J Korean Med Sci.  2024 Feb;40(5):e16. 10.3346/jkms.2025.40.e16.

National Expenditures on Anticancer and Immunomodulating Agents During 2013–2022 in Korea

• Yun J
• Chang Y
• Jo M
• Heo Y
• Kim DS

• KMID: 2565115
• DOI: http://doi.org/10.3346/jkms.2025.40.e16

Abstract

Background
This study investigated trends in national expenditures on anticancer and immunomodulating agents from 2013 to 2022.
Methods
Information was obtained from the National Health Insurance claims data spanning a period of 10 years, from 2013 to 2022. The subjects of this study are patients diagnosed with cancer who used anticancer agents between January 1, 2013, and December 31, 2022. Trends were examined across various categories, including sex, age groups, routes of healthcare use, and types of healthcare institutions. We calculated the compound annual growth rate in both the number of patients and expenditures by year.
Results
In 2013, pharmaceutical expenditures amounted to USD 11,984 million, representing 25.5% of the total healthcare expenditures, which were USD 46,984 million. Within this pharmaceutical expenditure, anticancer medications constituted USD 584 million, or 4.9%. By 2022, pharmaceutical expenditures had risen to USD 22,093 million, accounting for 22.8% of the total healthcare expenditures of USD 96,904 million. Of this amount, USD 1,566 million was allocated to anticancer drugs, which represented 7.1% of the total pharmaceutical expenditures. Between 2013 and 2022, total healthcare expenditures experienced a significant increase of 106.2%, reaching USD 49,920 million. Concurrently, pharmaceutical expenditures rose by 91.1% to USD 10,919 million, while expenditures on anticancer drugs surged by 168.2% to USD 982 million. In 2022, the category with the highest expenditures was ATC L01FF, which includes programmed cell death protein 1/death ligand 1 inhibitors such as nivolumab, totaling USD 266.2 million. This was followed by L01FD at USD 198.8 million and L01EA at USD 140.4 million. Since 2018, however, spending on immune checkpoint blockers targeting cell death proteins or ligands has continued to rise and currently ranks first.
Conclusion
The number of patients using anticancer drugs and the associated drug expenditures have risen between 2013 and 2022. As the share of anticancer drugs in total drug expenditures grows, so too do the overall expenditures. This escalating financial burden highlights the necessity for policymakers to thoroughly understand the appropriate and costeffective usage of anticancer drugs, as it directly influences the affordability and accessibility of healthcare services.

Keyword

Pharmaceutical Expenditure; Anticancer Drugs; Korea; National Health Insurance

Figure

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  Fig. 1 Yearly trends in pharmaceutical expenditures and anticancer drug expenditures.TPE = total pharmaceutical expenditures.

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  Fig. 2 Expenditures on anticancer drug agents by therapeutic class (Anatomical Therapeutic Chemical level 4). L01FF: Programmed cell death protein 1/death ligand 1 (PD-1/PDL-1) inhibitors (e.g., Nivolumab); L01FD: Human Epidermal Growth Factor Receptor 2 (HER2) inhibitors (e.g., Trastuzumab); L01EA: BCR-ABL tyrosine kinase inhibitors (e.g., Imatinib); L01EB: Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (e.g., Gefitinib); L01FG: Vascular Endothelial Growth Factor (VEGF/VEGFR) inhibitors (e.g., Ramucirumab); L01CD: Taxanes (e.g., Paclitaxel); L01EX: Other protein kinase inhibitors (e.g., Sorafenib); L01ED: Anaplastic lymphoma kinase (ALK) inhibitors (e.g., Crizotinib); L01XA: Platinum compounds (e.g., Cisplatin); L01EF: Cyclin-dependent kinase (CDK) inhibitors (e.g., Palbociclib); L01BC: Pyrimidine analogues (e.g., Fluorouracil); L01XG: Proteasome inhibitors (e.g., Carfilzomib); L01FE: Epidermal Growth Factor Receptor (EGFR) inhibitors (e.g., Cetuximab); L01FA: Clusters of Differentiation 20 (CD20) inhibitors (e.g., Rituximab); L01BA: Folic acid analogues (e.g., Methotrexate); L01CE: Topoisomerase 1 (TOP1) inhibitors (e.g., Irinotecan); L01EJ: Janus-associated kinase (JAK) inhibitors (e.g., Ruxolitinib).CAGR = compound annual growth rate.

Reference

1. Korean Statistical Information Service (KOSIS). National Health Insurance Statistics. Sejong, Korea: KOSIS;2022.

2. Jeong HS, Shin JW. Trends in scale and structure of Korea's health expenditure over last three decades (1980-2009): financing, functions and providers. J Korean Med Sci. 2012; 27 Suppl(Suppl):S13–S20. PMID: 22661865.

3. Hyun KR, Kang S, Lee S. Population aging and healthcare expenditure in Korea. Health Econ. 2016; 25(10):1239–1251. PMID: 26085120.

4. Kang SH, Jeong W, Park EC. Catastrophic health expenditure and trend of South Korea in 2019. Health Policy Manag. 2021; 31(1):140–144.

5. Health Insurance Review and Assessment Service. Total Health Expenditure. Wonju, Korea: HIRA Bigdata Open Portal;2022.

6. Ministry of Health and Welfare (KR). National Health Accounts. Sejong, Korea: Ministry of Health and Welfare;2022.

7. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 71(3):209–249. PMID: 33538338.

8. Belloni A, Morgan D, Paris V. Pharmaceutical Expenditure and Policies: Past Trends and Future Challenges. OECD Health Working Papers No. 87. Paris, France: Organization for Economic Cooperation and Development (OECD);2016.

