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Wouters OJ, Kesselheim AS, Kuha J, Luyten J. Sales Revenues for New Therapeutic Agents Approved by the United States Food and Drug Administration From 1995 to 2014. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:1373-1381. [PMID: 38977188 DOI: 10.1016/j.jval.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 06/04/2024] [Accepted: 06/23/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES This study aimed to analyze worldwide sales of new therapeutic agents and to estimate the time it takes for product sales to exceed industry-wide average drug development costs. METHODS Data obtained from company reports were analyzed to track worldwide sales of new medicines approved by the US Food and Drug Administration from 1995 to 2014. All sales figures were reported in 2019 US dollars. Kaplan-Meier curves were used to evaluate the time it took for discounted product sales to exceed the average costs associated with developing 1 new drug (accounting for the costs of failed trials), using published estimates of these costs. RESULTS Based on data for 361 of 558 new therapeutic agents approved over the study period (median follow-up 13.2 years), mean sales revenue per product was $15.2 billion through the end of 2019; the median was $6.7 billion. These products jointly generated global sales of $5.5 trillion since approval. Revenues were highly skewed, with the 25 best selling products (7%, 25 of 361) accounting for 38% of this amount ($2.1 trillion of $5.5 trillion). Approximately 47% of products had discounted sales that exceeded the estimated industry-wide average costs of development within 5 years of approval, and 75% within 10 years. After attributing potential production, marketing, and other costs, these numbers dropped to 21% of products within 5 years of approval, and 46% within 10 years. CONCLUSIONS Sales of new medicines approved from 1995 to 2014 were highly skewed, but many products had net discounted sales that exceeded the industry-wide average costs of development within 10 years of approval. An understanding of how sales revenues accrue in the years after initial approval, alongside data on business costs, can inform discussions about how to incentivize private investment in innovation while ensuring affordable prices for patients and the healthcare system.
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Affiliation(s)
- Olivier J Wouters
- Department of Health Policy, London School of Economics and Political Science, London, England, UK.
| | - Aaron S Kesselheim
- Program on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jouni Kuha
- Department of Statistics, London School of Economics and Political Science, London, England, UK
| | - Jeroen Luyten
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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2
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Zhang T, Tian E, Xiong Y, Shen X, Li Z, Yan X, Yang Y, Zhou Z, Wang Y, Wang P. Development of a RNA-protein complex based smart drug delivery system for 9-hydroxycamptothecin. Int J Biol Macromol 2024; 276:133871. [PMID: 39009257 DOI: 10.1016/j.ijbiomac.2024.133871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/01/2024] [Accepted: 07/12/2024] [Indexed: 07/17/2024]
Abstract
Camptothecin (CPT) is a monoterpenoid indole alkaloid with a wide spectrum of anticancer activity. However, its application is hindered by poor solubility, lack of targeting specificity, and severe side effects. Structural derivatization of CPT and the development of suitable drug delivery systems are potential strategies for addressing these issues. In this study, we discovered that the protein Cytochrome P450 Family 1 Subfamily A Member 1 (CYP1A1) from Homo sapiens catalyzes CPT to yield 9-hydroxycamptothecin (9-HCPT), which exhibits increased water solubility and cytotoxicity. We then created a RNA-protein complex based drug delivery system with enzyme and pH responsiveness and improved the targeting and stability of the nanomedicine through protein module assembly. The subcellular localization of nanoparticles can be visualized using fluorescent RNA probes. Our results not only identified the protein CYP1A1 responsible for the structural derivatization of CPT to synthesize 9-HCPT but also offered potential strategies for enhancing the utilization of silk-based drug delivery systems in tumor therapy.
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Affiliation(s)
- Tong Zhang
- CAS-Key Laboratory of Synthetic Biology, CAS Center for Excellence in Molecular Plant Sciences, Chinese Academy of Sciences, Shanghai 200032, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Ernuo Tian
- CAS-Key Laboratory of Synthetic Biology, CAS Center for Excellence in Molecular Plant Sciences, Chinese Academy of Sciences, Shanghai 200032, China; University of Chinese Academy of Sciences, Beijing 100049, China; School of Pharmacy, East China University of Science and Technology, Shanghai 200037, China
| | - Ying Xiong
- CAS-Key Laboratory of Synthetic Biology, CAS Center for Excellence in Molecular Plant Sciences, Chinese Academy of Sciences, Shanghai 200032, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xiao Shen
- CAS-Key Laboratory of Synthetic Biology, CAS Center for Excellence in Molecular Plant Sciences, Chinese Academy of Sciences, Shanghai 200032, China
| | - Zhenhua Li
- CAS-Key Laboratory of Synthetic Biology, CAS Center for Excellence in Molecular Plant Sciences, Chinese Academy of Sciences, Shanghai 200032, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xing Yan
- CAS-Key Laboratory of Synthetic Biology, CAS Center for Excellence in Molecular Plant Sciences, Chinese Academy of Sciences, Shanghai 200032, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yi Yang
- School of Pharmacy, East China University of Science and Technology, Shanghai 200037, China
| | - Zhihua Zhou
- CAS-Key Laboratory of Synthetic Biology, CAS Center for Excellence in Molecular Plant Sciences, Chinese Academy of Sciences, Shanghai 200032, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yan Wang
- CAS-Key Laboratory of Synthetic Biology, CAS Center for Excellence in Molecular Plant Sciences, Chinese Academy of Sciences, Shanghai 200032, China.
| | - Pingping Wang
- CAS-Key Laboratory of Synthetic Biology, CAS Center for Excellence in Molecular Plant Sciences, Chinese Academy of Sciences, Shanghai 200032, China.
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Broer LN, Knapen DG, de Groot DJA, Mol PG, Kosterink JG, de Vries EG, Lub-de Hooge MN. Monoclonal antibody biosimilars for cancer treatment. iScience 2024; 27:110115. [PMID: 38974466 PMCID: PMC11225859 DOI: 10.1016/j.isci.2024.110115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Monoclonal antibodies are important cancer medicines. The European Medicines Agency (EMA) approved 48 and the Food and Drug Administration (FDA) 56 anticancer monoclonal antibody-based therapies. Their high prices burden healthcare systems and hamper global drug access. Biosimilars could retain costs and expand the availability of monoclonal antibodies. In Europe, five rituximab biosimilars, six trastuzumab biosimilars, and eight bevacizumab biosimilars are available as anti-cancer drugs. To gain insight into the biosimilar landscape for cancer treatment, we performed a literature search and analysis. In this review, we summarize cancer monoclonal antibodies' properties crucial for the desired pharmacology and point out sources of variability. The analytical assessment of all EMA-approved bevacizumab biosimilars is highlighted to illustrate this variability. The global landscape of investigational and approved biosimilars is mapped, and the challenges for access to cancer biosimilars are identified.
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Affiliation(s)
- Linda N. Broer
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Daan G. Knapen
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Derk-Jan A. de Groot
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Peter G.M. Mol
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jos G.W. Kosterink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Pharmaco-, Therapy-, Epidemiology- and Economy, Groningen Research Institute for Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Elisabeth G.E. de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marjolijn N. Lub-de Hooge
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Coles CE, Earl H, Anderson BO, Barrios CH, Bienz M, Bliss JM, Cameron DA, Cardoso F, Cui W, Francis PA, Jagsi R, Knaul FM, McIntosh SA, Phillips KA, Radbruch L, Thompson MK, André F, Abraham JE, Bhattacharya IS, Franzoi MA, Drewett L, Fulton A, Kazmi F, Inbah Rajah D, Mutebi M, Ng D, Ng S, Olopade OI, Rosa WE, Rubasingham J, Spence D, Stobart H, Vargas Enciso V, Vaz-Luis I, Villarreal-Garza C. The Lancet Breast Cancer Commission. Lancet 2024; 403:1895-1950. [PMID: 38636533 DOI: 10.1016/s0140-6736(24)00747-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/18/2023] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Affiliation(s)
| | - Helena Earl
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Benjamin O Anderson
- Global Breast Cancer Initiative, World Health Organisation and Departments of Surgery and Global Health Medicine, University of Washington, Seattle, WA, USA
| | - Carlos H Barrios
- Oncology Research Center, Hospital São Lucas, Porto Alegre, Brazil
| | - Maya Bienz
- Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, London, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - David A Cameron
- Institute of Genetics and Cancer and Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Wanda Cui
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Prudence A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Reshma Jagsi
- Emory University School of Medicine, Atlanta, GA, USA
| | - Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA; Tómatelo a Pecho, Mexico City, Mexico
| | - Stuart A McIntosh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Kelly-Anne Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | | | | | - Jean E Abraham
- Department of Oncology, University of Cambridge, Cambridge, UK
| | | | | | - Lynsey Drewett
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | | | - Farasat Kazmi
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - Dianna Ng
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Szeyi Ng
- The Institute of Cancer Research, London, UK
| | | | - William E Rosa
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | | | | | | | | | | | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
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Vural EH, Kaskati T, Vural İM, Özalp MA, Gümüşel B. Are Turkish pharmaceutical pricing strategies an access barrier to oncology medicines for Türkiye? Front Pharmacol 2024; 15:1364341. [PMID: 38799164 PMCID: PMC11117076 DOI: 10.3389/fphar.2024.1364341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/02/2024] [Indexed: 05/29/2024] Open
Abstract
Objectives: Cancer diagnosis is increasing day by day all over the world. Deaths due to cancer are among the most common causes of death. Access to cancer drugs is a priority of health policies. The aim of this study is to evaluate access to cancer drugs through drug box sales data by modeling population growth, cancer incidence, and Fixed Euro Exchange (FEE) rate parameters used in drug pricing in Türkiye. Methods: Access to cancer drugs was evaluated by drug box sales figures obtained from IQVIA. Box sales data were classified according to diagnosis codes (ICD-10), reference, or generic status. Consumption of cancer drugs was examined over time with panel regression analysis, taking into account variables of population growth, cancer incidence, and the FEE rate in drug pricing in Türkiye. Results: The incidence of cancer in Türkiye was 215.1 in 2010 and 223.1 (per hundred thousand) in 2017. Whereas there was a 127.02% increase in the real euro exchange rate, there was an 89.6% increase in the FEE rate. With the regression approach, there is a negative relationship between the real and fixed exchange rate difference (RFED) and reference and generic drug consumption data. Medicine access is affected depending on diagnosis codes at different levels. Colorectal cancer medicine sales had negative correlations for each variable, namely, exchange rate, population growth, and cancer incidence. On the contrary, there was a positive correlation between non-small-cell lung cancer and relevant variables. Innovative medicine groups such as monoclonal antibodies and protein kinase inhibitor consumption showed a negative correlation. Conclusion: According to our results, pricing strategy may be an access barrier for oncology medicines in Türkiye. It should be reviewing the pricing policy that is beneficial for oncology medicine access in Türkiye.
