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Hanna E, Rémuzat C, Auquier P, Toumi M. Advanced therapy medicinal products: current and future perspectives. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2016; 4:31036. [PMID: 27123193 PMCID: PMC4846788 DOI: 10.3402/jmahp.v4.31036] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/15/2016] [Accepted: 03/16/2016] [Indexed: 05/07/2023]
Abstract
BACKGROUND Advanced therapy medicinal products (ATMPs) are innovative therapies that encompass gene therapy, somatic cell therapy, and tissue-engineered products. These therapies are expected to bring important health benefits, but also to substantially impact the pharmaceuticals budget. OBJECTIVE The aim of this study was to characterise the ATMPs in development and discuss future implications in terms of market access. METHODS Clinical trials were searched in the following databases: EudraCT (EU Drug Regulating Authorities Clinical Trials), ClinicalTrials.gov, and ICTRP (International Clinical Trials Registry Platform of the World Health Organization). Trials were classified by category of ATMP as defined by European regulation EC No. 1394/2007, as well as by development phase and disease area. RESULTS The database search identified 939 clinical trials investigating ATMPs (85% ongoing, 15% completed). The majority of trials were in the early stages (Phase I, I/II: 64.3%, Phase II, II/III: 27.9%, Phase 3: 6.9%). Per category of ATMP, we identified 53.6% of trials for somatic cell therapies, 22.8% for tissue-engineered products, 22.4% for gene therapies, and 1.2% for combined products (incorporating a medical device). Disease areas included cancer (24.8%), cardiovascular diseases (19.4%), musculoskeletal (10.5%), immune system and inflammation (11.5%), neurology (9.1%), and others. Of the trials, 47.2% enrolled fewer than 25 patients. Due to the complexity and specificity of ATMPs, new clinical trial methodologies are being considered (e.g., small sample size, non-randomised trials, single-arm trials, surrogate endpoints, integrated protocols, and adaptive designs). Evidence generation post-launch will become unavoidable to address payers' expectations. CONCLUSION ATMPs represent a fast-growing field of interest. Although most of the products are in an early development phase, the combined trial phase and the potential to cure severe chronic conditions suggest that ATMPs may reach the market earlier than standard therapies. Targeted therapies have opened the way for new trial methodologies, from which ATMPs could benefit to get early access. ATMPs may be the next source of major impact on payers' drug budgets.
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Affiliation(s)
- Eve Hanna
- Public Health Department - Research Unit, EA 3279, Aix Marseille University, Marseille, France
- Creativ-Ceutical, Paris, France
- Correspondence to: Eve Hanna, Creativ-Ceutical, 215, rue du Faubourg St Honoré, FR-75008 Paris, France,
| | | | - Pascal Auquier
- Public Health Department - Research Unit, EA 3279, Aix Marseille University, Marseille, France
| | - Mondher Toumi
- Public Health Department - Research Unit, EA 3279, Aix Marseille University, Marseille, France
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Hanna E, Rémuzat C, Auquier P, Toumi M. Advanced therapy medicinal products: current and future perspectives. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2016; 4:31036. [PMID: 27123193 DOI: 10.3402/jmahp.v3404.31036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/15/2016] [Accepted: 03/16/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND Advanced therapy medicinal products (ATMPs) are innovative therapies that encompass gene therapy, somatic cell therapy, and tissue-engineered products. These therapies are expected to bring important health benefits, but also to substantially impact the pharmaceuticals budget. OBJECTIVE The aim of this study was to characterise the ATMPs in development and discuss future implications in terms of market access. METHODS Clinical trials were searched in the following databases: EudraCT (EU Drug Regulating Authorities Clinical Trials), ClinicalTrials.gov, and ICTRP (International Clinical Trials Registry Platform of the World Health Organization). Trials were classified by category of ATMP as defined by European regulation EC No. 1394/2007, as well as by development phase and disease area. RESULTS The database search identified 939 clinical trials investigating ATMPs (85% ongoing, 15% completed). The majority of trials were in the early stages (Phase I, I/II: 64.3%, Phase II, II/III: 27.9%, Phase 3: 6.9%). Per category of ATMP, we identified 53.6% of trials for somatic cell therapies, 22.8% for tissue-engineered products, 22.4% for gene therapies, and 1.2% for combined products (incorporating a medical device). Disease areas included cancer (24.8%), cardiovascular diseases (19.4%), musculoskeletal (10.5%), immune system and inflammation (11.5%), neurology (9.1%), and others. Of the trials, 47.2% enrolled fewer than 25 patients. Due to the complexity and specificity of ATMPs, new clinical trial methodologies are being considered (e.g., small sample size, non-randomised trials, single-arm trials, surrogate endpoints, integrated protocols, and adaptive designs). Evidence generation post-launch will become unavoidable to address payers' expectations. CONCLUSION ATMPs represent a fast-growing field of interest. Although most of the products are in an early development phase, the combined trial phase and the potential to cure severe chronic conditions suggest that ATMPs may reach the market earlier than standard therapies. Targeted therapies have opened the way for new trial methodologies, from which ATMPs could benefit to get early access. ATMPs may be the next source of major impact on payers' drug budgets.
