Hungary's National Health Insurance Fund has issued a press release detailing its spending on cancer treatment in 2013, in which it warns of a "cost explosion" and mentions the possibility of introducing new regulatory mechanisms to keep costs down in this therapeutic area.
IHS Life Sciences perspective | |
Significance | Hungary's National Health Insurance Fund (OEP) has recently published details of its expenditure on cancer care in 2013, warning against a "cost explosion" in oncology treatment in Hungary and proposing new cost-containment mechanisms that could be employed in this therapeutic area. |
Implications | Hungary has a relatively high incidence of cancer, especially in some forms of the disease. The OEP has needed to devise cost-containment mechanisms to respond to this as well as the increase of high-cost treatments in this area. |
Outlook | With Hungary's public finances notoriously constrained, and a limited healthcare budget, the OEP's suggestions for potential new cost-sharing mechanisms involving pharmaceutical companies could develop into concrete plans in the coming months. |
Spending on the treatment of cancer by Hungary's National Health Insurance Fund (OEP) is continuously increasing, and, in 2013, the total expenditure on the disease by the fund amounted to HUF160 million (USD698.6 million), according to a recent OEP press release. The OEP informs that spending on the inpatient treatment of cancer in 2013 amounted to HUF68.477 billion, which represents around double the figure for 2001.
Large increase in cancer hospitalisations
This reflects the substantial increase in the incidence of cancer in the country, which is borne out by figures provided on the number of hospitalisations of cancer patients from 2004 to 2013. According to these, in 2004, the total number of hospital cancer patients on the clinical oncology side amounted to 252,706 and, in 2013, this number rose to 442,330, with steady increases in the intervening years. A similar situation can be observed concerning radiotherapy and oncocardiology patients: in 2004, the total number of these in hospitals was 497,609 while, in 2013, this increased to 868,752.
ALL tops list of cancer types for drug expenditure
According to the OEP's data, the type of cancer with the largest amount of expenditure in 2013 was acute lymphoblastic leukaemia (ALL), for which the fund gave out HUF9.640 billion. This was followed by hormone therapy for breast cancer and prostate cancer patients, with spending of HUF6.212 billion and HUF6.006 billion, respectively.
Top-15 cancer types, associated treatment areas for OEP drug reimbursement, 2013 | |
Type of cancer or associated treatment area | OEP expenditure in 2013 (,000 HUF) |
Acute lymphoblastic leukaemia | 9,640,883 |
Breast cancer hormone therapy | 6,212,652 |
Prostate cancer hormone therapy | 6,006,482 |
Neutropaenia with fever | 5,197,558 |
Intravenous drugs, interferons | 4,089,225 |
Targeted treatment of kidney cancer | 3,430,646 |
Bone metastasis | 3,256,215 |
Anorexia-cachexia | 1,805,405 |
Targeted treatment of liver tumours | 1,449,284 |
Painkillers | 1,311,612 |
Anaemia | 1,165,155 |
Glioblastoma | 882,986 |
Vomiting | 731,029 |
Lymphoid leukaemia | 172,708 |
Vesical cancer treatment | 136,095 |
Source: OEP | |
The OEP reports that its expenditure on cancer medicines obtained by patients at open-care pharmacies in 2013 amounted to HUF45.5 billion, while its spending on cancer medicines reimbursed under the "itemised reimbursement" system, used only in hospitals, amounted to HUF21.3 billion.
Possible new financial- and performance-based cost-sharing mechanisms
The OEP concludes its overview on its expenditure on oncology care in 2013, stating that due to a "cost explosion" in this area, it has become increasingly necessary to implement new mechanisms for sharing the cost of treatment between the fund and the pharmaceutical company supplying the medicines in question. It mentions the possibility of these mechanisms being purely financial- or performance-based, while emphasising the importance of the role of doctors in choosing treatments and the need to be guided by cost-effectiveness criteria.
The full OEP document can be accessed here, in Hungarian.
Outlook and implications
The OEP reports that its expenditure on cancer drugs in 2012 exceeded HUF60 billion, according to the news website of Hungarian television channel ATV. Indeed, if the amounts the fund spent on cancer drugs through open-care pharmacies and itemised reimbursement in hospitals in 2013 are added together, the sum amounts to HUF66.8 billion – approximately the same figure as in the previous year, with a slight increase likely.
Hungary has a relatively high overall incidence of cancer, especially in certain types of the disease. The Hungarian authorities have been grappling with the problem of how to increase access to high-cost treatment at a time when demand for it is growing. An apparently successful approach is the itemised reimbursement system, used for drugs administered exclusively in hospitals (see Hungary - Europe: 11 February 2014: Itemised reimbursement: Hungary's answer to expansion of high-cost treatment options in oncology and other serious disease areas). The OEP has reported that thanks to this system, which involves close supervision of the use of high-cost drugs in hospitals, it has been able to reduce costs and expand access.
However, judging by the conclusions in the OEP's document on cancer spending in 2013, the introduction of new regulatory mechanisms to help keep costs down further in the field of oncology could be on their way.