Evaluation of Market Access of Pembrolizumab: A Comparative Study Between Portugal, Spain and the United Kingdom

Equity plays a key role in public administration, with social equity important for achieving equitable outcomes. In oncology, the sustainability of the system is a major concern, as rising prices of cancer medicines have increased spending on cancer care, posing affordability challenges even in high-income countries with public health systems. Pembrolizumab has changed the course of many oncologic diseases and has a huge impact on hospital budgets. The aim of this study was to evaluate national-level differences in access across Portugal, Spain, and the UK. From the empirical analysis, it is possible to conclude that there is a mean approval delay of more than 350 days, with delays more pronounced in Portugal and the UK, even though this evaluation does not capture uptake at the local and individual levels. It is also a potential measure to improve the national authority’s approval. The centralised assessment by the European HTA might reduce inequalities between countries, which is particularly relevant for oncology medicines. The role of patient advocacy groups in market access is yet to be determined. However, a change in the culture of HTA bodies can bring them into every step of the process.