Efficiency of Oncology Health Systems in Ten European Countries: A Comparative Analysis of Expenditure, Outcomes, and Access to Medicines

Background: Substantial variation exists across Europe in cancer outcomes, health spending, and access to oncology medicines. Understanding how these dimensions interact is crucial to evaluating health system performance. Objectives: To assess the relative efficiency of oncology systems in ten European countries by comparing health and oncology expenditure with cancer outcomes and access to high-value therapies. Methods: A cross-national, ecological study was conducted for Poland, Czechia, Estonia, Germany, Spain, Slovenia, Netherlands, United Kingdom, Italy, and Finland. Data on health expenditure, site-standardized relative survival (proxy SS-RS), and medicine access were drawn from international sources (OECD, ECIR, Eurostat, Epfia Wait Report and IHE Report, EMA). Efficiency tiers were derived by integrating inputs, outputs, and access. Results: High-efficiency systems (e.g., Finland, Netherlands, UK) combine moderate-to-high spending with favourable outcomes and timely access. In contrast, Poland and Estonia exhibit lower efficiency due to restricted access, delayed reimbursement, and weaker survival indicators. Spending alone did not predict outcomes; access and system design were critical modifiers. Conclusions: Improving oncology system performance requires strategic resource allocation, rapid access to high-benefit treatments, and integrated service delivery. EU-level coordination and national reforms should prioritize value-based cancer care and equity in access.