Determinants of utilisation differences for cancer medicines in Belgium, Scotland and SwedenReport as inadecuate

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The European Journal of Health Economics

pp 1–11

First Online: 09 December 2016Received: 24 April 2016Accepted: 22 November 2016DOI: 10.1007-s10198-016-0855-5

Cite this article as: Ferrario, A. Eur J Health Econ 2016. doi:10.1007-s10198-016-0855-5


BackgroundLittle comparative evidence is available on utilisation of cancer medicines in different countries and its determinants. The aim of this study was to develop a statistical model to test the correlation between utilisation and possible determinants in selected European countries.

MethodsA sample of 31 medicines for cancer treatment that obtained EU-wide marketing authorisation between 2000 and 2012 was selected. Annual data on medicines’ utilisation covering the in- and out-patient public sectors were obtained from national authorities between 2008 and 2013. Possible determinants of utilisation were extracted from HTA reports and complemented by contacts with key informants. A longitudinal mixed effect model was fitted to test possible determinants of medicines utilisation in Belgium, Scotland and Sweden.

ResultsIn the all-country model, the number of indications reimbursed positively correlated with increased consumption of medicines one indication 2.6, 95% CI 1.8–3.6; two indications 2.4, 95% CI 1.4–4.3; three indications 4.9, 95% CI 2.2–10.9; all P < 0.01, years since EU-wide marketing authorisation 1.2, 95% CI 1.02–1.4; p < 0.05, price per DDD 0.9, 95% CI 0.998–0.999, P < 0.01, and Prescrire rating 0.5, 95% CI 0.3–0.9, P < 0.05 after adjusting for time and other covariates.

ConclusionsIn this study, the most important correlates of increased utilisation in a sample of cancer medicines introduced in the past 15 years were: medicines coverage and time since marketing authorisation. Prices had a negative effect on consumption in Belgium and Sweden. The positive impact of financial MEAs in Scotland suggests that the latter may remove the regressive effect of list prices on consumption.

KeywordsMedicines utilisation Multilevel mixed-effects data models Oncology Managed entry agreements Pharmaceutical policy Electronic supplementary materialThe online version of this article doi:10.1007-s10198-016-0855-5 contains supplementary material, which is available to authorized users.

JEL ClassificationI10 I14  Download fulltext PDF

Author: Alessandra Ferrario


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