title: Price comparison of high-cost originator medicines in European countries.
abstract: BACKGROUND
  In recent years, high-cost medicines have increasingly been challenging the public health budget in all countries including high-income economies. In this context, this study aims to survey, analyze and compare prices of medicines that likely contribute to high expenditure for the public payers in high-income countries.
  
  
  METHODS
  We chose the following 16 European countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Italy, the Netherlands, Portugal, Sweden, Slovakia, Spain and United Kingdom. The ex-factory price data of 30 medicines in these countries were collected in national databases accessible through the Pharmaceutical Price Information (PPI) service of Gesundheit Österreich GmbH (Austrian Public Health Institute).
  
  
  RESULTS
  The ex-factory prices (median) per unit (e.g. per tablet, vial) ranged from 10.67 cent (levodopa + decarboxylase inhibitor) to 17,000 euro (ipilimumab). A total of 53% of the medicines surveyed had a unit ex-factory price (median) above 200 Euro. For two thirds of the medicines, price differences between the highest-priced country and lowest-priced country ranged between 25 and 100%; the remaining medicines, mainly low-priced medicines, had higher price differential, up to 251%. Medicines with unit prices of a few euros or less were medicines for the treatment of diseases in the nervous system (anti-depressants, medicines to treat Parkinson and for the management of neuropathic pain), of obstructive airway diseases and cardio-vascular medicines (lipid modifying agents). High-priced medicines were particularly cancer medicines.
  
  
  CONCLUSIONS
  Medicine prices of Greece, Hungary, Slovakia and UK were frequently at the lower end, German and Swedish, as well as Danish and Irish prices at the upper end. For high-priced medicines, actual paid prices are likely to be lower due to confidential discounts and similar funding arrangements between industry and public payers. Pricing authorities refer to the higher undiscounted prices when they use price data from other countries for their pricing decisions.
authors.affiliation: a WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Health Economics Department , Gesundheit Österreich GmbH (Austrian Public Health Institute) , Vienna , Austria.
authors.forename: Sabine
authors.initials: S
authors.lastname: Vogler
authors.affiliation: a WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Health Economics Department , Gesundheit Österreich GmbH (Austrian Public Health Institute) , Vienna , Austria.
authors.forename: Nina
authors.initials: N
authors.lastname: Zimmermann
authors.affiliation: b Division of Pharmacy Practice, School of Pharmacy, Faculty of Medical and Health Sciences , University of Auckland , Auckland , New Zealand.|c Lahore Pharmacy College (A project of Lahore Medical and Dental College) , Tulspura Canal Bank , Lahore 53400 , Pakistan.
authors.forename: Zaheer-Ud-Din
authors.initials: ZU
authors.lastname: Babar
mesh_terms: D003132:Commerce / Q000191:economics* / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D003657:Decision Making; D019049:Developed Countries; D016527:Drug Costs / Q000706:statistics & numerical data*; D004345:Drug Industry / Q000191:economics; D005060:Europe; D006801:Humans; D004364:Pharmaceutical Preparations / Q000191:economics*
chemical_list: D004364:Pharmaceutical Preparations
keywords: Europe; High-cost medicines; comparison; discounts; external price referencing; medicine prices; price analysis; price study; price survey; transparency