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Review Supportive Care Potential Solutions for Sustaining the Costs of Cancer Drugs Gilberto Lopes, 1 Arnold Vulto, 2 Nils Wilking, 3 Wim van Harten, 4,5 Klaus Meier 6 and Steven Simoens 7 1. Sylvester Comprehensive Cancer Center, University of Miami, FL, US; 2. Erasmus University Medical Center, Rotterdam, The Netherlands; 3. Karolinska Institutet, Solna, Sweden; 4. Rijnstate Hospital, Arnhem, The Netherlands; 5. University Twente, Enschede, The Netherlands; 6. HKK Soltau, Lower Saxony & Heidekreis-Klinikum GmbH, Soltau, Germany; 7. KU Leuven, Leuven, Belgium T he growing burden of cancer urgently requires sustainable solutions to ensure continued access to effective and safe treatments for all patients within Europe. The aim of this article, the third in a series of perspectives, is to discuss potential approaches to sustain cancer care and increase patient access to treatments. Much work remains to ensure the sustainability ceiling (where costs of care exceed the benefits) is not reached. Immediate steps must be taken to avoid this, including patient education to encourage earlier diagnosis, use of treatment-response biomarkers, improving efficiency of healthcare systems, use of managed-entry agreements, introduction of value-based medicines with measurable outcomes and use of less expensive medicines. Here we discuss these potential solutions with a focus on reducing the cost of cancer drugs, using biosimilar medicines as an example. Biosimilar and generic medicines offer a cost- effective treatment option that may help combat the substantially increasing costs of cancer drugs. Competition from biosimilar medicines is expected to drive a decrease in the cost of medicines, resulting in increased affordability and access to therapy, and therefore a greater number of patients could be treated. However, various barriers must be overcome to increase the uptake of biosimilar medicines and education is needed to allay misperceptions and encourage greater use. Keywords Introduction Sustainability, oncology, value, outcome, biosimilar With the growing burden of cancer, sustainable solutions are urgently required to ensure access to effective and safe treatments for all patients. 1 Health expenditure on cancer in Europe more than doubled between 1995 and 2014, increasing from €35.7 billion to €83.2 billion; 2 high-cost cancer drugs are the main drivers of this increase in many countries. Every patient has the right to benefit from medical treatment, regardless of financial means, gender or nationality, 3 but at the current rate of spending this will not be achievable in the near future. Disclosures: Gilberto Lopes, Nils Wilking, Wim van Harten, Klaus Meier and Steven Simoens have nothing to disclose in relation to this article. Arnold Vulto reports no conflict of interest in relation to this work and no financial interest in any pharmaceutical company. His institution receives financial compensation consulting/ lecturing activities on behalf of AbbVie, Amgen, Biogen, Boehringer Ingelheim, EGA (Medicines for Europe), Mundipharma, Pfizer/Hospira, Roche and Novartis/ Sandoz/Hexal. This study involves a review of the literature and did not involve any studies with human or animal subjects performed by any of the authors. Acknowledgments: All authors critically reviewed the manuscript and approved the final version for submission. Medical writing support was provided under the direction of the authors. Editorial assistance was provided by Amanda Pedder of Spirit Medical Communications Ltd., funded by Sandoz International GmbH. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non- commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: 8 June 2017 A multidisciplinary and multipathway approach facilitated by experts in hospital pharmacy, health economics and oncology is needed. To explore current issues and potential solutions, experts in these fields from across Europe have collaborated on a series of perspectives. The current situation and consequences of reaching the sustainability ceiling (where costs of treatment outweigh the benefits), including definitions of sustainability and value, are discussed further in the first and second articles in this series of three perspectives. 4,5 Accepted: 15 November 2017 Citation: European Oncology & Haematology, 2017;13(2):102–7 Correspondence: Gilberto Lopes, Sylvester Comprehensive Cancer Center, University of Miami, 1475 N.W. 12th Avenue, Miami, FL 33136, US. E: glopes.md@gmail.com Support: The publication of this article was supported by Sandoz International GmbH, who was given the opportunity to review the article for scientific accuracy before submission. Any resulting changes were made at the authors’ discretion. To regulate spending and allow continued – or even improved – access to cancer treatments, changes must be made before the sustainability ceiling is reached. 4,5 As detailed in the first two articles of this series, the continuing exponential rise in costs is driven, in part, by the introduction of a large number of new, high-cost treatments. Although innovation and research into new treatments should be encouraged, additional focus is needed on value-based medicine, characterised by evidence-based medicine, patient-centred care and cost-effectiveness. 4,6 The availability of additional safe, effective and affordable value-based options will enable health systems to expand access to beneficial treatments for more patients, free up resources for access to other medicines, and relieve pressure on healthcare budgets. 7 In this third perspective, we focus on solutions, providing potential options for sustaining cancer care and increasing access to treatments 102 TOU C H ME D ICA L ME D IA