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Affiliation(s)
- Elif Hilal Vural
- Medical Pharmacology Department, Faculty of Medicine, Lokman Hekim University, Ankara, Türkiye
| | | | - İsmail Mert Vural
- Department of Pharmacology, Gulhane Faculty of Pharmacy, University of Health Sciences Türkiye, Ankara, Türkiye
| | - Mustafa Asım Özalp
- Department of Actuarial Sciences, Faculty of Science, Hacettepe University, Ankara, Türkiye
| | - Bülent Gümüşel
- Pharmacology Department, Faculty of Pharmacy, Lokman Hekim University, Ankara, Türkiye
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6
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Brinkhuis F, Goettsch WG, Mantel-Teeuwisse AK, Bloem LT. Added benefit and revenues of oncology drugs approved by the European Medicines Agency between 1995 and 2020: retrospective cohort study. BMJ 2024; 384:e077391. [PMID: 38418086 PMCID: PMC10899806 DOI: 10.1136/bmj-2023-077391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVES To evaluate the added benefit and revenues of oncology drugs, explore their association, and investigate potential discrepancies between added benefit and revenues across different approval pathways of the European Medicines Agency (EMA). DESIGN Retrospective cohort study. SETTING Oncology drugs and their indications approved by the EMA between 1995 and 2020. MAIN OUTCOME MEASURES Added benefit was evaluated using ratings published by seven organisations: health technology assessment agencies from the United States, France, Germany, and Italy, two medical oncology societies, and a drug bulletin. All retrieved ratings were recategorised using a four point ranking scale to indicate negative or non-quantifiable, minor, substantial, or major added benefit. Revenue data were extracted from publicly available financial reports and compared with published estimates of research and development (R&D) costs. Finally, the association between added benefit and revenue was evaluated. All analyses were performed within the overall study cohort, and within subgroups based on the EMA approval pathway: standard marketing authorisation, conditional marketing authorisation, and authorisation under exceptional circumstances. RESULTS 131 oncology drugs with 166 indications were evaluated for their added benefit by at least one organisation within the required timeframe, yielding a total of 458 added benefit ratings; 189 (41%) were negative or non-quantifiable. The median time to offset the median R&D costs ($684m, £535m, €602m, adjusted to 2020 values) was three years; 50 of 55 (91%) drugs recovered these costs within eight years. Drugs with higher added benefit ratings generally had greater revenues. Negative or non-quantifiable added benefit ratings were more frequent for conditional marketing authorisations and authorisations under exceptional circumstances than for standard marketing authorisations (relative risk 1.53, 95% confidence interval 1.23 to 1.89). Conditional marketing authorisations generated lower revenues and took longer to offset R&D costs than standard marketing authorisations (four years compared with three years). CONCLUSIONS While revenues seem to align with added benefit, most oncology drugs recover R&D costs within a few years despite providing little added benefit. This is particularly true for drugs approved through conditional marketing authorisations, which inherently appear to lack comprehensive evidence. Policy makers should evaluate whether current regulatory and reimbursement incentives effectively promote development of the most effective drugs for patients with the greatest needs.
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Affiliation(s)
- Francine Brinkhuis
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Wim G Goettsch
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- National Health Care Institute, Diemen, The Netherlands
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Lourens T Bloem
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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7
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Garg R, Sayre EC, Pataky R, McTaggart-Cowan H, Peacock S, Loree JM, McKenzie M, Brown CJ, Yeung SS, De Vera MA. Direct Medical Spending on Young and Average-Age Onset Colorectal Cancer before and after Diagnosis: a Population-Based Costing Study. Cancer Epidemiol Biomarkers Prev 2024; 33:72-79. [PMID: 37878338 PMCID: PMC10774739 DOI: 10.1158/1055-9965.epi-23-0498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/31/2023] [Accepted: 10/23/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Despite a better understanding of the increasing incidence of young-onset colorectal cancer (yCRC; age at diagnosis <50 years), little is known about its economic burden. Therefore, we estimated direct medical spending on yCRC before and after diagnosis. METHODS We used linked administrative health databases in British Columbia, Canada, to create a study population of yCRC and average-age onset colorectal cancer (aCRC; age at diagnosis ≥50 years) cases, along with cancer-free controls. Over the 1-year period preceding a colorectal cancer diagnosis, we estimated direct medical spending on hospital visits, healthcare practitioners, and prescription medications. After diagnosis, we calculated cost attributable to yCRC and aCRC, which additionally included the cost of cancer treatments (e.g., chemotherapy and radiotherapy) across phases of care. RESULTS We included 1,058 yCRC (45.4% females; age at diagnosis 42.4 ± 6.2 years) and 12,619 aCRC (44.8% females; age at diagnosis of 68.1 ± 9.2 years) cases. Direct medical spending on the average yCRC and aCRC case during the year before diagnosis was $6,711 and $8,056, respectively. After diagnosis, the overall average annualized cost attributable to yCRC significantly differed in comparison with aCRC for the initial ($50,216 vs. $37,842; P < 0.001), continuing ($8,361 vs. $5,014; P < 0.001), and end-of-life cancer phase ($86,125 vs. $61,512; P < 0.001) but not end-of-life non-cancer phase ($77,273 vs. $23,316; P = 0.372). CONCLUSIONS Reported cost estimates may be used as inputs for future economic evaluations pertaining to yCRC. IMPACT We provided comprehensive cost estimates for healthcare spending on young-onset colorectal cancer.
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Affiliation(s)
- Ria Garg
- University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
| | | | | | - Helen McTaggart-Cowan
- BC Cancer, Vancouver, BC, Canada
- Simon Fraser University, Faculty of Health Sciences, Burnaby, BC, Canada
| | - Stuart Peacock
- BC Cancer, Vancouver, BC, Canada
- Simon Fraser University, Faculty of Health Sciences, Burnaby, BC, Canada
| | - Jonathan M. Loree
- BC Cancer, Vancouver, BC, Canada
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Carl J. Brown
- Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- St. Paul's Hospital, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | | | - Mary A. De Vera
- University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
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8
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Michaeli DT, Michaeli T. Cancer Drug Prices in the United States: Efficacy, Innovation, Clinical Trial Evidence, and Epidemiology. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1590-1600. [PMID: 37516196 DOI: 10.1016/j.jval.2023.06.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/24/2023] [Accepted: 06/29/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVES Rising cancer drug prices challenge patients and healthcare systems. Although prices are routinely assigned to original drug indications receiving US Food and Drug Administration (FDA) approval, the pricing of supplemental indication approvals remains uncertain. This study identifies and quantifies factors associated with cancer drug prices, distinctly analyzing original and supplemental indications. METHODS Clinical trial evidence and epidemiologic data supporting new indications' FDA approval (2003-2022) were collected from the Drugs@FDA database, ClinicalTrials.gov, and Global Burden of Disease study. Indication-specific monthly treatment costs were calculated for Medicare patients. The association between log-prices and collected variables were assessed in regression analyses. RESULTS We identified 145 drugs approved across 373 cancer indications. Drugs were priced at $24 444 per month on average (median = $16 013). For original indications, prices weakly correlated to improvements in overall survival (β = 0.28, P = .037) and progression-free survival (β = 0.16, P = .001). Original indications' prices were as follows: (1) negatively associated with disease incidence (β = -0.21, P < .001) and prevalence; (2) positively correlated with first-in-class drugs (26%, P = .057), gene and cell therapies (176%, P < .001), hematologic cancers (62%, P < .001), and severe diseases with substantial unmet needs (6% per disability-adjusted life-year, P < .001); and (3) negatively correlated to indications with randomized-controlled phase 3 trials. Prices were poorly associated with supplemental indications' efficacy, clinical evidence, and epidemiology. CONCLUSIONS Cancer drug prices are set based on the original indication's characteristics, thereby omitting the value of supplemental indications. Indication-specific pricing, coverage, and reimbursement policies considering each indication's safety, efficacy, innovativeness, and unmet needs are necessary to align a drug's value and price.
