Introduction: The European Union (EU) is a political and economic confederation <p>composed by 27 member states (EU-27). The EU implemented several standardizations in laws, <p>justice and home affairs and shares the consensus that health care should be regulated by the <p>state. A high level of human protection should be ensured in all its member states. European <p>health systems are funded and managed by each national government and for historical <p>reasons health policy and health expenditure are not homogeneous. <p>Whereas cancer incidence is dependent on factors such as population age, life-style and <p>genetic predisposition, cancer mortality in general is dependent on the efficacy of health <p>systems in providing cancer prevention, efficient screening methods and treatments. <p>Around 20% of the breast cancers show amplification/overexpression of HER2 that is <p>associated with a more aggressive disease and worse clinical outcome. By targeting the HER2 <p>receptor trastuzumab has significantly improved overall survival and changed the natural <p>course of this disease. <p>Objectives: This study aims to evaluate (1) the association of health expenditure with <p>breast cancer outcome, (2) to explore to which degree the differences in breast cancer survival <p>are related to the speed of uptake of trastuzumab and its determinants and (3) to evaluate the <p>real usage of trastuzumab and its relation to breast cancer survival in the EU. <p>Results: Breast cancer survival was found strongly correlated with health expenditure. A <p>clear cutoff divides Western and Eastern Europe in that regard, with western countries showing <p>higher health expenditure and higher breast cancer survival than Eastern Europe. Trastuzumab <p>reimbursement was faster in Western European countries, a factor associated with higher <p>health expenditure and better health policy performance. Trastuzumab uptake is increasing all <p>over Europe in the last 12 years, however it is still being under used in Eastern countries while <p>in Western Europe the uptake is sufficient to treat virtually all patients in need of the drug. <p>Conclusion: Important discrepancies in breast cancer survival exist in the EU. Western <p>Europe has higher breast cancer survival and higher health expenditure than Eastern Europe. <p>This can be partially explained by the faster approval and increased uptake of trastuzumab in <p>Western countries. Higher health expenditure and better health policy performance were <p>factors linked to faster reimbursement and uptake of trastuzumab. / Doctorat en sciences médicales / info:eu-repo/semantics/nonPublished