castration-resistant metastatic prostate cancer.
authors.affiliation: Cancer Pain and Palliative Medicine Service, Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel feedback@esmo.org.
authors.forename: N
authors.initials: N
authors.lastname: Cherny
authors.affiliation: Kings Health Partners Integrated Cancer Centre, King's College London, Institute of Cancer Policy, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Sullivan
authors.affiliation: Advocacy and Programmes, Union for International Cancer Control (UICC), Geneva, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Torode
authors.affiliation: Tartu University Hospital, Tartu, Estonia.
authors.forename: M
authors.initials: M
authors.lastname: Saar
authors.affiliation: Department of Breast Tumors, Cancer Institute Ion Chiricuta Cluj-Napoca, Cluj-Napoca, Romania.
authors.forename: A
authors.initials: A
authors.lastname: Eniu
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics; D001943:Breast Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D005060:Europe; D005260:Female; D005102:Health Expenditures; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008545:Melanoma / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents
keywords: ESMO; anticancer medications; cost of medications; medication shortages; pharmaco-economics; public policy