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Affiliation(s)
- Daniel Tobias Michaeli
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Baden-Wuerttemberg, Germany; Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, North Rhine-Westphalia, Germany.
| | - Thomas Michaeli
- Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, North Rhine-Westphalia, Germany; Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Baden-Wuerttemberg, Germany; Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), Heidelberg University, Heidelberg, Baden-Wuerttemberg, Germany; DKFZ-Hector Cancer Institute, University Medical Center Mannheim, Mannheim, Baden-Wuerttemberg, Germany
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9
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Li J, Chen Y, Wu L, Tuo X, Wang L, Zhou G, Huang SX, Xiong W, Huang JP. Phytochemical Analysis of Nothapodytes tomentosa and Distribution and Content of Camptothecin and its Analogues in Four Plants. PLANTA MEDICA 2023; 89:1250-1258. [PMID: 37044129 DOI: 10.1055/a-2072-2177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Camptothecin (CPT) and its derivatives have attracted worldwide attention because of their notable anticancer activity. However, the growing demand for CPT in the global pharmaceutical industry has caused a severe shortage of CPT-producing plant resources. In this study, phytochemical analysis of Nothapodytes tomentosa results in the isolation and identification of CPT (13: ) and 16 analogues (1: - 12, 14: - 17: ), including a new (1: ) and five known (9, 10, 12, 15: , and 17: ) CPT analogues with an open E-ring. In view of the potential anticancer activity of CPT analogues with an open E-ring, the fragmentation pathways and mass spectra profiles of these six CPT analogues (1, 9, 10, 12, 15: , and 17: ) are investigated, providing a reference for the rapid detection of these compounds in other plants. Furthermore, based on the fragmentation patterns of CPT (13: ) and known analogues (2: - 8, 11, 14, 16, 18: - 26: ), the distribution and content of these compounds in different tissues of N. tomentosa, N. nimmoniana, Camptotheca acuminata, and Ophiorrhiza japonica are further studied. Our findings not only provide an alternative plant resource for further expanding the development and utilization of CPT and its analogues, but also lay a foundation for improving the utilization of known CPT-producing plant resources.
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Affiliation(s)
- Junheng Li
- State Key Laboratory of Southwestern Chinese Medicine Resources, and School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- State Key Laboratory of Phytochemistry and Plant Resources in West China, and CAS Center for Excellence in Molecular Plant Sciences, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, China
| | - Yin Chen
- State Key Laboratory of Phytochemistry and Plant Resources in West China, and CAS Center for Excellence in Molecular Plant Sciences, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, China
| | - Lei Wu
- Institute of Applied Chemistry, Jiangxi Academy of Sciences, Nanchang, China
| | - Xiaotao Tuo
- State Key Laboratory of Southwestern Chinese Medicine Resources, and School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- State Key Laboratory of Phytochemistry and Plant Resources in West China, and CAS Center for Excellence in Molecular Plant Sciences, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, China
| | - Li Wang
- State Key Laboratory of Southwestern Chinese Medicine Resources, and School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- State Key Laboratory of Phytochemistry and Plant Resources in West China, and CAS Center for Excellence in Molecular Plant Sciences, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, China
| | - Guanglian Zhou
- State Key Laboratory of Southwestern Chinese Medicine Resources, and School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- State Key Laboratory of Phytochemistry and Plant Resources in West China, and CAS Center for Excellence in Molecular Plant Sciences, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, China
| | - Sheng-Xiong Huang
- State Key Laboratory of Phytochemistry and Plant Resources in West China, and CAS Center for Excellence in Molecular Plant Sciences, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, China
| | - Wei Xiong
- Institute of Applied Chemistry, Jiangxi Academy of Sciences, Nanchang, China
| | - Jian-Ping Huang
- State Key Laboratory of Southwestern Chinese Medicine Resources, and School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- State Key Laboratory of Phytochemistry and Plant Resources in West China, and CAS Center for Excellence in Molecular Plant Sciences, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, China
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Sachs R, Adler L, Frank R. A holistic view of innovation incentives and pharmaceutical policy reform. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad004. [PMID: 38756835 PMCID: PMC10985921 DOI: 10.1093/haschl/qxad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 05/18/2024]
Abstract
The Inflation Reduction Act is set to transform how Medicare pays for prescription drugs, most notably by enabling Medicare to negotiate for the prices of certain high-cost medications. The pharmaceutical industry argues it will drastically reduce innovation, but a full analysis of its impacts on innovation requires considering not merely the number of new drugs produced but their clinical value. Several features of the negotiation process aim to minimize its impacts on innovation, particularly for drugs with high clinical value. The Biden Administration has also implemented several policies alongside the Inflation Reduction Act, such as the Advanced Research Projects Agency for Health and a National Biotechnology and Biomanufacturing Initiative, that are designed to reward and promote clinically valuable innovation. Taken together, these policies should go a long way toward mitigating any negative impacts on new drug development and may even better promote the development of higher-value drugs.
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Affiliation(s)
- Rachel Sachs
- School of Law, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, United States
- Brookings Institution, 1775 Massachusetts Avenue NW, Suite 824, Washington, DC 20036, United States
| | - Loren Adler
- Brookings Institution, 1775 Massachusetts Avenue NW, Suite 824, Washington, DC 20036, United States
| | - Richard Frank
- Brookings Institution, 1775 Massachusetts Avenue NW, Suite 824, Washington, DC 20036, United States
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Serra-Burriel M, Perényi G, Laube Y, Mitchell AP, Vokinger KN. The cancer premium - explaining differences in prices for cancer vs non-cancer drugs with efficacy and epidemiological endpoints in the US, Germany, and Switzerland: a cross sectional study. EClinicalMedicine 2023; 61:102087. [PMID: 37521033 PMCID: PMC10371812 DOI: 10.1016/j.eclinm.2023.102087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023] Open
Abstract
Background High treatment prices of new cancer drugs are a global public health challenge to patients and healthcare systems. Policymakers in the US and Europe are debating reforms to drug pricing. The objective of this study was to assess whether drug efficacy or epidemiological characteristics (prevalence, incidence, mortality) explain the gap in treatment prices between cancer and non-cancer drugs in the US, Germany, and Switzerland. Methods This cross-sectional study identified all new drugs approved in the US, Germany, and Switzerland between 2011 and 2020. Drug efficacy was extracted from pivotal trials, drug prices from public and commercial databases, and epidemiological characteristics from the Global Burden of Disease (GBD) 2019 study. We used regression models to explain drug prices with drug efficacy and epidemiological characteristics (prevalence, incidence, mortality). Findings The cohort included 181 drugs, including 68 (37.5%) drugs approved for treatment of cancer. A significant negative correlation was found between incidence/prevalence and treatment prices, and a significant positive correlation was observed between mortality and treatment prices for both, cancer and non-cancer drugs. A significant association between relative drug efficacy and treatment prices of drugs was observed, however, less pronounced for cancer drugs. Our regression estimates indicated that after adjusting for efficacy and epidemiological characteristics, cancer drugs were on average approximately three times more expensive compared to non-cancer drugs in all three countries, indicating a cancer premium; i.e., treatment prices of cancer drugs were on average USD 74,412 (95% CI [62,810; 86,015]) more expensive in the US compared to non-cancer drugs, USD 37,770 (95% CI [26,175; 49,367]) more expensive in Germany, and USD 32,801 (95% CI [27,048; 38,555]) more expensive in Switzerland. Our model explained 72% of the variance in observed prices (R2). Interpretation Drug pricing reforms should target the cancer premium to improve access of patients to cancer drugs as well as to achieve equity across the different therapeutic areas and sustainability in the health care systems. Funding This study was funded by the Swiss National Science Foundation (SNSF, grant number PCEGP1_194607) and the Swiss Cancer Research Foundation (Krebsforschung Schweiz).
