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Anthony R Green PhD FRCP FRCPath FMedSci
President, European Hematology Association
The price of medicines is taking great prominence in the public debate in Europe these days. The Dutch presidency of the European Union has put the issue high on the agenda and in different countries the issue has reached mainstream media attention. High profile examples such as the 1000 dollar-a-pill Hepatitis C treatment Sovaldi (sofosbuvir) or the price hike of 5556% for Daraprim (pyrimethamine) in the United States in September 2015 have entered the public sphere. 
Disproportionately affected by this trend are innovative medicines for blood disorders, such as Blincyto (blinatumomab) for acute lymphoblastic leukaemia or Soliris (eculizumab) for paroxysmal nocturnal haemoglobinuria.
The threat this problem poses to the sustainability of the healthcare system — even in the more affluent countries of the world — is very real and further price increases are likely to transpire. Yet, if one looks at total healthcare cost of haematologic disorders, it is striking to see that hospital (that is, inpatient) care makes up more than one and a half times the cost of pharmaceuticals.
In a forthcoming independent study1 by the Health Economics Research Centre (HERC) of the University of Oxford, commissioned by the European Hematology Association (EHA), the total cost of haematologic disorders in Europe2 was calculated.  Amounting to €23 billion per year, these cost included healthcare costs, costs due to productivity losses, and informal care costs. 
Of the healthcare costs, that for inpatient care was estimated to be €7.5 billion per year and accounts for almost half (48%) of the total healthcare costs of blood disorders (€15.9 billion).  The remaining healthcare costs were pharmaceuticals (28%), outpatient care (12%), primary care (9%), and emergency care (3%). Other important findings are the approximately 50/50 split between the inpatient care cost for malignant and non-malignant blood disorders. 
This can probably be attributed to the lower incidence of the more resource-intensive malignant blood disorders. In addition, the study finds huge variation in the cost of hospital care between the countries in the study. For example, whereas in Germany an inpatient day costs €573, this same number more than doubles in the Netherlands at €1426.
These numbers were calculated from 2012 data. Given that most medicines for blood disorders that since have gained marketing authorisation will be priced well above average, this means that the cost of pharmaceuticals is underestimated when extrapolating these numbers to the situation today. Further investigation should establish the magnitude of this trend, and a political response may be required to help curb it. 
Nevertheless, it is most likely that hospital care still accounts for most of the healthcare expenditure for blood disorders. This is an important conclusion and certainly justifies more research into the nature of these costs and how to reduce them without compromising on the quality of care.
  1. Luengo-Fernandez R, Burns R, Leal J. Economic Burden of Blood Disorders Accross Europe. 2016 Unpublished. Manuscript under review. 
  2. EU28 and Switzerland, Norway and Iceland.