Oncoindex is the first portal in Spain designed to inform patients about the status of public financing of oncological and hematological treatments.
We check which medicines registered by the European Medicines Agency (EMA) in the past 15 years and recommended by the European Society for Medical Oncology (ESMO) are reimbursed.
Our idea: to clearly illustrate the scope of reimbursement of modern therapies in individual countries regarding cancer treatment and to show the range of options available in a particular situation.
Comparison of the index over time indicates how patients' situation changes with regard to access to modern pharmaceutical therapies. Data concerning medicine reimbursement in particular types of cancers support patients in selecting optimal therapies.
Cancer types included in Oncoindex
Oncoindex is the source of knowledge about reimbursement of modern pharmaceutical therapies for as many as 20 different types of cancers. They include:
in the group of solid tumours: 10 types that are the most common causes of death in cancer patients in Europe.
in the group of haemato-oncological diseases: 10 types that are the most common causes of death in cancer patients in Europe.
Therapies included in Oncoindex
We analyse therapies which were granted marketing authorisation by the European Medicines Agency (EMA) in the past 15 years and then were recommended by the European Society for Medical Oncology (ESMO).
Why the past 15 years? We do our best to provide practical knowledge and show the situation of patients who should be entitled to treatment in accordance with current medical knowledge. It does not mean that by definition we consider the previously registered medicines to be less effective; in certain cases they remain optimal therapies. However, we wish to clearly state that patients should have access to all medicines that are recommended by international standards.
EMA and ESMO - why are these organisations our points of reference?
The European Medicines Agency (EMA) is an EU institution which grants marketing authorisations to medicinal products in the European Union and controls them. It cooperates with member state institutions responsible for this area and follows the highest scientific standards.
We take into consideration medicines registered by the EMA to be sure that Oncoindex includes solely these therapies which have undergone the a restrictive marketing authorisation in the European Union and are available within its area.
The European Society for Medical Oncology (ESMO) is a widely respected organisation which specialises in clinical oncology. It associates over 25,000 experts from 160 countries and is a reliable source of oncological guidelines used by healthcare professionals. We analyse medicines recommended by ESMO to be certain that Oncindex considers solely therapies indicated by the most renowned clinical oncology experts and practitioners.
Why does the Oncoindex value fall or rise?
The Oncoindex value is presented as a figure; its minimal value is 0 and maximal value is 100. A given country’s Oncoindex value amounting to 0 it means that the patients in this country do not have access to any of the medicines covered by our index. 100, in turn, means that they have access to all of them.
The given country’s Oncoindex value is affected by two types of events:
- European Society for Medical Oncology (ESMO) recommends another cancer medicie.
- A particular country decides on the reimbursement of a medicine recommended by ESMO.
A simplified example:
The new ESMO guidelines include recommendation for four new pharmaceutical therapies that should be available for every patient. At a national level, the decision is made regarding full reimbursement of one of them and limited reimbursement for another one. As a result of these two events the Oncoindex value will fall, and not rise, because despite inclusion of other medicines in the reimbursement scheme, the level of reimbursement in this country has in fact deteriorated and not improved in relation to European medical.
Treatment in accordance with current medical knowledge is one of the fundamental patient rights. Therefore, a negative Oncoindex value is unacceptable. We want to see the value of the index increase and reach zero. Each of us is entitled to that in line with the applicable provisions of law.
How can we measure real progress in access to cancer treatment?
Real progress in a given country is related to, among the others, reimbursement of other medicines recommended by ESMO; however, the very fact of reimbursement of a particular medicine is not tantamount to success. A public health care system is truly improved when the country approaches European standards.
Many European countries, particularly in the Central and Eastern Europe, are far behind highly-developed countries. In order to minimise these inequalities they need to actively make up for their delays and reimburse new therapies.
When do patients have guaranteed access to medicines?
The reimbursement system
Access to cancer medicines is related to the level of medicine reimbursement. In general, there are three possible scenarios:
- 1. Full reimbursement: therapy with a particular medicine in a particular indication may be financed from public funds for all patients in total accordance with the ESMO guidelines - without any limitations.
- 2. Partial reimbursement: therapy with a particular medicine in a particular indication may be financed from public funds, however, there are certain population, territory, procedural, formal and time limitations associated with the initiation or continuation of this therapy.
- 3. No reimbursement: therapy with a particular medicine in a particular indication may not be financed from public funds or such financing covers a marginally narrow group of patients of all the patients eligible for this treatment, in accordance with ESMO guidelines.
The Oncoindex value equals 100 when all medicines recommended by ESMO are fully reimbursed.
This should be a standard in every country!
Cancer treatment in Spain. What is the current situation and what should it look like?
Currently, as many as 72% of pharmaceutical therapies recommended based on evidence are not reimbursed or are only partially reimbursed. We are monitoring access to therapies in 20 different types of cancers. Of the 132 pharmaceutical therapies registered in Europe in the last 15 years and recommended by the European Society for Medical Oncology:
only 37 (28%) are available in accordance with the standards,
as many as 27% are not reimbursed at all,
45% are available with limitations (which are not medically justified).