OBJECTIVES: Hospital pharmaceutical expenditure (HPE) is a considerable component of total pharmaceutical expenditure, which is not systemically captured by international databases. This study aims to examine HPE trends across European countries.

METHODS: A literature review was conducted, from 2010 onwards, and items were located with a structured (term- and criteria-based) search strategy in PubMed and Cochrane Library. The search was complemented by reports or other grey literature located through Google Scholar or national organizations. The country-level data that were identified were used for the calculation of a series of indexes for 13 European countries. For each country we aimed to (a) calculate the share of HPE as part of total pharmaceutical expenditure (inpatient and outpatient paid – paid by third-party payers) and (b) identify trends in HPE (namely the proportional change between years and the compound annual growth rate) by comparing point estimates of spending referring to distinct years, where available.

RESULTS: HPE increased in all countries in the sample for the years where data was available, with the exception of Germany (where it remained almost stable) and Greece, where it declined by 21.6% (period 2012-2019). Belgium and Italy were the countries with the highest increases in HPE (+88.2% and +88.1% respectively), followed by UK (+63.4%), Finland (+56.9%) and Denmark (+51.0%). Moreover, HPE of the examined countries accounts for approximately 31.5% of total pharmaceutical expenditures paid by compulsory schemes (social insurance).

CONCLUSIONS: The identified trends across EU countries demonstrate the increasing magnitude of HPE, which can be attributed to an approach to channel demand through hospital settings for reasons of monitoring the administration process – especially for drugs for severe and life-threatening diseases.