Spending on healthcare and drugs for cancer varies widely between countries in the European Union, accounting for an estimated $169 billion (€126 billion) annually across the whole E.U., according to the first comprehensive E.U.-wide study.

“The main driver of cancer-related healthcare costs is a nation’s wealth,” says Ramon Luengo-Fernandez, a senior researcher at the Health Economics Research Centre at the University of Oxford and lead author of the study, published in The Lancet Oncology70442-X/fulltext) “Wealthier countries tend to spend more, both in absolute and relative terms on healthcare and subsequently on cancer care.”

In 2008, 2.45 million people were diagnosed with cancer in the E.U. and 1.23 million died due to cancer. Researchers found the per-person costs of cancer highest in Luxembourg and Germany and lowest in Bulgaria, with overall expenditures on cancer therapeutics accounting for $18.9 billion (€14 billion), or about a quarter of the costs. Spending on cancer medications as a percentage of health care costs was lowest in Lithuania, and highest in Cyprus.

The Pfizer-sponsored study based its finding on international health organization data from 2009, the most recent year for which comprehensive data were available.

The overall cost of cancer in the E.U., $169 billion (€126 billion), included the direct cost of cancer care, the cost of drugs, the cost of productivity losses due to premature death, the cost of people being unable to work due to illness, and the cost of informal care from friends and relatives.

Breast cancer, colorectal cancer, lung cancer, and prostate cancer accounted for nearly half of all new cancer diagnoses and deaths in 2009, with lung cancer carrying the highest overall cost, at $25 billion (€18.8 billion), due primarily to lost productivity, and breast cancer carrying the highest healthcare cost at $9 billion (€6.7 billion), largely due to high rates of spending on therapeutics.

“More effective targeting of investment may prevent health care systems from reaching a breaking point—a real danger given the increasing burden of cancer,” says Richard Sullivan, co-author of the study and director of the Institute of Cancer Policy at King’s College London. “In some countries better allocation of funding could even improve survival rates.”

As pressures mount on government payers in Europe to achieve the biggest bang for their euro amid rising care costs, it will be essential for them to understand which aspects of care are the biggest cost centers. Luengo-Fernandez says he hopes that the study’s results will help policymakers better allocate research funds and deliver cancer services in a cost-effective way.