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Affiliation(s)
- Eve Hanna
- Public Health Department - Research Unit, EA 3279, Aix Marseille University, Marseille, France; Creativ-Ceutical, Paris, France
| | | | - Pascal Auquier
- Public Health Department - Research Unit, EA 3279, Aix Marseille University, Marseille, France
| | - Mondher Toumi
- Public Health Department - Research Unit, EA 3279, Aix Marseille University, Marseille, France
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Usmani SZ, Cavenagh JD, Belch AR, Hulin C, Basu S, White D, Nooka A, Ervin-Haynes A, Yiu W, Nagarwala Y, Berger A, Pelligra CG, Guo S, Binder G, Gibson CJ, Facon T. Cost-effectiveness of lenalidomide plus dexamethasone vs. bortezomib plus melphalan and prednisone in transplant-ineligible U.S. patients with newly-diagnosed multiple myeloma. J Med Econ 2016; 19:243-58. [PMID: 26517601 DOI: 10.3111/13696998.2015.1115407] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To conduct a cost-effectiveness assessment of lenalidomide plus dexamethasone (Rd) vs bortezomib plus melphalan and prednisone (VMP) as initial treatment for transplant-ineligible patients with newly-diagnosed multiple myeloma (MM), from a U.S. payer perspective. METHODS A partitioned survival model was developed to estimate expected life-years (LYs), quality-adjusted LYs (QALYs), direct costs and incremental costs per QALY and LY gained associated with use of Rd vs VMP over a patient's lifetime. Information on the efficacy and safety of Rd and VMP was based on data from multinational phase III clinical trials and a network meta-analysis. Pre-progression direct costs included the costs of Rd and VMP, treatment of adverse events (including prophylaxis) and routine care and monitoring associated with MM. Post-progression direct costs included costs of subsequent treatment(s) and routine care and monitoring for progressive disease, all obtained from published literature and estimated from a U.S. payer perspective. Utilities were obtained from the aforementioned trials. Costs and outcomes were discounted at 3% annually. RESULTS Relative to VMP, use of Rd was expected to result in an additional 2.22 LYs and 1.47 QALYs (discounted). Patients initiated with Rd were expected to incur an additional $78,977 in mean lifetime direct costs (discounted) vs those initiated with VMP. The incremental costs per QALY and per LY gained with Rd vs VMP were $53,826 and $35,552, respectively. In sensitivity analyses, results were found to be most sensitive to differences in survival associated with Rd vs VMP, the cost of lenalidomide and the discount rate applied to effectiveness outcomes. CONCLUSIONS Rd was expected to result in greater LYs and QALYs compared with VMP, with similar overall costs per LY for each regimen. Results of this analysis indicated that Rd may be a cost-effective alternative to VMP as initial treatment for transplant-ineligible patients with MM, with an incremental cost-effectiveness ratio well within the levels for recent advancements in oncology.