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Affiliation(s)
- Miquel Serra-Burriel
- Institute of Law, University of Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Yannic Laube
- Institute of Law, University of Zurich, Switzerland
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de Castro MSM, da Silva GDM, Figueiredo IVO, de Miranda WD, Magalhães Júnior HM, dos Santos FP, de Sousa RP. Health litigation and cancer survival in patients treated in the public health system in a large Brazilian city, 2014-2019. BMC Public Health 2023; 23:534. [PMID: 36944943 PMCID: PMC10029205 DOI: 10.1186/s12889-023-15415-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/09/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Litigation for health care, also known as health judicialization, is frequent in Brazil. It involves recourse to the court system to access health services. The study aimed to evaluate whether cancer patients in Belo Horizonte, Minas Gerais, Brazil, increased their overall survival by increasing access to certain drugs or treatments through litigation, controlling for the effect of demographic and disease-related variables. METHODS A retrospective cohort study was conducted. Patients with breast, prostate, brain, lung, or colon cancers from 2014 to 2019 were included. Survival analysis was performed using the Cox proportional hazards model. RESULTS In the multivariate analysis, litigation was significantly associated with increased survival in cancers of breast (HR = 0.51, 95%CI 0.33-0.80), prostate (HR = 0.50, 95%CI 0.30-0.85), colon (HR = 0.59, 95%CI 0.38-0.93), and lung (HR = 0.36, 95%CI 0.22-0.60). Five-year survival rates of patients who sued for treatment were 97.8%, 88.7%, 59.3%, and 26.0%, compared to median survival of 95.7%, 78.7%, 41.2%, and 2.4%, respectively, among patient that did not resort to court action. The study suggests that litigation for access to cancer treatment may represent a step forward in obtaining more effective treatment. This study´s main limitations are the lack of patients´ clinical information for use as control variables and the lack of variables to assess patients´ quality of life. The study also found that many cases involved claims that could have been solved by administrative rather than legal action. Some claims thus reflect the lack of adequate administrative procedures. CONCLUSION When based on scientific evidence, access to new therapies, combined with other technologies already available, can favor patient survival. Access to new therapies through litigation may increase health inequalities since low-income patients have limited access to legal recourse against the State to meet their needs. The timely approval of new effective therapies can mitigate the judicialization of cancer treatment.
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Affiliation(s)
- Mônica Silva Monteiro de Castro
- René Rachou Institute, Oswaldo Cruz Foundation (IRR - Fiocruz), Av. Augusto de Lima, 1715 - Barro Preto, Belo Horizonte, MG 30190-002 Brazil
| | - Gabriela Drummond Marques da Silva
- René Rachou Institute, Oswaldo Cruz Foundation (IRR - Fiocruz), Av. Augusto de Lima, 1715 - Barro Preto, Belo Horizonte, MG 30190-002 Brazil
| | - Iara Veloso Oliveira Figueiredo
- René Rachou Institute, Oswaldo Cruz Foundation (IRR - Fiocruz), Av. Augusto de Lima, 1715 - Barro Preto, Belo Horizonte, MG 30190-002 Brazil
| | | | - Helvécio Miranda Magalhães Júnior
- René Rachou Institute, Oswaldo Cruz Foundation (IRR - Fiocruz), Av. Augusto de Lima, 1715 - Barro Preto, Belo Horizonte, MG 30190-002 Brazil
| | - Fausto Pereira dos Santos
- René Rachou Institute, Oswaldo Cruz Foundation (IRR - Fiocruz), Av. Augusto de Lima, 1715 - Barro Preto, Belo Horizonte, MG 30190-002 Brazil
| | - Rômulo Paes de Sousa
- René Rachou Institute, Oswaldo Cruz Foundation (IRR - Fiocruz), Av. Augusto de Lima, 1715 - Barro Preto, Belo Horizonte, MG 30190-002 Brazil
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13
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Monoclonal antibodies in breast cancer: A critical appraisal. Crit Rev Oncol Hematol 2023; 183:103915. [PMID: 36702424 DOI: 10.1016/j.critrevonc.2023.103915] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/01/2022] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
In breast cancer, mAbs can play multifunctional roles like targeting cancer cells, sometimes directly attacking them, helping in locating and delivering therapeutic drugs to targets, inhibiting cell growth and blocking immune system inhibitors, etc. Monoclonal antibodies are also one of the important successful treatment strategies especially against HER2 but they have not been explored much for other types of breast cancers especially in triple negative breast cancers. Monoclonal antibodies impact the feasibility of antigen specificity, bispecific and trispecific mAbs have opened new doors for more targeted specific efficacy. Monoclonal antibodies can be used diversly and with efficacy as compared to other methods of treatment thus maining it a suitable candidate for breast cancer treatment. However, mAbs treatment also causes various side effects such as fever, trembling, fatigue, headache and muscle pain, nausea/vomiting, difficulty in breathing, rashes and bleeding. Understanding the pros and cons of this strategy, we have explored in this review, the current and future potential capabilities of monoclonal antibodies with respect to diagnosis and treatment of breast cancer. DATA AVAILABILITY: Not applicable.
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K M, Kumar V, Dwivedi P, Gangaprasad A, Dey A, Pandey DK. Identification of elite species of Ophiorrhiza utilizing HPTLC analysis and camptothecin as a phytochemical marker: Assessment of extraction effectiveness and organ selection. BIOCATALYSIS AND AGRICULTURAL BIOTECHNOLOGY 2023. [DOI: 10.1016/j.bcab.2023.102632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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15
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16
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Lythgoe MP, Sullivan R. Could the UK's fixed-fee subscription improve access to antimicrobials and other essential medicines in low-income and middle-income countries? THE LANCET. MICROBE 2022; 3:e724-e725. [PMID: 35961327 DOI: 10.1016/s2666-5247(22)00224-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Mark P Lythgoe
- Department of Surgery and Cancer, Imperial College London, London W12 0HS, UK.
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17
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Ollila E, Kataja V, Sailas L. A David and Goliath set-up: a qualitative study of the challenges of ensuring the introduction of cost-effective new cancer medicines in Finland. J Pharm Policy Pract 2022; 15:52. [PMID: 36038900 PMCID: PMC9422122 DOI: 10.1186/s40545-022-00449-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background To combat the global challenge of cancer, priority has been placed on the research and development of new cancer medicines (NCMs). NCMs are often approved for marketing in accelerated processes. Despite significant advances in treating cancer, the overall added value and high prices of NCMs has been questioned. While market authorisations for NCMs are granted at the EU level, the assessment of added value, price negotiations and purchase or reimbursement decisions are made by member states. This article explores the practices in Finland for assessing and deciding on purchasing or reimbursing NCMs. Methods Semi-structured interviews were conducted with 26 civil servants, hospital employees, scientists, and representatives of cancer NGOs and of the pharmaceutical industry in 2019 and 2020. The transcribed interviews were coded inductively using Atlas.ti software and analysed thematically under 3 major themes and 11 sub-themes.
Results The clinical value of NCMs is considered to be high, especially regarding NCMs for certain types of cancer. Proper patient selection is important but difficult and not all NCMs can be considered as adding value. The prices are considered to often be very high, leading to concerns about the sustainability and equity of health systems. Equity concerns among cancer patients are raised concerning differences in the availability of NCMs between hospital districts and cost differences for patients between those receiving outpatient and inpatient treatment. The systems and processes in Finland for deciding on the introduction of NCMs are fragmentary, involving separate approaches for outpatient care and hospital medicines by under-resourced evaluation bodies. The scientific evidence available is often limited for evidence-based decisions on introduction. Individual hospital districts sometimes introduce NCMs without assessment by national bodies. This can hamper the proper assessment of some NCMs before their uptake and lead to unequal access to NCMs by hospitals. There is an increasing lack of transparency about pricing, due to the rapid increase of market entry agreements. Lack of transparency on information on prices poses a challenge for authorities responsible for equitable access to cost-effective care within the available resources.
Conclusions Robust reform of the national introductory systems is needed. Internationally, efforts are needed to increase price transparency, to revise incentives within the system of market approval and to accumulate and assess evidence of comparable value and cost-effectiveness after the market approval of NCMs.
Supplementary Information The online version contains supplementary material available at 10.1186/s40545-022-00449-5.
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Affiliation(s)
- Eeva Ollila
- Cancer Society of Finland, P.O. Box 238, 00131, Helsinki, Finland. .,Faculty of Social Sciences, University of Tampere, Tampere, Finland.
| | - Vesa Kataja
- Kaiku Health, Part of ELEKTA, Helsinki, Finland.,University of Eastern Finland, Jyväskylä, Finland
| | - Liisa Sailas
- Cancer Center, Joint Municipal Authority for North Karelia Social and Health Care Services (SiunSote), Joensuu, Finland
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18
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Powell K, Prasad V. Multiplicity: When many analytic plans are applied or many redundant studies are run, false-positive results are ensured. Eur J Clin Invest 2022; 52:e13802. [PMID: 35488444 DOI: 10.1111/eci.13802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Kerrington Powell
- College of Medicine, Texas A&M Health Science Center, Bryan, Texas, USA
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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Tajima G, Matsumaru N, Tsukamoto K. Impact of expedited programs in the United States, as foreign regulatory factors, on clinical development time in Japan. J Clin Pharm Ther 2022; 47:1395-1401. [PMID: 35488803 DOI: 10.1111/jcpt.13677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/30/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Regulatory authorities in several regions have introduced a number of expedited programs (EPs) to promote the development of innovative drugs for patients in their own countries. The EPs in the United States (US), alone or in combination, have been successful in shortening the clinical development time in the US. We examined whether US-EPs, as well as other related factors, have an impact on the clinical development time in Japan to obtain new insights for more efficient drug development. METHODS In total, 168 drugs approved as new molecular entities (NMEs) in Japan and approved in the US between 2012 and 2019 were surveyed. We compared the clinical development time in Japan for those drugs with or without US-EPs. We also examined the impact of overlapping designations of US-EPs on clinical development time in Japan. Multiple regression analysis was performed to identify associated factors related to clinical development time in Japan, including US-EPs. RESULTS AND DISCUSSION The clinical development time in Japan was significantly shorter at 37.4 [Interquartile range, IQR, 28.7-48.9] months for Accelerated Approval (AA), 42.2 [30.0-53.6] months for Breakthrough Therapy (BT), 42.3 [29.3-56.4] months for Fast Track (FT), 44.5 [30.7-60.0] months for US Priority Review, and 45.2 [31.3-61.8] months for US Orphan Designation. Multiple regression analysis revealed that AA (p = 0.008), FT (p = 0.013), Japan Priority Review, and the difference in development initiation dates between the US and Japan were significant factors related to a decrease in the clinical development time in Japan, whereas Japan Orphan Designation and the development of anticancer drugs were significant factors linked to an increase in the clinical development time. WHAT IS NEW AND CONCLUSION US-EPs were associated with a decrease in the clinical development time in Japan for the drugs that were approved as NMEs in Japan and approved in the US. This association was not restricted to particular therapeutic areas or development strategies. Stakeholders involved in drug development, including the drug developers and regulatory authorities in Japan, should realize these effects for efficient drug development.
