Italy - Evidence package EFPIA Roundtables on Cancer 2017-05-11

Content Analysis of the development in cancer care in Italy based on IHE:s comparator report 2016:4

Key findings Cancer incidence is increasing; Italy is 3rd highest in Europe. Mortality has decreased with 23 % in Italy between 1995-2012 compared to -17% for overall Europe. 5-year survival has improved, Italy’s survival rate above the European average. The burden (measured in DALYs) of cancer disease has overtaken cardiovascular disease. Overall spend on health care below the average of the Big EU countries(-21% in per capita terms) as well as for medicines

Key findings The total healthcare direct per capita expenditure of cancer is somewhat lower than the European average (155 € compared to 169 €, -8%) and than other Big EU Countries (199 €, -21%). All over the main EU countries, pharmaceutical expenditure for oncology products amounts to 23% of the total healthcare expenditure in cancer and can determine savings in the remaining 77%. Total direct per capita expenditure of cancer have decreased since 2010 (-11%). Italy is a pioneer in its implementation of Managed Entry Agreements OECD health ministerial state the need to develop a system of health outcomes and health system performance for all countries to learn from best practice. Source: OECD Health Ministerial Meeting: The next generation of health reforms (17 January, 2017)

Burden of cancer

Increased incidence in line with European pattern Large increases in all countries Cancer incidence in Italy was 520 per 100,000 in 1995 and 597 per 100,000 in 2012 which is among the highest in Europe and represents a 15 % increase. Cancer incidence in Europe was 523 per 100,000 in 2012. Italian figures based on data from Veneto and Umbira scaled to national levels. Cancer incidence cases per 100,000 inhabitants (crude rates, both sexes) Notes: Hatched bars indicate that national estimates are based on regional data or based on neighboring countries. Source: Steliarova-Foucher et al (2012), Ferlay et al (2013)

Mortality decreases, Italy rates slightly below the European average Male cancer mortality in Italy was 260 per 100,000 in 1995 and 200 per 100,000 in 2012. This represents a 23 % decrease in mortality rates. Male cancer mortality overall in Europe was 270 per 100,000 in 1995 and 224 per 100,000 in 2012 which is a 17 % decrease. Similar pattern from women. Male cancer mortality cases per 100,000 inhabitants (age-standardized rates) Source: Bray et al (2002), Ferlay et al (2013)

Survival has improved, Italy's survival rates are above the European average Increases in all countries between 1990-2007. The survival rate improvement was larger in Italy than for the EU average, between the time periods 1990-1994 and 2000-2007 (9 vs 8 percentage points) 5-year age-adjusted relative survival rates for all cancers in patients aged ≥15 years, 1990–2007 Notes: Hatched bars indicate that national estimates are based on regional data. Source: EUROCARE-3 to EUROCARE-5

Cancer has overtaken cardiovascular disease in terms of disease burden Source: WHO

Expenditure of cancer drugs per capita (in 2014 prices) is increasing in Italy at a lower pace than in Europe Spending on cancer drugs doubled from €19 to €38 (in 2014 prices) in Europe. Italy's cancer drugs expenditure is growing less, in percentage, than the European average between 2005-2014. Despite higher incidence of the disease and the higher costs of drugs, better therapies lead to lower total costs in recent years. Notes: Data for EE, LV, LU, and EL only comprise retail sales. * The value for 2005 for IE is from 2006 and for PT from 2010. Source: IMS Health MIDAS database

Total direct expenditure per capita have declined since 2010 while costs due to mortality is steadily declining The economic burden of productivity loss due to premature mortality in Italy is steadily declining due to improved patient outcomes. This trend is in line with the European experience. Despite higher incidence of the disease and the higher expenditure of drugs, better therapies produced lower total expenditure in Italy in recent years. Between 2010-2014, total healthcare expenditure for cancer in absolute values declined in Italy (-2%), while it grew for the European average (+8%). In the same period the share of cancer on total HC expenditure decreased in Italy (-0.06 percentage points) while it was stable for the EU average Notes: “direct” = direct health cost of cancer; “m-loss” = productivity loss due to premature mortality from cancer. 2014 prices. Cancer is defined as ICD-10 C00-D48 for direct health costs, and C00-C97,B21 for productivity loss Notes: “direct” = direct health cost of cancer; “m-loss” = productivity loss due to premature mortality from cancer. 2014 prices. No data on cost of drugs as share of direct costs 1995-2000.

Italy have lower cancer medicine expenditures and better outcome in form of lower mortality loss than the big EU countries Comparison of Italy and big EU countries, in per capita unadjusted €, 2014 Italy´s expenditure in cancer medicine was lower than the average of the big EU countries in 2014 (€40 vs €47 per capita). The mortality loss was €83 per capita for Italy and €116,1 per capita for big EU countries in 2014. Notes: Mortality loss: economic burden of productivity loss due to premature mortality. Big EU countries include: Germany, France, Spain and UK. These are weighted after population size

Per capita spending on cancer slightly below the European average Health spending on cancer: € 155 in Italy and €169 in Europe. Large country variations Cost of cancer per capita (2014) Notes: Hatched bars indicate that the direct cost is estimated based on data from similar countries.