9. Kim W, Koo H, Lee HJ, Han E. The effects of cost containment and price policies on pharmaceutical expenditure in South Korea. Int J Health Policy Manag. 2022; 11(10):2198–2207. PMID: 34814666.

10. Clemente J, Marcuello C, Montañés A. Pharmaceutical expenditure, total health-care expenditure and GDP. Health Econ. 2008; 17(10):1187–1206. PMID: 18050150.

11. Moreno-Torres I, Puig-Junoy J, Raya JM. The impact of repeated cost containment policies on pharmaceutical expenditure: experience in Spain. Eur J Health Econ. 2011; 12(6):563–573. PMID: 20809092.

12. Okunade AA, Suraratdecha C. The pervasiveness of pharmaceutical expenditure inertia in the OECD countries. Soc Sci Med. 2006; 63(1):225–238. PMID: 16459005.

13. Freemantle N, Bloor K. Lessons from international experience in controlling pharmaceutical expenditure. I: Influencing patients. BMJ. 1996; 312(7044):1469–1471. PMID: 8664631.

14. Mousnad MA, Shafie AA, Ibrahim MI. Systematic review of factors affecting pharmaceutical expenditures. Health Policy. 2014; 116(2-3):137–146. PMID: 24726509.

15. Lichtenberg FR, Tatar M, Çalışkan Z. The effect of pharmaceutical innovation on longevity, hospitalization and medical expenditure in Turkey, 1999-2010. Health Policy. 2014; 117(3):361–373. PMID: 24996837.

16. Organization for Economic Cooperation and Development (OECD). Improving Forecasting of Pharmaceutical Spending - Insights From 23 OECD and EU Countries. Paris, France: OECD;2019.

17. Kim J, Lee D, Kim S, Kim DS, Kim J, Lee D, et al. A critical evaluation and international comparison of pharmaceutical consumption and sales statistics. Health Policy Manag. 2020; 30(3):311–325.

18. Kim Y, Chae J, Shin S, Jo G, Shin J, Kim B, et al. Trends in National Pharmaceutical Expenditure in Korea during 2011 - 2020. Infect Chemother. 2023; 55(2):237–246. PMID: 37407241.

19. Park J, Moon K, Kim DS. Health care utilization and anti-cancer drug expenditure for six solid cancers in Korea from 2007 to 2019. Front Oncol. 2022; 12:862173. PMID: 35832556.

20. Chang Y, Hwang SH, Cho SA, Lee H, Cho E, Lee JY. Health inequities in cancer incidence according to economic status and regions are still existed even under universal health coverage system in Korea: a nationwide population based study using the National Health Insurance database. Cancer Res Treat. 2024; 56(2):380–403. PMID: 38062707.

21. Hong S, Won YJ, Lee JJ, Jung KW, Kong HJ, Im JS, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2018. Cancer Res Treat. 2021; 53(2):301–315. PMID: 33735559.

22. Oh JY, Lee JY, Kim DS. Trends in orphan drug use and spending among children and adolescents during 2010-2020 in Korea. Front Pharmacol. 2022; 13:964426. PMID: 36120352.

23. Park D, Lee H, Kim DS. High-cost users of prescription drugs: National Health Insurance data from South Korea. J Gen Intern Med. 2022; 37(10):2390–2397. PMID: 34704207.

24. Cho DY, Park J, Kim DS. The impact of expanding health insurance coverage for anti-cancer drugs on cancer survival in Korea. Cancer Med. 2021; 10(13):4555–4563. PMID: 34145980.

25. Gwon YG, Han SJ, Kim KH. Trends in the quality of primary care and acute care in Korea from 2008 to 2020: a cross-sectional study. J Prev Med Public Health. 2023; 56(3):248–254. PMID: 37287202.

26. Kang E, Jang WM, Shin MS, Lee H, Lee JY. Changes in the hospital standardized mortality ratio before and during the COVID-19 pandemic: a disaggregated analysis by region and hospital type in Korea. J Prev Med Public Health. 2023; 56(2):180–189. PMID: 37055360.

27. World Health Organization Collaborating Centres. Anatomical Therapeutic Chemical (ATC)/Defined Daily Dose (DDD) index. Updated 2020. Accessed June 1, 2024. https://www.whocc.no/atc_ddd_index/ . .

28. Park J, Kwon S, Choi EK, Lee E, Choe W, Lee SR, et al. Validation of diagnostic codes of major clinical outcomes in a National Health Insurance database. Int J Arrhythm. 2019; 20(1):5.

29. Avorn J. Learning about the safety of drugs. a half-century of evolution. N Engl J Med. 2011; 365(2151):(3):

30. Jung JH, Kim DJ, Suh K, You J, Lee JH, Joung KI, et al. International price comparisons of anticancer drugs: a scheme for improving patient accessibility. Int J Environ Res Public Health. 2021; 18(2):670. PMID: 33466893.

31. Annadurai K, Danasekaran R, Mani G. Personalized medicine: a paradigm shift towards promising health care. J Pharm Bioallied Sci. 2016; 8(1):77–78. PMID: 26957875.

32. Tebani A, Afonso C, Marret S, Bekri S. Omics-based strategies in precision medicine: toward a paradigm shift in inborn errors of metabolism investigations. Int J Mol Sci. 2016; 17(9):1555. PMID: 27649151.

33. Leighl NB, Nirmalakumar S, Ezeife DA, Gyawali B. An arm and a leg: the rising cost of cancer drugs and impact on access. Am Soc Clin Oncol Educ Book. 2021; 41:e1–e12.

34. Laviana AA, Luckenbaugh AN, Resnick MJ. Trends in the cost of cancer care: beyond drugs. J Clin Oncol. 2020; 38(4):316–322. PMID: 31804864.