Austria and Switzerland led Europe in the use of newer cancer medicines in 2023, while Spain stayed in the middle. Approval and funding still do not guarantee that patients receive treatment quickly.
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. Across twelve cancer types and product families, the widest gap between countries was threefold, down from more than five to one in 2018.
The narrower gap does not mean patients have the same chance of receiving treatment. The useful measure is not simply whether a drug has been authorised or reimbursed. Doctors must be able to use it in everyday care. 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.
Since 2025, new oncology medicines have been subject to a European Joint Clinical Assessment of clinical evidence. The assessment is intended to reduce duplicated national work, but countries still decide separately on price, reimbursement and practical use.
Germany shows why formal access rankings can be misleading. It often leads European industry studies on availability and funding, yet it ranked only fifth for effective consumption in 2023.
European approval starts another administrative process rather than ending one. Once the European Medicines Agency, or EMA, authorises a medicine, national authorities still set prices and decide on reimbursement. The EFPIA Patients W.A.I.T. Indicator has tracked major differences for more than a decade, both in the share of authorised medicines that receive public funding and in the time 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. 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 and 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 more assessments or approvals in decentralised systems. Spain, Italy and Sweden all have this extra layer. In Spain, national reimbursement does not automatically mean that hospitals and other care centres can use a medicine at once. Regional evaluations and guideline decisions can push treatment back.
The Zepzelca case illustrates the difference 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.
Spain sits in the middle of Europe’s five largest pharmaceutical markets. Doctors 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, strict cost-effectiveness thresholds and central budget controls. Those limits 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 changes by disease. Breast cancer had the most even spread of consumption across the countries studied in 2023. 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 gets 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, as earlier clinical coverage has focused on decisions beyond the headline therapy.
The IHE report points to execution as Europe’s main weakness. Health systems need funding for medicines and the diagnostics tied to them. They also need better data systems, updated treatment guidelines, checks on prescribing and enough money to 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 innovative 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.
