Europe’s biggest drugmakers have warned that Germany’s attempts to curb healthcare costs will undermine one of the country’s few remaining globally competitive industries and cede further ground to the US and China.

Private companies conducted and funded 568 trials in Germany last year, down from 641 a decade ago, according to industry body the Verband Forschender Arzneimittelhersteller (VFA). Once the world’s largest location for such trials after the US, Germany has slipped to fifth position behind China, Spain and Australia.