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ACKNOWLEDGEMENTS......................................2

 

1 THE BURDEN OF CANCER IN EUROPE........................................5

 1.1 SUMMARY........................................................................5
  1.1.1 Study Background & Objectives.........................................5
  1.1.2 Objectives...........................................................6
  1.1.3 The previous report (2007)........................................................6
  1.1.4 Methods and Materials..............................................................6

 1.2 INCIDENCE AND MORTALITY.......................................................7

 1.3 SURVIVAL............................................................................10

 1.4 DALYS.....................................................................................12

 1.5 ECONOMIC BURDEN................................................................14
  1.5.1 Direct Medical Costs................................................14
  1.5.2 Hospitalizations........................................................18
  1.5.3 Drugs........................................................................19
  1.5.4 Indirect costs............................................................21
  1.5.5 Trends in costs of cancer treatment.........................................22
  1.5.6 Budget allocation....................................................................23

2 MEDICAL REVIEW.....................................................................25

 2.1 SUMMARY...................................................................25

 2.2 INTRODUCTION...............................................................26

 2.3 ADVANCES IN DIAGNOSTIC TECHNIQUES...........................................27

  2.3.1 The basis for recent advances in the medical treatment of cancer- understanding cell

           biology, tumour cells and their microenvironment.................................28
  2.3.2 Targeting hormones, growth factors & cell signalling pathways............................29
  2.3.3 Endocrine therapy............................................................30
  2.3.4 Inhibiting growth factors and signal transduction systems............................30
  2.3.5 Inhibiting angiogenesis................................................................................33
  2.3.6 Biotherapy..........................................................................................34
  2.3.7 Advances in supportive drug treatment......................................................35
  2.3.8 Advances towards curing cancer..........................................................36
  2.3.9 Advances towards the prevention of cancer...........................................38

 2.4 CONCLUSIONS...................................................................38

3 MARKET UPTAKE OF NEW ONCOLOGY DRUGS................................................40

 3.1 SUMMARY.....................................................................................................40
 3.2 ONCOLOGY DRUGS.......................................................................................40
 3.3 SALES OF NEW ONCOLOGY DRUGS..............................................43
 3.4 UPTAKE OF SELECTED CANCER DRUGS....................................................46
  3.4.1 Brain tumours..............................................................................47
  3.4.2 Breast cancer..........................................................................49
  3.4.3 Colorectal cancer.....................................................................57
  3.4.4 Chronic myeloid leukaemia (CML), Non-Hodgkin’s lymphoma (NHL) and multiple

          myeloma (MM)..63
  3.4.5 Non-small cell lung cancer (NSCLC)........................................67
  3.4.6 Renal cell cancer (RCC) and liver cell cancer (LCC).......................72
 3.5 CONCLUSIONS..................................................................................75

 

4 MARKET ACCESS FOR CANCER DRUGS AND THE ROLE OF HEALTH ECONOMICS......76
 4.1 PHARMACEUTICAL REGULATION AND MARKET ACCESS............................76
 4.2 HOSPITAL BUDGETS AND PATIENT ACCESS TO DRUGS...........................77
 4.3 PRICING OF PHARMACEUTICALS..............................................................79
 4.4 HOW CAN NEW DRUG THERAPIES BE FUNDED?.......................................80

 4.5 IMPACT OF REIMBURSEMENT DECISIONS ON DRUG AVAILABILITY......................81
 4.6 SOME POLICY ISSUES IN THE ALLOCATION OF RESOURCES FOR NEW DRUGS.............85
 4.7 THE ROLE OF HEALTH TECHNOLOGY ASSESSMENTS...................................87

  4.7.1 HTA Agencies...................................................................87

 4.8 REVIEW OF DATABASES ON HEALTH TECHNOLOGY ASSESSMENTS.......................91
  4.8.1 The INAHTA health technology assessment database......................................92
  4.8.2 The Health Economic Evaluation Database.........................................96
  4.8.3 The International Society for Pharmacoeconomics and Outcomes Research...........98

 4.9 ASSESSING THE IMPACT OF HTA ON DECISION MAKING...............................101
  4.9.1 Relations between HTAs and patient access to cancer drugs...................106
 4.10 CONCLUSIONS........................................................................109

REFERENCES.................................................................................111