OBJECTIVES: Patients clinically eligible for oncology therapies, as defined by regulatory labels, may be unable to access them because of reimbursement decisions. This study analyzed whether gross domestic product (GDP) per capita (GDPPC) and health expenditure explain the access restrictions imposed in various markets.

METHODS: Therapies approved for breast, kidney, lung, and prostate cancer, multiple myeloma, and melanoma in Australia, Belgium, Canada, Denmark, France, Germany, Italy, the Netherlands, Poland, Portugal, Spain, Sweden, and the UK were identified (2006–2016). For each indication, reimbursement decisions by national agencies were identified and classified according to the level of access restriction on clinically eligible population (none, partial, or full). GDPPC and health expenditure as a proportion of GDP were identified from published sources; mean values over the study period were calculated and related to the restrictions.

RESULTS: Reimbursement agencies often do not explain the reasons for restrictions, suggesting a lack of transparency in decision-making. Across 65 cancer drug/indication combinations covering 892 reimbursement decisions by individual agencies, countries with a similar GDPPC such as Australia, Canada, and Germany showed variable rates of full restriction (0–31% of licensed indications). Poland and Portugal, with lower GDPPC, restricted 69% and 60%, respectively; however Spain, with a similarly low GDPPC, applied less restrictions at the national level. Furthermore, Poland, Australia, Italy, and the UK, with <9% mean health expenditure as a proportion of GDP, restricted access in a high percentage of indications while Germany, France, and the Netherlands, with ≥10% mean health expenditure, imposed far fewer restrictions.

CONCLUSIONS: Access to cancer therapies varies between countries with similar GDP; healthcare expenditure as a proportion of GDP was moderately predictive of all reimbursement restrictions. The findings suggest unwarranted limitations and inequitable access to cancer treatment among countries with similar living standards, and potential inefficiencies in the organization of healthcare.