Uptake and availability of new outpatient cancer medicines in 2010-2021 in Nordic countries – Survey for competent authorities

Abstract

Abstract Background: Nordic countries excel in cancer care, but studies on uptake, costs, or managed entry agreements of cancer medicines have not been conducted in Nordiccountries recently. The aim of this study was to examine the uptake and availability of orally administered new cancer medicines in Nordic countries. Firstly, we studied the distribution, costs and adoption of managed entry agreements of cancer medicines in general, and secondly, uptake of, and adopted managed entry agreements for orally administered cancer medicines, used in the outpatient care, that were granted marketing authorization in Europe in 2010–2021. Methods: E-mail survey for competent authorities in Denmark, Finland, Iceland, Norway, and Sweden in April-June 2022. The data were analysed using frequencies and percentages for descriptive analysis. Results: The distribution of cancer medicines is somewhat uniform in Finland, Iceland, Norway, and Sweden, where cancer medicines can be distributed both via hospitals or hospital pharmacies for inpatient use, and via community pharmacies for outpatient use. In Denmark, cancer medicines are predominantly distributed via publicly funded hospitals. In all countries that provided data on the costs, the costs of cancer medicines had notably gone up from 2010 to 2021. The number of reimbursable medicines out of new cancer medicines varied from country to another, but the majority of medicines were reimbursed in most Nordic countries. Managed entry agreements, often with confidential discounts, were in use in all Nordic countries, but the number of agreements and the cancer types, for which agreements were most often made, varied. Average days from authorization to reimbursement of new cancer medicines also varied from an average of 416 to 895 days. Conclusions: Nordic countries share similar characteristics but also differ in terms of the details in distribution, adopted managed entry agreements, market entry, and availability of new cancer medicines used in the outpatient care. The costs of cancer medicines have increased in all Nordic countries during the last decade. Due to differences in health care and because orally administered cancer medicines can be dispensed at community and hospital pharmacies, the number of reimbursable medicines and managed entry agreements vary between countries. However, Nordic countries mainly seem to agree in entry and reimbursement decisions of novel cancer medicines.