Austria and Switzerland recorded the highest use of new oncology medicines in Europe in 2023, measured in milligrams consumed per diagnosed case. Latvia and Poland ranked at the bottom. Spain remained in the middle of Europe’s five largest pharmaceutical markets, where approval and reimbursement still do not guarantee that patients receive treatment quickly. Across twelve cancer types and product families, the widest gap between countries was threefold, down from more than five to one in 2018.
A narrower gap does not mean patients have the same chance of receiving treatment. What matters is whether doctors can use a drug in everyday care, not simply whether it has been authorised or reimbursed. The Comparator Report on Cancer in Europe 2025 from the Instituto Sueco de Economía de la Salud, or IHE, treats real consumption and uptake as the clearest sign that a medicine is reaching patients.
Germany shows why formal access rankings can mislead. It often leads European industry studies on availability and funding, yet ranked only fifth for effective consumption in 2023.
European approval starts another administrative process; it does not end one. Once the European Medicines Agency, or EMA, authorises a medicine, national authorities still set prices and decide on reimbursement. For more than a decade, the EFPIA Patients W.A.I.T. Indicator has tracked major differences in the share of authorised medicines that receive public funding, as well as in how long those decisions take.
The European Commission puts the typical period from application to authorisation at roughly 400 days. It has proposed cutting the EMA assessment timetable from 210 to 180 days. Since 2025, new oncology medicines have been subject to a European Joint Clinical Assessment of clinical evidence. The European Commission says the assessment is intended to reduce duplicated national work. Countries will still decide separately on prices and reimbursement, as well as on practical use. Faster regulatory review could help, but it would not remove national reimbursement delays.
Europe still works through 27 national systems. Industry representatives have proposed launching medicines in all countries at the same time, then handling price and reimbursement talks afterward. That remains a proposal, not a rule.
Funding is not the last gate. A medicine may still need a place in national clinical guidelines, followed by further assessments or approvals in decentralised systems. Spain has this extra layer. Italy and Sweden do too. In Spain, national reimbursement does not automatically mean hospitals and other care centres can use a medicine at once. Regional evaluations and guideline decisions can delay treatment.
The Zepzelca case illustrates the gap between European authorisation and patient access. Even after approval of its combination with atezolizumab for extensive-stage small-cell lung cancer, national funding procedures remained necessary. In France, the relevant request for early access or reimbursement was rejected.
Doctors in Spain use new oncology medicines less often than those in Germany and France, but more often than those in the United Kingdom. Italy is also in the middle group.
The report links the United Kingdom’s position to health technology assessments and strict cost-effectiveness thresholds. Central budget controls also make adoption more selective and slower.
The old East-West divide is becoming less clear. Several Central and Eastern European countries have increased their uptake, while some Western countries have slipped in the rankings. Slovenia is now close to the countries with the strongest access indicators. Portugal and the Netherlands are near the lower end for utilisation. Policy choices and the ability to put decisions into practice now matter as much as national wealth or geography.
The gap varies by disease. Breast cancer had the most even spread of consumption across the countries studied in 2023, while lung cancer had the widest spread. Gynaecological tumours also showed lower use in several Central and Eastern European countries. The report links that weaker uptake to more limited access to advanced biomarker testing in those areas.
That diagnostic link points to the practical problem. Paying for a medicine without covering the tests needed to identify eligible patients leaves treatment technically available but out of reach in clinical practice. The same implementation gap has appeared in other medical fields. Earlier clinical coverage has also focused on decisions beyond the headline therapy.
The IHE report identifies execution as Europe’s basic weakness. Health systems need funding for medicines and the diagnostics tied to them. They also need stronger data systems and updated treatment guidelines. Prescribing needs oversight, and budgets must cover every eligible patient.
EMA activity reporting for 2024 identifies oncology as an area where faster, more data-based assessment methods are being tested. The aim is to help new medicines reach patients sooner. Spain and other decentralised systems will not close the remaining gap through national reimbursement alone. The final test is whether a funded treatment reaches the clinic and the patient without another administrative delay.