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Affiliation(s)
- S Z Usmani
- a a Levine Cancer Institute/Carolinas Healthcare System , Charlotte, NC , USA
| | - J D Cavenagh
- b b St. Bartholomew's Hospital , West Smithfield, London , UK
| | - A R Belch
- c c Cross Cancer Institute , University of Alberta , Edmonton, AB , Canada
| | - C Hulin
- d d Bordeaux Hospital University Center (CHU) , Bordeaux , France
| | - S Basu
- e e Royal Wolverhampton Hospitals NHS Trust , Wolverhampton , UK
| | - D White
- f f Dalhousie University and QEII Health Sciences Center , Halifax, NS , Canada
| | - A Nooka
- g g Winship Cancer Institute , Emory University , Atlanta , GA , USA
| | | | - W Yiu
- h h Celgene Corporation , Summit, NJ , USA
| | | | - A Berger
- i i Evidera , Lexington, MA , USA
| | | | - S Guo
- i i Evidera , Lexington, MA , USA
| | - G Binder
- h h Celgene Corporation , Summit, NJ , USA
| | - C J Gibson
- h h Celgene Corporation , Summit, NJ , USA
| | - T Facon
- j j Service des Maladies du Sang , Hôpital Huriez , CHRU Lille, Lille , France
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154
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Chaudhary T, Chahar A, Sharma JK, Kaur K, Dang A. Phytomedicine in the Treatment of Cancer: A Health Technology Assessment. J Clin Diagn Res 2015; 9:XC04-XC09. [PMID: 26816981 DOI: 10.7860/jcdr/2015/15701.6913] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/05/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Cancer is reported to cause about 0.4 million deaths annually. The cost of diagnosis and treatment of cancer in India is enormous. AIM This Health Technology Assessment (HTA) aims to understand the role, effect on mortality and adverse event occurrence, and cost effectiveness of phytomedicine in cancer treatment. MATERIALS AND METHODS Health technology assessment by systematic review of published literature. An electronic literature search was performed in Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Medline, PubMed, Science Direct, SCOPUS, EMBASE, LANCET, and Google Scholar databases for randomized controlled trial, observational analytical studies, case control and cohort studies pertaining to phytomedicine and herbal medicine in cancer treatment published from 1987 till 2(nd) Novemeber 2014. Overall outcome measures collected included changes in mortality and adverse event profile. Cochrane Review Manager's Risk of Bias Table was used to assess the risk of bias. RESULTS Out of 76 studies which were screened, 14 studies involving a total of 1965 participants (817 received various forms of phytomedicine or herbal medicine in addition to conventional therapy, and 1148 received conventional therapy only) suffering from various cancers (including cancers of the breast, prostate, nasopharynx, pancreas, stomach, ovary, non-small cell lung cancer and osteosarcoma), were included in this review. In comparison with conventional therapy, phytomedicine resulted in a significant reduction in mortality: Risk Ratio (RR) 0.67 (95% Confidence Interval (CI) 0.51 to 0.90). The combination of phytomedicine with conventional therapy resulted in a significant reduction in adverse drug reactions: RR 0.62 (95% CI 0.54 to 0.71). Addition of phytomedicine to chemotherapy resulted in an increase in the annual cost of treatment by INR 1.241 Billion (US$ 19.64 Million) and prevented 25,217 deaths: the cost-effectiveness of phytomedicine is INR 49,237/death averted (US$ 779/death averted). CONCLUSION When taken with conventional cancer treatment, phytomedicine shows clinical and cost effectiveness. Domestic manufacturing and practice of phytomedicine should be encouraged.
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Affiliation(s)
- Tanushree Chaudhary
- HTA Fellow, Centre for Health Technology Assessment (HTA) , New Delhi, India
| | - Akriti Chahar
- Research Associate, Health Technology Assessment, Division of Healthcare Technology, National Health Resource Centre, Ministry of Health & Family Welfare, Government of India , New Delhi, India
| | - Jitendar Kumar Sharma
- Head - Division of Healthcare Technology, National Health Resource Centre, Ministry of Health & Family Welfare, Government of India , New Delhi, India
| | - Kirandeep Kaur
- Associate Professor, Department of Pharmacology, Dayanand Medical College and Hospital , Civil Lines, Ludhiana, Punjab, India
| | - Amit Dang
- Founder and CEO, MarksMan Healthcare Solutions, HEOR and RWE Consulting , Navi Mumbai, Maharashtra, India
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155
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Kepner GR. Terminal cancer drug treatment? Need for a simple cost-benefit measure. J Cancer Policy 2015. [DOI: 10.1016/j.jcpo.2015.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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156
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Petrou P, Talias MA. Price Determinants of the Tendering Process for Pharmaceuticals in the Cyprus Market. Value Health Reg Issues 2015; 7:67-73. [PMID: 29698154 DOI: 10.1016/j.vhri.2015.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 08/31/2015] [Accepted: 09/03/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tendering has been a promising approach for procuring pharmaceuticals. Significant price reductions have been well documented by several authors. To our knowledge, there are limited data detailing the impact of variables in the tendering process. OBJECTIVES In this article, our objective was to evaluate the impact of potentially exploratory variables, which included innovation status, total value and volume of sales of each product, health care setting administration (hospital/outpatient), patent status (branded/generic), tendering type, and wholesale price, on price reduction in the tendering process. METHODS Financial data of public sector sales during 2011 were analyzed. On the basis of these data, we selected 178 medicines with corresponding sales of €49 million, out of a total market value of €104 million. Medicines were selected according to volume, value, and therapeutic value across all therapeutic areas. We performed a beta regression for the assessment of impact of variables and applied the same methodology to different subgroups. CONCLUSIONS The generic status of medicines is statistically significantly associated with a higher price reduction. Tendering type by alternative, high wholesale prices, and high volume are robust estimators for price reduction. Innovation status does not have any effect on price reduction. Outpatient medicines reach lower prices as compared with hospital medicines. A rather unexpected finding is the negative correlation of high sales value with price reduction. These findings will lead to better understanding of the tendering framework, enabling us to further evolve its operational capacity, aiming to generate more savings. Moreover, our study indicates areas in which a more optimized approach is needed.
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Affiliation(s)
- Panagiotis Petrou
- HealthCare Management Programme, Open University of Cyprus, Nicosia, Cyprus.
| | - Michael A Talias
- HealthCare Management Programme, Open University of Cyprus, Nicosia, Cyprus
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Abstract
Supplemental Digital Content is available in the text. Objective: To determine health system expenditure on cancers by time since diagnosis using data for an entire country. Methods: New Zealand cancer registry data was linked to hospitalization, pharmaceutical, outpatient, general practice, laboratory, and other datasets, with costs ascribed to each event occurring in 2006–2011. “Excess” cancer costs were estimated by subtracting “expected costs” for citizens without cancer from the “total cost” for cancer patients ($2011 inflation-adjusted). Gamma regressions were used to estimate costs per person-month. Results: For first adult cancer diagnosed that the excess cost per person was between US$3400 and US$4300 in the first month postdiagnosis (varied by sex and age), fell to US$50–US$150 per month at 2 or more years postdiagnosis (excluding those within a year of death), but increased again if dying from their cancer (US$3800–US$8300 in the last month of life). Such patterns varied by cancer, for example, in the first month postdiagnosis for 65 year olds it varied 20-fold from US$800 for prostate to US$15,900 for brain cancer. Per diagnosed case, total excess costs varied from US$8000 (melanoma) to US$98,000 (bone and connective tissue). Excess cancer costs made up 6.5% of total Vote:Health expenditure in 2010–2011, with colorectal (14.7%), breast (14.4%) being the top 2 contributors, and prostate, non-Hodgkin lymphoma, leukemia, and lung each contributing about 6%. Conclusions: Costs vary substantially by time since diagnosis and cancer type. The results and regression equations reported in this paper can be used in modeling requiring cancer costs by time since diagnosis and proximity to death.
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158
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Kantarjian H, Rajkumar SV. Why are cancer drugs so expensive in the United States, and what are the solutions? Mayo Clin Proc 2015; 90:500-4. [PMID: 25792242 DOI: 10.1016/j.mayocp.2015.01.014] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/09/2015] [Accepted: 01/13/2015] [Indexed: 11/28/2022]
Abstract
High cancer drug prices are a worsening trend in cancer care and are affecting patient care and our health care system. In the United States, the average price of cancer drugs for about a year of therapy increased from $5000 to $10,000 before 2000 to more than $100,000 by 2012, while the average household income has decreased by about 8% in the past decade. Further, although 85% of cancer basic research is funded through taxpayers' money, Americans with cancer pay 50% to 100% more for the same patented drug than patients in other countries. Bound by the Hippocratic Oath, oncologists have a moral obligation to advocate for affordable cancer drugs. In this article, we discuss the high cost of cancer drugs, the reasons for these high prices, the implications for patients and the health care system, and potential solutions to the problem.
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Affiliation(s)
- Hagop Kantarjian
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX.
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159
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Paulden M, Stafinski T, Menon D, McCabe C. Value-based reimbursement decisions for orphan drugs: a scoping review and decision framework. PHARMACOECONOMICS 2015; 33:255-69. [PMID: 25412735 PMCID: PMC4342524 DOI: 10.1007/s40273-014-0235-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND The rate of development of new orphan drugs continues to grow. As a result, reimbursing orphan drugs on an exceptional basis is increasingly difficult to sustain from a health system perspective. An understanding of the value that societies attach to providing orphan drugs at the expense of other health technologies is now recognised as an important input to policy debates. OBJECTIVES The aim of this work was to scope the social value arguments that have been advanced relating to the reimbursement of orphan drugs, and to locate these within a coherent decision-making framework to aid reimbursement decisions in the presence of limited healthcare resources. METHODS A scoping review of the peer reviewed and grey literature was undertaken, consisting of seven phases: (1) identifying the research question; (2) searching for relevant studies; (3) selecting studies; (4) charting, extracting and tabulating data; (5) analyzing data; (6) consulting relevant experts; and (7) presenting results. The points within decision processes where the identified value arguments would be incorporated were then located. This mapping was used to construct a framework characterising the distinct role of each value in informing decision making. RESULTS The scoping review identified 19 candidate decision factors, most of which can be characterised as either value-bearing or 'opportunity cost'-determining, and also a number of value propositions and pertinent sources of preference information. We were able to synthesize these into a coherent decision-making framework. CONCLUSION Our framework may be used to structure policy discussions and to aid transparency about the values underlying reimbursement decisions for orphan drugs. These values ought to be consistently applied to all technologies and populations affected by the decision.
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Affiliation(s)
- Mike Paulden
- Department of Emergency Medicine, University of Alberta, 736 University Terrace, 8303 112 St, Edmonton, AB, T6G 2T4, Canada,
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160
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The State of Cancer Care in America, 2015: A Report by the American Society of Clinical Oncology. J Oncol Pract 2015; 11:79-113. [DOI: 10.1200/jop.2015.003772] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this second annual State of Cancer Care in America report, ASCO provides background and context to help understand what is happening today in cancer care and describes trends in the cancer care workforce that may affect cancer care in the coming years.
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161
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Lim CS, Lee YG, Koh Y, Heo DS. International comparison of the factors influencing reimbursement of targeted anti-cancer drugs. BMC Health Serv Res 2014; 14:595. [PMID: 25432511 PMCID: PMC4258032 DOI: 10.1186/s12913-014-0595-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 11/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reimbursement policies for anti-cancer drugs vary among countries even though they rely on the same clinical evidence. We compared the pattern of publicly funded drug programs and analyzed major factors influencing the differences. METHODS We investigated reimbursement policies for 19 indications with targeted anti-cancer drugs that are used variably across ten countries. The available incremental cost-effectiveness ratio (ICER) data were retrieved for each indication. Based on the comparison between actual reimbursement decisions and the ICERs, we formulated a reimbursement adequacy index (RAI): calculating the proportion of cost-effective decisions, either reimbursement of cost-effective indications or non-reimbursement of cost-ineffective indications, out of the total number of indications for each country. The relationship between RAI and other indices were analyzed, including governmental dependency on health technology assessment, as well as other parameters for health expenditure. All the data used in this study were gathered from sources publicly available online. RESULTS Japan and France were the most likely to reimburse indications (16/19), whereas Sweden and the United Kingdom were the least likely to reimburse them (5/19 and 6/19, respectively). Indications with high cost-effectiveness values were more likely to be reimbursed (ρ = -0.68, P = 0.001). The three countries with high RAI scores each had a healthcare system that was financed by general taxation. CONCLUSIONS Although reimbursement policies for anti-cancer drugs vary among countries, we found a strong correlation of reimbursements for those indications with lower ICERs. Countries with healthcare systems financed by general taxation demonstrated greater cost-effectiveness as evidenced by reimbursement decisions of anti-cancer drugs.
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Ades F, Zardavas D, Senterre C, de Azambuja E, Eniu A, Popescu R, Piccart M, Parent F. Hurdles and delays in access to anti-cancer drugs in Europe. Ecancermedicalscience 2014; 8:482. [PMID: 25525460 PMCID: PMC4263523 DOI: 10.3332/ecancer.2014.482] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Indexed: 11/06/2022] Open
Abstract
Demographic changes in the world population will cause a significant increase in the number of new cases of cancer. To handle this challenge, societies will need to adapt how they approach cancer prevention and treatment, with changes to the development and uptake of innovative anticancer drugs playing an important role. However, there are obstacles to implementing innovative drugs in clinical practice. Prior to being incorporated into daily practice, the drug must obtain regulatory and reimbursement approval, succeed in changing the prescription habits of physicians, and ultimately gain the compliance of individual patients. Developing an anticancer drug and bringing it into clinical practice is, therefore, a lengthy and complex process involving multiple partners in several areas. To optimize patient treatment and increase the likelihood of implementing health innovation, it is essential to have an overview of the full process. This review aims to describe the process and discuss the hurdles arising at each step.
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Affiliation(s)
- F Ades
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels 1000, Belgium
| | - D Zardavas
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels 1000, Belgium
| | - C Senterre
- Research Centre of Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles, Brussels 1050, Belgium
| | - E de Azambuja
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels 1000, Belgium
| | - A Eniu
- Department of Breast Tumours, Cancer institute Ion Chiricuta, Cluj-Napoca RO-400015, Romania
| | - R Popescu
- Department of Medical Oncology, Hirslanden Clinic Aarau, Aarau 5001, Switzerland
| | - M Piccart
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels 1000, Belgium
| | - F Parent
- Research Centre of Social Approaches of Health, School of Public Health, Université Libre de Bruxelles, Brussels 1050, Belgium
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Swetz KM, Burkle CM, Berge KH, Lanier WL. Ten common questions (and their answers) on medical futility. Mayo Clin Proc 2014; 89:943-59. [PMID: 24726213 DOI: 10.1016/j.mayocp.2014.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 02/07/2014] [Accepted: 02/12/2014] [Indexed: 12/25/2022]
Abstract
The term medical futility is frequently used when discussing complex clinical scenarios and throughout the medical, legal, and ethics literature. However, we propose that health care professionals and others often use this term inaccurately and imprecisely, without fully appreciating the powerful, often visceral, response that the term can evoke. This article introduces and answers 10 common questions regarding medical futility in an effort to define, clarify, and explore the implications of the term. We discuss multiple domains related to futility, including the biological, ethical, legal, societal, and financial considerations that have a bearing on definitions and actions. Finally, we encourage empathetic communication among clinicians, patients, and families and emphasize how dialogue that seeks an understanding of multiple points of view is critically important in preventing or attenuating conflict among the involved parties.
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Affiliation(s)
- Keith M Swetz
- Department of Medicine, Section of Palliative Medicine and Biomedical Ethics Program, Mayo Clinic, Rochester, MN.
| | | | - Keith H Berge
- Department of Anesthesiology, Mayo Clinic, Rochester, MN
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Karikios DJ, Schofield D, Salkeld G, Mann KP, Trotman J, Stockler MR. Rising cost of anticancer drugs in Australia. Intern Med J 2014; 44:458-63. [DOI: 10.1111/imj.12399] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 02/19/2014] [Indexed: 11/26/2022]
Affiliation(s)
- D. J. Karikios
- NHMRC Clinical Trials Centre; University of Sydney; Sydney New South Wales Australia
| | - D. Schofield
- NHMRC Clinical Trials Centre; University of Sydney; Sydney New South Wales Australia
| | - G. Salkeld
- Sydney School of Public Health; Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - K. P. Mann
- NHMRC Clinical Trials Centre; University of Sydney; Sydney New South Wales Australia
| | - J. Trotman
- Concord Repatriation General Hospital; University of Sydney; Sydney New South Wales Australia
| | - M. R. Stockler
- NHMRC Clinical Trials Centre; University of Sydney; Sydney New South Wales Australia
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165
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Steensma DP, Kantarjian HM. Impact of cancer research bureaucracy on innovation, costs, and patient care. J Clin Oncol 2014; 32:376-8. [PMID: 24395852 DOI: 10.1200/jco.2013.54.2548] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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167
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Abstract
Oncologists must decide how to work with accountable care organizations while ensuring high-quality care to their patients and controlling the growth of health care expenditures.
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168
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Rosamond T. The high cost of cancer drugs and what we can do about it. Mayo Clin Proc 2013; 88:306. [PMID: 23489458 DOI: 10.1016/j.mayocp.2013.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/07/2013] [Indexed: 11/29/2022]
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Bunnell C. Integrating value assessment into discussions about the price of cancer drugs. Mayo Clin Proc 2012; 87:932-4. [PMID: 23036668 PMCID: PMC3497837 DOI: 10.1016/j.mayocp.2012.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 08/31/2012] [Indexed: 11/23/2022]
Affiliation(s)
- Craig Bunnell
- Correspondence: Address to Craig Bunnell, MD, MPH, MBA, Chief Medical Officer, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215
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