Clinical and Translational Oncology

, Volume 15, Issue 1, pp 9–19 | Cite as

Analysis of economic evaluations of pharmacological cancer treatments in Spain between 1990 and 2010

  • Ángel Sanz-Granda
  • Álvaro HidalgoEmail author
  • Juan E. del Llano
  • Joan Rovira
Educational Series – Red Series NEW TRENDS IN CLINICAL ONCOLOGY


Economic evaluation of pharmacological cancer treatment is a critical clinical problem currently under consideration worldwide. We have analysed their main characteristics in Spain between 1990 and 2010 following a systematic review of the 29 complete economic analyses published. The pathology most frequently evaluated was non-small cell lung cancer (31 %). Cost-effectiveness analyses (69 %) were the most frequent analyses. A wide range of incremental cost-effectiveness values (295–160,667 €/QALY) has been reported, and mostly are developed from the perspective of the National Health System (65.5 %). However, none of the studies estimated the indirect costs. The major conclusion is that the absence of regulations concerning the application of the efficiency criterion in decision-making on the subject of price and financing and, most importantly, the fact that these are not included in Spanish hospitals forms make it difficult to analyse the real impact of economic evaluations of cancer treatments on such decisions.


Economic evaluation Cost-effectiveness Medications Drugs Cancer/oncology Spain 



The authors thank Lilly S.A. Spain, for the help provided in the performance of the study.

Conflict of interest

ASG, AH, JDL and JR have received an investigator-led research from Lilly.


