OBJECTIVES:  Orphan drugs have been a highlight of discussions due to its higher price than non-orphan drugs. Moreover, there is currently no European consensus on value assessment which has led to differences in price and access among countries. This study aimed to assess price differences among countries by comparing the annual treatment cost per patient of similarly available orphan drugs in France, Germany, Italy, Norway, Spain, Sweden, and the UK. METHODS:  Orphan drugs granted market authorisation up to June 13, 2016 were extracted from the European Medicines Agency (EMA) website. The annual treatment costs per drug were calculated using ex-factory prices from IHS POLI and country price databases. The treatment cost in the comparator country was compared to the UK and ratios were analysed. Subanalyses were done on cost quartiles (most to least expensive orphan drugs in the UK) and disease areas. RESULTS: