Whether pain patients in Europe have access to various appropriate opioid painkillers depends less on medical criteria or treatment guidelines than on the good fortune of living in the right country. As a current study of the European Federation EFIC Pain shows, there are striking discrepancies in approval and reimbursement for potent analgesic agents among the 30 European countries for which data is available. The results of the current study were presented at the 9th Congress of the European Federation EFIC Pain, "Pain in Europe IX" in Vienna.
"In Western Europe, the number of different opioid preparations did pain patients can take is generally much higher than in Eastern Europe," said Prof Hans Georg Kress, Head of the Department of Special Anaesthesia and Pain Therapy, Medical University / AKH Vienna. Prof Kress, so past President of the EFIC and member of the EFIC Task Force conducted this study, then continued: "Germany leads the way in this regard with 47 approved oral opioid painkillers. The costs for all of them are reimbursed by the statutory health insurance funds. That puts Germany in the lead in Europe clearly, in front of Italy, with 42 approved and reimbursed medications. "Denmark follows with 37 medications on the market, of which 22 are reimbursed. Sweden is next with 35 approved and reimbursed medications. Bringing up the rear are Kosovo (4 approved formulations, none of which are reimbursed), Russia (4/4), Bosnia-Herzegovina (3/0) and Ukraine, where not a single oral opioid is available. "
In some European countries, the costs of opioids are automatically covered by the statutory health insurance funds or the government as soon as the medication is approved. However, in most countries approval of a medication by Government Authorities and assumption of the costs for it by the statutory health insurance system are not linked processes. In Eastern European countries, costs are therefore reimbursed for most approved products.
In several Western European countries with free pricing, the authorities are reluctant to reimburse innovative yet expensive opioid products. This is especially true of rapid onset opioid (Roos), quick and short-acting fentanyl formulations That need not be swallowed and are indeed especially suitable for the treatment of breakthrough pain in cancer patients. They are approved as nasal sprays or sublingual tablets in 18 of the 30 countries examined but are reimbursed in just 11 or 12 countries. As lozenges or buccal tablets, They are on the market in 13 countries (9 or reimbursed in 8 countries) and the new buccal film is approved in just 6 countries and is reimbursed thus far in just one. Prof Kress: "Access to these important painkillers is restricted in everyday life by the reimbursement practices of the healthcare system even though synthesis drugs are officially approved and available at apothecaries."