  1. 1.
    GLOBOCAN [database on the Internet], World Health Organization (2008) [cited September 2011].
  2. 2.
    Cabanes A, Pérez-Gómez B, Aragones N et al (2009) Vigilancia epidemiológica del cáncer. Monitorización de la situación del cáncer en España. Instituto de Salud Carlos III, MadridGoogle Scholar
  3. 3.
    Cabanes A, Vidal E, Aragones N et al (2010) Cancer mortality trends in Spain: 1980–2007. Ann Oncol 21(Suppl 3):iii14–iii20Google Scholar
  4. 4.
    Antoñanzas F, Oliva J, Velasco M et al (2006) Costes directos e indirectos del cáncer en España. Cuadernos Económicos del ICE 2:281–309Google Scholar
  5. 5.
    Garcia-Altes A (2001) Twenty years of health care economic analysis in Spain: are we doing well? Health Econ 10(8):715–729PubMedCrossRefGoogle Scholar
  6. 6.
    Oliva J, Del Llano J, Sacristan JA (2002) Analysis of economic evaluations of health technologies performed in Spain between 1990 and 2000. Gac Sanit 16(Suppl 2):2–11PubMedGoogle Scholar
  7. 7.
    Catala-Lopez F, Garcia-Altes A (2010) Economic evaluation of healthcare interventions during more than 25 years in Spain (1983–2008). Rev Esp Salud Publica 84(4):353–369PubMedCrossRefGoogle Scholar
  8. 8.
    Quecedo L, Del Llano J, Amador M (2009) Revisión de análisis económicos sobre tecnologías emergentes en oncología. Pharmacoecon Spanish Res Articles 6:146–158Google Scholar
  9. 9.
    Centre for Evidence Based Medicine, Oxford Centre for Evidence-based Medicine—Levels of Evidence (2009) Electronic document [cited June 2010].
  10. 10.
    Critical assessment of Economic Evaluation (2005) In: Drummond M, Sculpher M, Torrance G, O’Brien B, Stoddart G (eds) Methods for the Economic Evaluation of Health Care Programmes, 3rd edn. Oxford University Press, New York, pp 27–53Google Scholar
  11. 11.
    Valderas JM, Mendivil J, Parada A et al (2006) Development of a geographic filter for PubMed to identify studies performed in Spain. Rev Esp Cardiol 59(12):1244–1251PubMedCrossRefGoogle Scholar
  12. 12.
    Lopez Bastida J, Oliva J, Antonanzas F et al (2010) A proposed guideline for economic evaluation of health technologies. Gac Sanit 24(2):154–170PubMedCrossRefGoogle Scholar
  13. 13.
    Soto J (1998) Cost-minimization analysis with different presentations of interferon alfa on the market used for treating hepatitis C and chronic myeloid leukemia. Farm Clin 15:219–226Google Scholar
  14. 14.
    Berger K, Fischer T, Szucs TD (1998) Cost-effectiveness analysis of paclitaxel and cisplatin versus cyclophosphamide and cisplatin as first-line therapy in advanced ovarian cancer. A European perspective. Eur J Cancer 34(12):1894–1901PubMedCrossRefGoogle Scholar
  15. 15.
    Ferriols R, Ferriols F (1998) Análisis coste-efectividad de la utilización de gemcitabina y cisplatino, ifosfamida y mesna en el tratamiento del cáncer de pulmón no microcítico. Farm Clin 15:326–335Google Scholar
  16. 16.
    Ferriols R, Ferriols F (1998) Evaluación farmacoeconómica de la asociación del ácido folínico y el 5-fluorouracilo en el tratamiento del carcinoma colorrectal avanzado. Farm Hosp 23:232–240Google Scholar
  17. 17.
    Gallego O, Cuenca R, Antón I et al (1999) Estudio descriptivo sobre coste-efectividad en el tratamiento del cáncer de pulmón no microcítico estadío IIIB-IV. Todo Hosp 161:773–777Google Scholar
  18. 18.
    Annemans L, Giaccone G, Vergnenegre A (1999) The cost-effectiveness of paclitaxel (Taxol) + cisplatin is similar to that of teniposide + cisplatin in advanced non-small cell lung cancer: a multicountry analysis. Anticancer Drugs 10(6):605–615PubMedCrossRefGoogle Scholar
  19. 19.
    Sacristan JA, Kennedy-Martin T, Rosell R et al (2000) Economic evaluation in a randomized phase III clinical trial comparing gemcitabine/cisplatin and etoposide/cisplatin in non-small cell lung cancer. Lung Cancer 28(2):97–107PubMedCrossRefGoogle Scholar
  20. 20.
    Ferriols R, Ferriols F, Magraner J (2000) Pharmacoeconomic assessment of taxanes as first-line therapy for advanced or metastatic non-microcytic lung cancer. Farm Hosp 24:226–240Google Scholar
  21. 21.
    Gonzalez-Larriba JL, Serrano S, Alvarez-Mon M et al (2000) Cost-effectiveness analysis of interferon as adjuvant therapy in high-risk melanoma patients in Spain. Eur J Cancer 36(18):2344–2352PubMedCrossRefGoogle Scholar