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Affiliation(s)
- Gentaro Tajima
- Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan.,Department of Regulatory Affairs, Pfizer R&D Japan G.K, Tokyo, Japan
| | - Naoki Matsumaru
- Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan
| | - Katsura Tsukamoto
- Global Regulatory Science, Gifu Pharmaceutical University, Gifu, Japan
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20
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Murayama A, Senoo Y, Harada K, Kotera Y, Saito H, Sawano T, Suzuki Y, Tanimoto T, Ozaki A. Awareness and Perceptions among Members of a Japanese Cancer Patient Advocacy Group Concerning the Financial Relationships between the Pharmaceutical Industry and Physicians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063478. [PMID: 35329160 PMCID: PMC8952770 DOI: 10.3390/ijerph19063478] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/02/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023]
Abstract
Objectives: Awareness and perceptions of financial conflicts of interest (FCOI) between pharmaceutical companies (Pharma) and healthcare domains remain unclear in Japanese cancer patient communities. This study aimed to assess awareness (RQ1), the influence of FCOI on physician trustworthiness (RQ2), and their perception (RQ3) among the Japanese cancer patient advocacy group members. Methods: A cross-sectional study using a self-administered survey was conducted with a Japanese cancer patient advocacy group between January and February 2019. The main outcome measures included awareness and perceptions of physician–Pharma interactions, their impact on physician trustworthiness, and attitudes towards FCOI among medical and other professions. Furthermore, we performed thematic analyses on the comments which responders provided in the surveys. Results: Among the 524 contacted members, 96 (18.3%) completed the questionnaire, including 69 (77.5%) cancer patients. In RQ1, most of the respondents were aware of physician–Pharma interactions, although the extent differed based on the nature of the interaction. Furthermore, the respondents mainly considered these interactions influential on clinical practice (RQ2) and agreed to the need for further regulation of physician–Pharma interactions (QR3). In qualitative analyses (n = 56), we identified the 4 following themes: perception towards the FCOI (Theme 1), concerns about the respondent’s treatment (Theme 2), reason of physician–Pharma interactions (Theme 3), and possible solutions from the patient perspective (Theme 4). Conclusions: Most respondents were generally aware of physician–Pharma-associated FCOI and perceived them negatively. Additionally, participants appeared supportive of further FCOI regulation to protect patient-centred care. Abbreviations: FCOI—financial conflicts of interest; United States—US; Pharma—pharmaceutical companies; RQ—research question.
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Affiliation(s)
- Anju Murayama
- Medical Governance Research Institute, Minato-ku, Tokyo 108-0074, Japan; (Y.S.); (K.H.); (Y.S.); (T.T.); (A.O.)
- School of Medicine, Tohoku University, Sendai 980-8574, Japan
- Correspondence: ; Tel.: +81-90-6321-6996
| | - Yuki Senoo
- Medical Governance Research Institute, Minato-ku, Tokyo 108-0074, Japan; (Y.S.); (K.H.); (Y.S.); (T.T.); (A.O.)
| | - Kayo Harada
- Medical Governance Research Institute, Minato-ku, Tokyo 108-0074, Japan; (Y.S.); (K.H.); (Y.S.); (T.T.); (A.O.)
| | - Yasuhiro Kotera
- School of Health Sciences, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai 980-0873, Japan;
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan;
| | - Yosuke Suzuki
- Medical Governance Research Institute, Minato-ku, Tokyo 108-0074, Japan; (Y.S.); (K.H.); (Y.S.); (T.T.); (A.O.)
| | - Tetsuya Tanimoto
- Medical Governance Research Institute, Minato-ku, Tokyo 108-0074, Japan; (Y.S.); (K.H.); (Y.S.); (T.T.); (A.O.)
- Department of Internal Medicine, Navitas Clinic Kawasaki, Tokyo 210-0007, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Minato-ku, Tokyo 108-0074, Japan; (Y.S.); (K.H.); (Y.S.); (T.T.); (A.O.)
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan
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Discovering and harnessing oxidative enzymes for chemoenzymatic synthesis and diversification of anticancer camptothecin analogues. Commun Chem 2021; 4:177. [PMID: 36697859 PMCID: PMC9814082 DOI: 10.1038/s42004-021-00602-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/05/2021] [Indexed: 01/28/2023] Open
Abstract
Semi-synthetic derivatives of camptothecin, a quinoline alkaloid found in the Camptotheca acuminata tree, are potent anticancer agents. Here we discovered two C. acuminata cytochrome P450 monooxygenases that catalyze regio-specific 10- and 11-oxidations of camptothecin, and demonstrated combinatorial chemoenzymatic C-H functionalizations of the camptothecin scaffold using the new enzymes to produce a suite of anticancer drugs, including topotecan (Hycamtin®) and irinotecan (Camptosar®). This work sheds new light into camptothecin metabolism, and represents greener approaches for accessing clinically relevant camptothecin derivatives.
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22
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Wang X, Cai T, Tian L, Bourgeois F, Parast L. Quantifying the feasibility of shortening clinical trial duration using surrogate markers. Stat Med 2021; 40:6321-6343. [PMID: 34474500 PMCID: PMC8595715 DOI: 10.1002/sim.9185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 08/08/2021] [Accepted: 08/17/2021] [Indexed: 11/09/2022]
Abstract
The potential benefit of using a surrogate marker in place of a long-term primary outcome is very attractive in terms of the impact on study length and cost. Many available methods for quantifying the effectiveness of a surrogate endpoint either rely on strict parametric modeling assumptions or require that the primary outcome and surrogate marker are fully observed that is, not subject to censoring. Moreover, available methods for quantifying surrogacy typically provide a proportion of treatment effect explained (PTE) measure and do not directly address the important questions of whether and how the trial can be ended earlier using the surrogate marker. In this article, we specifically address these important questions by proposing a PTE measure to quantify the feasibility of ending trials early based on endpoint information collected at an earlier landmark point t 0 in a time-to-event outcome setting. We provide a framework for deriving an optimally predicted outcome for individual patients at t 0 based on a combination of surrogate marker and event time information in the presence of censoring. We propose a non-parametric estimator for the PTE measure and derive the asymptotic properties of our estimators. Finite sample performance of our estimators are illustrated via extensive simulation studies and a real data application examining the potential of hemoglobin A1c and fasting plasma glucose to predict treatment effects on long term diabetes risk based on the Diabetes Prevention Program study.
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Affiliation(s)
- Xuan Wang
- Department of Biostatistics, Harvard University, Boston, MA, USA
| | - Tianxi Cai
- Department of Biostatistics, Harvard University, Boston, MA, USA
- Department of Biomedical Informatics, Harvard University, Boston, MA, USA
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University, Standord, CA, USA
| | | | - Layla Parast
- Statistics Group, RAND Corporation, Santa Monica, CA, USA
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Boudewyns V, O'Donoghue AC, Paquin RS, Aikin KJ, Ferriola‐Bruckenstein K, Scott VM. Physician Interpretation of Data of Uncertain Clinical Utility in Oncology Prescription Drug Promotion. Oncologist 2021; 26:1071-1078. [PMID: 34510619 PMCID: PMC8649057 DOI: 10.1002/onco.13972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/20/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Little is known about how physicians interpret data displays that depict preliminary or exploratory clinical data in physician-targeted sales aids for oncology drugs. Using three factorial experiments, we examined whether disclosures of data limitations and clinical uncertainty adequately communicate the limitations and practical utility of this type of data. SUBJECTS, MATERIALS, AND METHODS The studies used a 2 (disclosure of data limitations: technical, nontechnical) × 2 (disclosure of clinical uncertainty: present, absent) + 1 (control: no disclosure) between-subjects experimental design to examine the impact of disclosures as they relate to presentations of preliminary or exploratory data in promotional communications for oncology products. In each experiment, we randomized oncologists and primary care physicians with oncology experience to view one version of a two-page sales aid. Following this exposure, physicians completed a web-based survey. The design was replicated in three concurrently conducted experiments using sales aids for different fictitious oncology drugs, each featuring one of three common data displays: a forest plot (n = 495), a Kaplan-Meier curve (n = 504), or a bar chart (n = 532). RESULTS Results provide initial evidence that in some contexts disclosures can improve understanding of the clinical utility of certain information about a drug and the limitations of results presented in a data display. Disclosures can also temper perceptions of how much evidence is presented that supports a conclusion that the drug is an appropriate treatment. In terms of the language used in the disclosure of data limitations, physicians in all three experiments strongly preferred the nontechnical disclosures. CONCLUSION The findings from the three experiments in this study suggest that disclosures have the potential to increase relevant knowledge, but more research is needed to establish best practice recommendations for using disclosures to convey contextual information relevant for interpreting data displays in promotional communications. IMPLICATIONS FOR PRACTICE This article reports the results from three large, online experimental studies that address a growing concern that drug companies often share favorable clinical trial results with physicians in promotional materials that lack important context for physicians to interpret the data. This series of studies investigates whether strategic use of two types of disclosures (disclosure of data limitations and a disclosure of clinical uncertainty) improves understanding and reduces misinterpretations among physicians. The results from these studies help identify communication factors that impact how physicians critically appraise preliminary or exploratory clinical trial data to inform policy and regulatory efforts.
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Affiliation(s)
| | - Amie C. O'Donoghue
- Center for Drug Evaluation and Research, Office of Prescription Drug Promotion, US Food and Drug AdministrationSilver SpringMarylandUSA
| | | | - Kathryn J. Aikin
- Center for Drug Evaluation and Research, Office of Prescription Drug Promotion, US Food and Drug AdministrationSilver SpringMarylandUSA
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Schnog JJB, Samson MJ, Gans ROB, Duits AJ. An urgent call to raise the bar in oncology. Br J Cancer 2021; 125:1477-1485. [PMID: 34400802 PMCID: PMC8365561 DOI: 10.1038/s41416-021-01495-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/09/2021] [Accepted: 07/09/2021] [Indexed: 02/07/2023] Open
Abstract
Important breakthroughs in medical treatments have improved outcomes for patients suffering from several types of cancer. However, many oncological treatments approved by regulatory agencies are of low value and do not contribute significantly to cancer mortality reduction, but lead to unrealistic patient expectations and push even affluent societies to unsustainable health care costs. Several factors that contribute to approvals of low-value oncology treatments are addressed, including issues with clinical trials, bias in reporting, regulatory agency shortcomings and drug pricing. With the COVID-19 pandemic enforcing the elimination of low-value interventions in all fields of medicine, efforts should urgently be made by all involved in cancer care to select only high-value and sustainable interventions. Transformation of medical education, improvement in clinical trial design, quality, conduct and reporting, strict adherence to scientific norms by regulatory agencies and use of value-based scales can all contribute to raising the bar for oncology drug approvals and influence drug pricing and availability.
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Affiliation(s)
- John-John B. Schnog
- Department of Hematology-Medical Oncology, Curaçao Medical Center, Willemstad, Curaçao ,Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
| | - Michael J. Samson
- Department of Radiation Oncology, Curaçao Medical Center, Willemstad, Curaçao
| | - Rijk O. B. Gans
- grid.4494.d0000 0000 9558 4598Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ashley J. Duits
- Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao ,grid.4494.d0000 0000 9558 4598Institute for Medical Education, University Medical Center Groningen, Groningen, The Netherlands ,Red Cross Blood Bank Foundation, Willemstad, Curaçao
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25
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Ferris MJ, Sun K, Savard C, Suresh T, Mishra MV. Factors Related to Small- and Mid-Capitalization Pharmaceutical Company Success Using Stock Performance as a Surrogate. Cureus 2021; 13:e18210. [PMID: 34692353 PMCID: PMC8526070 DOI: 10.7759/cureus.18210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/07/2022] Open
Abstract
Background Developing novel pharmaceuticals demands substantial investment despite high uncertainty of success and ultimate market value. While many established drug companies are highly profitable and have large portfolios of diversified assets, much of new drug innovation, a very high-risk, high-reward gambit, stems from smaller companies striving to bring their first products to market. While drug costs, and thus pharmaceutical company profits, can be controversial, it is unquestionable that the products from these companies provide great benefit to humanity. Hence, the ongoing success of the industry as a whole is quite relevant from a public health perspective. Methodology We sought to investigate factors influencing pharmaceutical company success using company stock performance on major US indices as a surrogate. As the profitability of large-capitalization (cap) pharmaceutical companies is well established, we focused on small- and mid-cap companies in this analysis. Small- and mid-cap pharmaceutical companies (both currently active and now defunct) and historical share prices were captured, including company details and the nature of drug pipelines. Funding by US academia was acquired via CMS.gov Open Payments and categorized into contributions < or ≥$100,000. Stock performance was considered good (+ ≥25%), mediocre (±25%), or poor (- ≥25%). Univariate and multivariate associations were assessed. Results Of the 420 companies included in the analysis, 101 (24%) had good, 76 (18%) mediocre, and 243 (58%) poor performance. The following were associated with performance in univariate analysis: initial public offering (IPO) price (P < 0.001), time from IPO (P < 0.001), number of drug programs (P = 0.019), and academic funding (P = 0.00013), with trend for diverse pipelines (both oncology and nononcology programs under development) (P = 0.069). On multivariate analysis, IPO price was inversely associated (P < 0.0001), while academic funding (P < 0.0001) and more drug programs (P = 0.0025) were positively associated with performance. Analysis of pharmaceutical IPOs since 2000 suggests a 20% rate of outright company failure. Conclusions The majority of included companies had lackluster stock performance, suggestive of low potential for drug development success and high probability of financial disaster. Robust drug pipelines and academic collaboration seem to be strongly related to company success.
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Affiliation(s)
- Matthew J Ferris
- Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - Kai Sun
- Radiation Oncology/Statistician, University of Maryland School of Medicine, Baltimore, USA
| | - Corey Savard
- Internal Medicine, Lankenau Medical Center, Wynnewood, USA
| | - Tejas Suresh
- Medical Oncology, Virginia Cancer Specialists, Fairfax, USA
| | - Mark V Mishra
- Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
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26
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Meyers DE, Meyers BS, Chisamore TM, Wright K, Gyawali B, Prasad V, Sullivan R, Booth CM. Trends in drug revenue among major pharmaceutical companies: A 2010-2019 cohort study. Cancer 2021; 128:311-316. [PMID: 34614198 DOI: 10.1002/cncr.33934] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/11/2021] [Accepted: 08/31/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Over the past 2 decades there has been a substantial increase in the number of new cancer medicines; this has been accompanied by a dramatic rise in drug costs. It is unknown how these trends impact the revenue of the pharmaceutical sector. METHODS Retrospective cohort study to characterize temporal trends of revenue generated from cancer medicines as a proportion of total drug revenue among 10 large pharmaceutical companies from 2010 to 2019. Itemized product-sales data publicly available through company websites or annual filings were used to identify annual drug revenue. Revenue data were adjusted for inflation and converted to 2019 US dollars. RESULTS During the study period, cumulative annual revenue generated from cancer drugs increased by 70%: from $55.8 billion to $95.1 billion, while cumulative revenue from nononcology drugs decreased 18%: from $342.2 billion to $281.5 billion. The proportion of total drug revenue generated from oncology drugs increased substantially over the study period: from 14% in 2010 to 25% in 2019 (τ = 1.0, P < .001). CONCLUSIONS Among 10 of the world's largest pharmaceutical companies, revenues generated from the sale of cancer drugs have increased by 70% over the past decade, while revenues from other medicines have decreased by 18%. Revenues from cancer drugs now account for one-quarter of the net revenues from these companies. Further work is needed to understand if this increase in sales revenue reflects industry profit, and to what extent increased spending has translated into improvements in patient and population outcomes.
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Affiliation(s)
- Daniel E Meyers
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Benjamin S Meyers
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada
| | - Timothy M Chisamore
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada
| | - Kristin Wright
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada.,Department of Medicine, Queen's University, Kingston, Canada
| | - Bishal Gyawali
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada.,Department of Oncology, Queen's University, Kingston, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Richard Sullivan
- Institute of Cancer Policy, School of Cancer Sciences, Kings College London, London, United Kingdom
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada.,Department of Oncology, Queen's University, Kingston, Canada.,Department of Medicine, Queen's University, Kingston, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Canada
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27
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Islam S, Wang S, Bowden N, Martin J, Head R. Repurposing existing therapeutics, its importance in oncology drug development: Kinases as a potential target. Br J Clin Pharmacol 2021; 88:64-74. [PMID: 34192364 PMCID: PMC9292808 DOI: 10.1111/bcp.14964] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/04/2021] [Accepted: 06/19/2021] [Indexed: 12/13/2022] Open
Abstract
Repurposing the large arsenal of existing non‐cancer drugs is an attractive proposition to expand the clinical pipelines for cancer therapeutics. The earlier successes in repurposing resulted primarily from serendipitous findings, but more recently, drug or target‐centric systematic identification of repurposing opportunities continues to rise. Kinases are one of the most sought‐after anti‐cancer drug targets over the last three decades. There are many non‐cancer approved drugs that can inhibit kinases as “off‐targets” as well as many existing kinase inhibitors that can target new additional kinases in cancer. Identifying cancer‐associated kinase inhibitors through mining commercial drug databases or new kinase targets for existing inhibitors through comprehensive kinome profiling can offer more effective trial‐ready options to rapidly advance drugs for clinical validation. In this review, we argue that drug repurposing is an important approach in modern drug development for cancer therapeutics. We have summarized the advantages of repurposing, the rationale behind this approach together with key barriers and opportunities in cancer drug development. We have also included examples of non‐cancer drugs that inhibit kinases or are associated with kinase signalling as a basis for their anti‐cancer action.
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Affiliation(s)
- Saiful Islam
- Drug Discovery and Development, Clinical and Health Sciences, University of South Australia, Adelaide, SA, 500, Australia
| | - Shudong Wang
- Drug Discovery and Development, Clinical and Health Sciences, University of South Australia, Adelaide, SA, 500, Australia
| | - Nikola Bowden
- Centre for Human Drug Repurposing and Medicines Research, University of Newcastle, NSW, 2305, Australia
| | - Jennifer Martin
- Centre for Human Drug Repurposing and Medicines Research, University of Newcastle, NSW, 2305, Australia
| | - Richard Head
- Drug Discovery and Development, Clinical and Health Sciences, University of South Australia, Adelaide, SA, 500, Australia
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28
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Bauer C, Herwig R, Lienhard M, Prasse P, Scheffer T, Schuchhardt J. Large-scale literature mining to assess the relation between anti-cancer drugs and cancer types. J Transl Med 2021; 19:274. [PMID: 34174885 PMCID: PMC8236166 DOI: 10.1186/s12967-021-02941-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/13/2021] [Indexed: 12/09/2022] Open
Abstract
Background There is a huge body of scientific literature describing the relation between tumor types and anti-cancer drugs. The vast amount of scientific literature makes it impossible for researchers and physicians to extract all relevant information manually. Methods In order to cope with the large amount of literature we applied an automated text mining approach to assess the relations between 30 most frequent cancer types and 270 anti-cancer drugs. We applied two different approaches, a classical text mining based on named entity recognition and an AI-based approach employing word embeddings. The consistency of literature mining results was validated with 3 independent methods: first, using data from FDA approvals, second, using experimentally measured IC-50 cell line data and third, using clinical patient survival data. Results We demonstrated that the automated text mining was able to successfully assess the relation between cancer types and anti-cancer drugs. All validation methods showed a good correspondence between the results from literature mining and independent confirmatory approaches. The relation between most frequent cancer types and drugs employed for their treatment were visualized in a large heatmap. All results are accessible in an interactive web-based knowledge base using the following link: https://knowledgebase.microdiscovery.de/heatmap. Conclusions Our approach is able to assess the relations between compounds and cancer types in an automated manner. Both, cancer types and compounds could be grouped into different clusters. Researchers can use the interactive knowledge base to inspect the presented results and follow their own research questions, for example the identification of novel indication areas for known drugs. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-021-02941-z.
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Affiliation(s)
- Chris Bauer
- MicroDiscovery GmbH, Marienburger Straße 1, 10405, Berlin, Germany.
| | - Ralf Herwig
- Department of Computational Molecular Biology, Max Planck Institute for Molecular Genetics, Ihnestraße 63, 14195, Berlin, Germany
| | - Matthias Lienhard
- Department of Computational Molecular Biology, Max Planck Institute for Molecular Genetics, Ihnestraße 63, 14195, Berlin, Germany
| | - Paul Prasse
- Department of Informatics, University of Potsdam, August-Bebel-Str. 89, 14482, Potsdam, Germany
| | - Tobias Scheffer
- Department of Informatics, University of Potsdam, August-Bebel-Str. 89, 14482, Potsdam, Germany
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29
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Industry payments to US physicians for cancer therapeutics: An analysis of the 2016–2018 open payments datasets. J Cancer Policy 2021; 28:100283. [DOI: 10.1016/j.jcpo.2021.100283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/28/2021] [Accepted: 03/31/2021] [Indexed: 11/19/2022]
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30
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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; 41:1-12. [PMID: 33956494 DOI: 10.1200/edbk_100028] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Increasing cancer drug prices present global challenges to treatment access and cancer outcomes. Substantial variability exists in drug pricing across countries. In countries without universal health care, patients are responsible for treatment costs. Low- or middle-income countries are heavily impacted, with limited patient access to novel cancer treatments. Financial toxicity is seen across cancer types, countries, and health care systems. Those at highest risk include younger patients, new immigrants, visible minority groups, and those without private health coverage. Currently, cancer drug pricing does not correlate with value or clinical benefit. Value-based pricing of oncology drugs may incentivize development of higher-value medicines and eliminate excess spending on drugs that yield little benefit. Generics and biosimilars in oncology can also improve affordability and patient access, offering dramatic reductions in drug spending while maintaining patient benefit. Oncologists can promote value-based care by following evidence-based clinical guidelines that avoid low-value treatments. Researchers can also engage in value-based research that critically explores optimal cancer drug dosing, schedules, and treatment duration and defines patient populations most likely to benefit (e.g., through biomarker selection). Cancer Groundshot proposes that we improve outcomes for today's patients with cancer, including broader global access for high-value treatments, promotion of affordable cancer control strategies, and reduction of cancer morbidity and mortality through low-cost prevention and screening initiatives. Moving forward, major oncology societies recommend promoting uniform global access to essential cancer medicines and avoiding financial harm for patients as key principles in addressing the affordability of cancer drugs.
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Affiliation(s)
- Natasha B Leighl
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sharon Nirmalakumar
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Doreen A Ezeife
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Bishal Gyawali
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
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31
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Korenstein D, Kaltenboeck A, Mamoor M, Chimonas S. Priceless Knowledge: Attitudes and Awareness Around Drug Pricing Among US Medical Students. MEDICAL SCIENCE EDUCATOR 2021; 31:489-494. [PMID: 34457906 PMCID: PMC8368429 DOI: 10.1007/s40670-020-01190-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 06/13/2023]
Abstract
UNLABELLED High US drug costs have garnered increasing attention, with multiple proposed reforms. While physicians are key stakeholders, medical education about drug pricing is not described, and medical students' understanding and attitudes are poorly understood. To assess students' awareness of drug pricing and its determinants, the authors conducted a cross-sectional, web-based survey of US medical students. Survey items included attitudes and knowledge around drug pricing and relevant education received (e.g., importance, quantity/quality of instruction). A composite knowledge score summed correct responses to 10 knowledge items. Descriptive statistics and t tests were used to evaluate associations. Among 815 viewers of the survey invitation, 361 visited the survey and 240 completed it (view rate 44%; participation rate 77%; completion rate 87%). Most participants were white (62%), in MD programs (82%), and female (53%). Nearly all (> 99%) said it was somewhat or very important to understand factors influencing drug pricing; over 90% were interested in learning more. Among year 3-4 students (n = 108), 59% reported receiving medical school instruction on pricing; few rated the quantity as adequate (7%) or the quality as excellent (3%) or good (8%). Among 10 knowledge questions, the median correct score was 6. Fewer than half (44%) knew that prices are uncorrelated with research/development costs. Knowledge was associated with year in school (p = 0.011) but not reported instructional quality or quantity. In sum, medical students report interest in drug pricing but inadequate instruction, and their knowledge is incomplete. Enhanced education is needed to equip future doctors to advocate effectively for patients around drug prices. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-020-01190-x.
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Affiliation(s)
- Deborah Korenstein
- Center for Health Policy & Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017 USA
| | - Anna Kaltenboeck
- Center for Health Policy & Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017 USA
| | - Maha Mamoor
- Center for Health Policy & Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017 USA
| | - Susan Chimonas
- Center for Health Policy & Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017 USA
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Kim S, Kim J, Cho H, Lee K, Ryu C, Lee JH. Trends in the pricing and reimbursement of new anticancer drugs in South Korea: an analysis of listed anticancer drugs during the past three years. Expert Rev Pharmacoecon Outcomes Res 2020; 21:479-488. [PMID: 33275463 DOI: 10.1080/14737167.2021.1860023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective: This study aimed to examine patient accessibility to new anticancer drugs including reimbursement coverage, time to listing, and listing price during the recent 3 years after the introduction of alternative pricing and reimbursement pathways in South Korea.Methods: Anticancer drugs were selected for analysis from the new drugs reviewed from January 2017 to March 2020. Descriptive statistics were used to present the levels of the listing prices. Pearson's correlation analysis was used to analyze the relationship between the list price in comparison to the External Reference Price(ERP) and the time to listing.Results: Thirty-two anticancer drugs were included in analysis. The average time to listing for these drugs was 36.7 months. The ratio of the listing price in comparison with Average Adjusted Price from seven reference countries was from 12.6% to 90.2%. Pearson's correlation coefficient for the correlation between the ratio of the listing price to the ERP and the time to listing was -0.37 and was statistically significant (p = 0.035).Conclusions: Policies that relate to the scope of reimbursement, time to reimbursement, and list price should be able to equally reflect patient accessibility and national health insurance finances, as well as the impact on industry as a whole.
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Affiliation(s)
- Sungju Kim
- Healthcare Group, Lee&Ko, Seoul, Republic of Korea
| | - Jinhong Kim
- Department of Market Access, GlaxoSmithKline Korea, Seoul, Republic of Korea
| | - Hyunyoung Cho
- Department of Market Access, AbbVie Korea, Seoul, Republic of Korea
| | - Kyungmin Lee
- Department of Patient Access and Public Affairs, Novartis Korea, Seoul, Republic of Korea
| | - Chiyoung Ryu
- Department of Healthcare Policy and Market Access, Korea Research-based Pharma Industry Association, Seoul, Republic of Korea
| | - Jong Hyuk Lee
- Department of Pharmaceutical Engineering, Hoseo University, Asan, Republic of Korea
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33
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Gotham D, Moja L, van der Heijden M, Paulin S, Smith I, Beyer P. Reimbursement models to tackle market failures for antimicrobials: Approaches taken in France, Germany, Sweden, the United Kingdom, and the United States. Health Policy 2020; 125:296-306. [PMID: 33402265 DOI: 10.1016/j.healthpol.2020.11.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/07/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The pipeline of new antibacterials remains limited. Reasons include low research investments, limited commercial prospects, and scientific challenges. To complement existing initiatives such as research grants, governments are exploring policy options for providing new market incentives to drug developers. MATERIALS AND METHODS Reimbursement interventions for antibacterials in France, Germany, Sweden, US, and UK were reviewed and analysed by the authors. RESULTS In France, Germany, and the US, implemented interventions centre on providing exceptions in cost-containment mechanisms to allow higher prices for certain antibacterials. In the US, also, certain antibacterials are granted additional years of protection from generic competition (exclusivity) and faster regulatory review. The UK is piloting a model that will negotiate contracts with manufacturers to pay a fixed annual fee for ongoing supply of as many units as needed. Sweden is piloting a model that will offer manufacturers of selected antibacterials contracts that would guarantee a minimum annual revenue. A similar model of guaranteed minimal annual revenues is under consideration in the US (PASTEUR Act). CONCLUSIONS The UK and Sweden are piloting entirely novel procurement and reimbursement models. Existing interventions in the US, France, and Germany represent important, but relatively minor interventions. More countries should explore the use of novel models and international coordination will be important for 'pull' incentives to be effective. If adopted, the PASTEUR legislation in the US would constitute a significant 'pull' incentive.
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Affiliation(s)
| | - Lorenzo Moja
- Department of Health Products Policy and Standards, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland.
| | - Maarten van der Heijden
- Department of Coordination and Partnership on AMR, AMR Division, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland.
| | - Sarah Paulin
- Department of Coordination and Partnership on AMR, AMR Division, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland.
| | - Ingrid Smith
- Research and Development Department, Haukeland University Hospital, Bergen, Norway.
| | - Peter Beyer
- Department of Coordination and Partnership on AMR, AMR Division, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland.
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Taylor DG. The political economics of cancer drug discovery and pricing. Drug Discov Today 2020; 25:2149-2160. [PMID: 32920059 PMCID: PMC7483036 DOI: 10.1016/j.drudis.2020.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/23/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022]
Abstract
Drug discoveries can, when used appropriately, save lives. Since 1970, cancer death rates among people aged under 65 have halved in countries such as the USA and the UK. Despite pharmaceutical market imperfections and fears about the prices of new treatments, further progress should be possible during the 2020s. Anticancer medicine outlays account for 0.1-0.2% of the gross domestic product (GDP) of developed countries. Total cancer service spending typically stands at ∼0.8% of GDP. The affordability of these sums is a political calculation. Improvements in the efficiency of drug development and global access to effective therapies are desirable. However, from a public interest perspective, these goals should not be pursued in ways that understate the value of better treatment outcomes and threaten the funding available for ongoing innovation.
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Affiliation(s)
- David G Taylor
- UCL School of Pharmacy Offices, University College London, BMA House, Tavistock Square, London, WC1H 9JP, UK.
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35
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Park J, Park S, Kim K, Hwang W, Yoo S, Yi GS, Lee D. An interactive retrieval system for clinical trial studies with context-dependent protocol elements. PLoS One 2020; 15:e0238290. [PMID: 32946464 PMCID: PMC7500653 DOI: 10.1371/journal.pone.0238290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/14/2020] [Indexed: 11/19/2022] Open
Abstract
A well-defined protocol for a clinical trial guarantees a successful outcome report. When designing the protocol, most researchers refer to electronic databases and extract protocol elements using a keyword search. However, state-of-the-art database systems only offer text-based searches for user-entered keywords. In this study, we present a database system with a context-dependent and protocol-element-selection function for successfully designing a clinical trial protocol. To do this, we first introduce a database for a protocol retrieval system constructed from individual protocol data extracted from 184,634 clinical trials and 13,210 frame structures of clinical trial protocols. The database contains a variety of semantic information that allows the filtering of protocols during the search operation. Based on the database, we developed a web application called the clinical trial protocol database system (CLIPS; available at https://corus.kaist.edu/clips). This system enables an interactive search by utilizing protocol elements. To enable an interactive search for combinations of protocol elements, CLIPS provides optional next element selection according to the previous element in the form of a connected tree. The validation results show that our method achieves better performance than that of existing databases in predicting phenotypic features.
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Affiliation(s)
- Junseok Park
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
- Bio-Synergy Research Center, KAIST, Daejeon, Republic of Korea
| | - Seongkuk Park
- Information & Electronics Research Institute, Daejeon, Republic of Korea
| | - Kwangmin Kim
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
- Bio-Synergy Research Center, KAIST, Daejeon, Republic of Korea
| | - Woochang Hwang
- The Milner Institute, University of Cambridge, Cambridge, United Kingdom
| | - Sunyong Yoo
- School of Electronics and Computer Engineering, Chonnam National University, Gwangju, Republic of Korea
| | - Gwan-su Yi
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
- Bio-Synergy Research Center, KAIST, Daejeon, Republic of Korea
| | - Doheon Lee
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
- Bio-Synergy Research Center, KAIST, Daejeon, Republic of Korea
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36
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Lin TA, Fuller CD, Verma V, Mainwaring W, Espinoza AF, Miller AB, Jethanandani A, Pasalic D, Das P, Minsky BD, Thomas CR, Fogelman DR, Subbiah V, Subbiah IM, Ludmir EB. Trial Sponsorship and Time to Reporting for Phase 3 Randomized Cancer Clinical Trials. Cancers (Basel) 2020; 12:E2636. [PMID: 32947844 PMCID: PMC7563891 DOI: 10.3390/cancers12092636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 11/17/2022] Open
Abstract
The pace of clinical trial data generation and publication is an area of interest within clinical oncology; however, little is known about the dynamics and covariates of time to reporting (TTR) of trial results. To assess these, ClinicalTrials.gov was queried for phase three clinical trials for patients with metastatic solid tumors, and the factors associated with TTR from enrollment completion to publication were analyzed. Based on the 319 included trials, cooperative-group-sponsored trials were reported at a slower rate than non-cooperative-group trials (median 37.5 vs. 31.0 months; p < 0.001), while industry-funded studies were reported at a faster rate than non-industry-supported trials (31.0 vs. 40.0 months; p = 0.005). Furthermore, successful trials (those meeting their primary endpoint) were reported at a faster rate than unsuccessful studies (27.5 vs. 36.0 months; p < 0.001). Multivariable analysis confirmed that industry funding was independently associated with a shorter TTR (p = 0.006), while cooperative group sponsorship was not associated with a statistically significant difference in TTR (p = 0.18). These data underscore an opportunity to improve cooperative group trial efficiency by reducing TTR.
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Affiliation(s)
- Timothy A. Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.A.L.); (C.D.F.); (V.V.); (D.P.); (P.D.); (B.D.M.)
- Department of Radiation Oncology and Molecular Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, 401 N. Broadway Baltimore, MD 21287, USA
| | - Clifton David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.A.L.); (C.D.F.); (V.V.); (D.P.); (P.D.); (B.D.M.)
| | - Vivek Verma
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.A.L.); (C.D.F.); (V.V.); (D.P.); (P.D.); (B.D.M.)
| | - Walker Mainwaring
- Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA 19096, USA;
| | | | - Austin B. Miller
- McGovern Medical School, The University of Texas Health Science Center, 7000 Fannin, Suite 1880, Houston, TX 77030, USA;
| | - Amit Jethanandani
- Department of Radiation Oncology, The University of Miami Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL 33136, USA;
| | - Dario Pasalic
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.A.L.); (C.D.F.); (V.V.); (D.P.); (P.D.); (B.D.M.)
| | - Prajnan Das
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.A.L.); (C.D.F.); (V.V.); (D.P.); (P.D.); (B.D.M.)
| | - Bruce D. Minsky
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.A.L.); (C.D.F.); (V.V.); (D.P.); (P.D.); (B.D.M.)
| | - Charles R. Thomas
- Department of Radiation Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA;
| | - David R. Fogelman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
| | - Ishwaria M. Subbiah
- