Price Transparency of Cancer medicines: A Crucial Step towards Informed Pricing Negotiations

Julie Vancoppenolle^1,2*Nora Franzen^3,4Cristina Andrianò⁵Morten Baltzer Houlind⁶Zora Ćetković⁷Aniek Dane⁸Albane Degrassat-Théas⁹Anne M.P. Eldering-Heldens¹⁰Martin J. Hug¹¹Holger Knoth¹²VITO LADISA¹³Péter Vajda¹⁴Ulrich Warnke¹⁵Valesca Retèl^3,4Wim H van Harten^2,3

• ¹The Netherlands Cancer Institute (NKI), Amsterdam, Netherlands
• ²Universiteit Twente, Enschede, Netherlands
• ³The Netherlands Cancer Institute, Amsterdam, Netherlands
• ⁴Erasmus Universiteit Rotterdam, Rotterdam, Netherlands
• ⁵IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
• ⁶Kobenhavns Universitetshospital, Copenhagen, Denmark
• ⁷Univerzitetski klinicki centar Srbije, Belgrade, Serbia
• ⁸Erasmus MC, Rotterdam, Netherlands
• ⁹Universite Paris Cite, Paris, France
• ¹⁰Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
• ¹¹Universitatsklinikum Freiburg, Freiburg, Germany
• ¹²Universitatsklinikum Carl Gustav Carus, Dresden, Germany
• ¹³Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
• ¹⁴Semmelweis Egyetem, Budapest, Hungary
• ¹⁵Klinikum Ernst von Bergmann, Potsdam, Germany

Background: The increasing cost of cancer medicines is a growing concern for EU-hospitals, leading to cost reduction strategies, such as price negotiations. The objective of this study is to compare actual prices and discounts of cancer medicines at hospital level across Europe. Methods: To report prices and discounts without compromising the hospitals’ anonymity, an anonymization pathway was developed. Pricing data of 15 cancer medicines in 2022 was collected through structured interviews with hospital staff and reference prices were derived from the IQVIA-MIDAS dataset. Descriptive analyses were used to demonstrate product and reference prices. Discounts were aggregated across countries and product types (patent status, competition situation, and ATC-4 classification). Furthermore, the accuracy of the participants' perceptions of their prices compared to others within their country was assessed. Results: 23 hospitals from nine EU-countries participated. To comply with the anonymization pathway, three countries were presented in general terms. The highest prices at hospital level were observed in France, followed by Serbia, Germany, Hungary and the Netherlands. Two Southern and one Northern EU-country had the lowest prices. When comparing them with their reference prices, Serbia reports the lowest discounts (-7%) and the Southern EU-countries the highest discounts (-38%). In addition, at least half of the hospitals had incorrect perceptions of their prices relative to others within their country, with some up to 22% higher than average. Discussion: Our study is one of few providing discounts and actual prices for 15 cancer medicines, revealing large price variations between and within countries. Additionally, reference prices often fail to provide an accurate indication of the actual price and hospitals have often misguided perceptions on their negotiation performance. Transparent, standardized reporting of prices and coordinated collaborations are essential to strengthen the bargaining power of hospitals and foster informed price negotiations.