  22. 22.
    Rubio-Terres C, Tisaire JL, Kobina S et al (2002) Cost-minimisation analysis of three regimens of chemotherapy (docetaxel–cisplatin, paclitaxel–cisplatin, paclitaxel–carboplatin) for advanced non-small-cell lung cancer. Lung Cancer 35(1):81–89PubMedCrossRefGoogle Scholar
  23. 23.
    Lindgren P, Jonsson B, Redaelli A et al (2002) Cost-effectiveness analysis of exemestane compared with megestrol in advanced breast cancer: a model for Europe and Australia. Pharmacoeconomics 20(2):101–108PubMedCrossRefGoogle Scholar
  24. 24.
    Ojeda B, de Sande LM, Casado A et al (2003) Cost-minimisation analysis of pegylated liposomal doxorubicin hydrochloride versus topotecan in the treatment of patients with recurrent epithelial ovarian cancer in Spain. Br J Cancer 89(6):1002–1007PubMedCrossRefGoogle Scholar
  25. 25.
    Díaz-Rubio E, Hart W, Kobina S et al (2003) Cost-effectiveness analysis of irinotecán plus fluorouracil/folinic acid compared with fluorouracil/folinic acid alone as first-line treatment for advanced colorectal cancer. Rev Oncol. 5(9):517–523Google Scholar
  26. 26.
    Rubio-Terres C, Alberola V, Casal J et al (2006) Análisis farmacoeconómico del tratamiento con erlotinib, docetaxel, pemetrexed o tratamiento de soporte de pacientes con cáncer de pulmón no microcítico avanzado, previamente tratado con quimioterapia. Pharmacoecon Spanish Res Articles 3(3):147–149Google Scholar
  27. 27.
    Gil JM, Rubio-Terres C, Del Castillo A et al (2006) Pharmacoeconomic analysis of adjuvant therapy with exemestane, anastrozole, letrozole or tamoxifen in postmenopausal women with operable and estrogen receptor-positive breast cancer. Clin Transl Oncol 8(5):339–348PubMedCrossRefGoogle Scholar
  28. 28.
    Ballester A, Ferriols F, Magraner J (2006) A cost-effectiveness study of first-line hormone therapy in post-menopausal patients with metastatic breast cancer on neoadjuvant treatment. Farm Hosp 30:71–77CrossRefGoogle Scholar
  29. 29.
    Ferriols F, Pitarch J, Magraner J (2006) Pharmacoeconomic assessment of taxanes as first-line therapy for advanced or metastatic non-microcytic lung cancer. Farm Hosp 30:211–222CrossRefGoogle Scholar
  30. 30.
    Casado M, Benavides M, Cajaraville G et al (2007) Análisis coste-efectividad y de impacto presupuestario del tratamiento en primera línea del cáncer colorrectal metastásico en España. Rev Esp Econ Salud 6:106–118Google Scholar
  31. 31.
    Alberola V, Anton A, Carrato A et al (2007) Evaluación económica de tratamientos para el cáncer de pulmón no microcítico. Rev Esp Econ Salud 6(4):242–249Google Scholar
  32. 32.
    Grupo de Farmacoeconomía del Linfoma Folicular (2008) Rituximab cost analysis for maintenance treatment of patients with follicular lymphoma. Farm Hosp 32(1):25–34CrossRefGoogle Scholar
  33. 33.
    Maroto P, Villavicencia H, Piñol C et al (2008) Análisis coste-efectividad de sorafenib oral en el tratamiento del carcinoma de células renales avanzado. Rev Esp Econ Salud 7(4):173–180Google Scholar
  34. 34.
    Paz-Ares L, Garcia del Muro X, Grande E et al (2008) Cost-effectiveness analysis of sunitinib in patients with metastatic and/or unresectable gastrointestinal stroma tumours (GIST) after progression or intolerance with imatinib. Clin Transl Oncol 10(12):831–839PubMedCrossRefGoogle Scholar
  35. 35.
    Martin-Jimenez M, Rodriguez-Lescure A, Ruiz-Borrego M et al (2009) Costeffectiveness analysis of docetaxel (Taxotere) vs. 5-fluorouracil in combined therapy in the initial phases of breast cancer. Clin Transl Oncol 11(1):41–47PubMedCrossRefGoogle Scholar
  36. 36.
    Arocho R, García M, Maurel J et al (2009) Análisis del coste de la terapia biológica del cáncer colorrectal metastásico con panitumumab y cetuximab. Pharmacoecon Spanish Res Articles 6(2):55–65Google Scholar
  37. 37.
    Delgado J, Febrer L, Nieves D et al (2009) Cost-reduction analysis for oral versus intravenous fludarabine (Beneflur) in Spain. Farm Hosp 33:240–246PubMedCrossRefGoogle Scholar
  38. 38.
    Asukai Y, Valladares A, Camps C et al (2010) Cost-effectiveness analysis of pemetrexed versus docetaxel in the second-line treatment of non-small cell lung cancer in Spain: results for the non-squamous histology population. BMC Cancer 10:26PubMedCrossRefGoogle Scholar
  39. 39.
    Paz-Ares L, del Muro JG, Grande E et al (2010) A cost-effectiveness analysis of sunitinib in patients with metastatic renal cell carcinoma intolerant to or experiencing disease progression on immunotherapy: perspective of the Spanish National Health System. J Clin Pharm Ther 35(4):429–438PubMedGoogle Scholar
  40. 40.
    Frias C, Cortes J, Segui MA et al (2010) Cost-effectiveness analyses of docetaxel versus paclitaxel once weekly in patients with metastatic breast cancer in progression following anthracycline chemotherapy, Spain. Clin Transl Oncol 12(10):692–700PubMedCrossRefGoogle Scholar
  41. 41.
    Gómez J, Rios R, Rubio C et al (2010) Análisis farmacoeconómico de la adición de rituximab a la quimioterapia de primera línea de los pacientes con linfoma folicular avanzado. Pharmacoecon Spanish Res Articles 7(2):55–67Google Scholar
  42. 42.
    Brown ML, Fintor L (1993) Cost-effectiveness of breast cancer screening: preliminary results of a systematic review of the literature. Breast Cancer Res Treat 25(2):113–118PubMedCrossRefGoogle Scholar
  43. 43.
    Earle CC, Chapman RH, Baker CS et al (2000) Systematic overview of cost–utility assessments in oncology. J Clin Oncol 18(18):3302–3317PubMedGoogle Scholar
  44. 44.
    Clegg A, Scott DA, Hewitson P et al (2002) Clinical and cost effectiveness of paclitaxel, docetaxel, gemcitabine, and vinorelbine in non-small cell lung cancer: a systematic review. Thorax 57(1):20–28PubMedCrossRefGoogle Scholar
  45. 45.
    Lodge M, Pijls-Johannesma M, Stirk L et al (2007) A systematic literature review of the clinical and cost-effectiveness of hadron therapy in cancer. Radiother Oncol 83(2):110–122PubMedCrossRefGoogle Scholar
  46. 46.
    Sfakianos GP, Havrilesky LJ (2011) A review of cost-effectiveness studies in ovarian cancer. Cancer Control 18(1):59–64PubMedGoogle Scholar
  47. 47.
    Greenberg D, Earle C, Fang CH et al (2010) When is cancer care cost-effective? A systematic overview of cost–utility analyses in oncology. J Natl Cancer Inst 102(2):82–88PubMedCrossRefGoogle Scholar
  48. 48.
    Sacristan JA, Dilla T, Luis Pinto J et al (2008) Economic drug evaluation: experiences and pathways to progress. Gac Sanit 22(4):354–357PubMedCrossRefGoogle Scholar
  49. 49.
    Manuel MR, Chen LM, Caughey AB et al (2004) Cost-effectiveness analyses in gynecologic oncology: methodological quality and trends. Gynecol Oncol 93(1):1–8PubMedCrossRefGoogle Scholar
  50. 50.
    Annemans L (2008) Methodological issues in evaluating cost effectiveness of adjuvant aromatase inhibitors in early breast cancer: a need for improved modelling to aid decision making. Pharmacoeconomics 26(5):409–423PubMedCrossRefGoogle Scholar
  51. 51.
    Friedberg M, Saffran B, Stinson TJ et al (1999) Evaluation of conflict of interest in economic analyses of new drugs used in oncology. JAMA 282(15):1453–1457PubMedCrossRefGoogle Scholar
  52. 52.
    Lexchin J, Bero LA, Djulbegovic B et al (2003) Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ 326(7400):1167–1170PubMedCrossRefGoogle Scholar
  53. 53.
    Sacristan JA, Oliva J, del Llano J et al (2002) What is an efficient health technology in Spain? Gac Sanit 16:334–343PubMedGoogle Scholar
  54. 54.
    Raftery J (2009) NICE and the challenge of cancer drugs. BMJ 338:b67PubMedCrossRefGoogle Scholar
  55. 55.
    Catalá-López F, García-Altés A, Álvarez-Martín E et al (2011) Economic evaluation of interventions for malignant neoplasms in Spain: systematic review and comparative analysis. Farm Hosp (Epub ahead of print)Google Scholar
  56. 56.
    Rodriguez Barrios JM, Perez Alcantara F, Crespo Palomo C et al (2011) The use of cost per life year gained as a measurement of cost-effectiveness in Spain: a systematic review of recent publications. Eur J Health Econ (Epub ahead of print)Google Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2012

Authors and Affiliations

  • Ángel Sanz-Granda
    • 1
  • Álvaro Hidalgo
    • 2
    Email author
  • Juan E. del Llano
    • 3
  • Joan Rovira
    • 4
  1. 1.Weber Economía y Salud, Pharmacoeconomics DepartmentMadridSpain
  2. 2.Universidad de Castilla-La ManchaMadridSpain
  3. 3.Gaspar Casal FoundationMadridSpain
  4. 4.Universidad de BarcelonaBarcelonaSpain

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