New EFIC study: striking differences in access to opioids in Europe

A new study of the European Pain Federation EFIC shows major discrepancies in the care given to Europe’s pain patients. The European countries handle the approval and funding of opioid medication very differently. Whether or not patients receive appropriate access to potent analgesic agents depends more on geographic accident than medical criteria according to Prof Hans Georg Kress, who was speaking at the Congress of the European Pain Federation (EFIC) in Vienna. Europe is far from achieving equal opportunity and equal treatment in the healthcare sector.

Vienna, 3 September 2015 – Whether pain patients in Europe have appropriate access to various opioid painkillers depends less on medical criteria or treatment guidelines than on the good fortune of living in the right country. As a current study of the European Pain Federation EFIC shows, there are striking discrepancies in approval and reimbursement for potent analgesic agents among the 30 European countries for which data is available. The results of the current study were presented at the 9th Congress of the European Pain Federation EFIC, “Pain in Europe IX”, in Vienna. More than 4,000 experts from around the globe are now gathered there to discuss the latest advances in all areas of pain medicine.

“In Western Europe, the number of different opioid preparations that pain patients can take is generally much higher than in Eastern Europe,” said Prof Hans Georg Kress, Head of the Department of Special Anaesthesia and Pain Therapy, Medical University/AKH Vienna. Prof Kress, also past President of the EFIC and member of the EFIC Task Force that conducted this study, then continued:  “Germany leads the way in this regard with 47 approved oral opioid painkillers. The costs for all of them are reimbursed by the statutory health insurance funds. That puts Germany clearly in the lead in Europe, in front of Italy, with 42 approved and reimbursed medications.” Denmark follows with 37 medications on the market, of which 22 are reimbursed. Sweden is next with 35 approved and reimbursed medications. Bringing up the rear are Kosovo (4 approved formulations, none of which are reimbursed), Russia (4/4), Bosnia-Herzegovina (3/0) and Ukraine, where not a single oral opioid is available.”

In some European countries, the costs of opioids are automatically covered by the statutory health insurance funds or the government as soon as the medication is approved. However, in most countries approval of a medication by government authorities and assumption of the costs for it by the statutory health insurance system are not linked processes. In Eastern European countries, costs are also reimbursed for most approved products.

In several Western European countries with free pricing, the authorities are reluctant to reimburse innovative yet expensive opioid products. This is especially true of rapid onset opioids (ROOs), quick and short-acting fentanyl formulations that need not be swallowed and that are especially suitable for the treatment of breakthrough pain in cancer patients. They are approved as nasal sprays or sublingual tablets in 18 of the 30 countries examined but are reimbursed in just 11 or 12 countries. As lozenges or buccal tablets, they are on the market in 13 countries (reimbursed in 9 or 8 countries) and the new buccal film is approved in just 6 countries and is thus far reimbursed in just one. Prof Kress: “Access to these important painkillers is restricted in everyday life by the reimbursement practices of the healthcare system even though these drugs are officially approved and available at apothecaries.”

Source: EFIC Abstract
European Pain Federation