Why do some countries approve a cancer drug and others don't?

- There are differences in cancer drug reimbursement decisions across countries.
- Proportion of drugs approved is higher in SHI systems than in tax-based systems.
- Cost-effective cancer drug-indications have a higher probability of reimbursement.
- Other countries are more likely to make a positive decision, if NICE also make it.
- During the financial crisis, the proportion of Favourable decisions was reduced.

The term drug reimbursement describes the policy system that determines whether or not a drug is entitled to reimbursement within the healthcare system. Countries make different decisions regarding which cancer treatments to routinely provide. As a result, depending on the cancer drug-indication and the country assessing it, the decision can be Favourable, Favourable with restrictions or Non-Favourable. The main objective of this paper is to describe the differences in drug reimbursement decisions on cancer drugs across 10 European countries. This aim is achieved through testing a number of hypotheses that can explain the differences in these specific reimbursement decisions. First of all, we collect data on cancer drug decisions for 10 European countries, from 2002 to 2014. Secondly, the hypotheses are tested on this database. The results show that Social Health Insurance systems tend to take more Favourable decisions than the tax-based systems, that cost-effective drug-indications have a higher probability of reimbursement and that other countries are more likely to make a Favourable decision if NICE also make it. Moreover, our findings also corroborate that an economic evaluation requirement reduces the number of Favourable decisions, and that, during the global financial crisis, the number of Favourable decisions has been reduced, compared to Non-Favourable and restricted. To sum up, characteristics of the drug reimbursement system, drug particularities and the socioeconomic situation are the main factors determining the differences across countries.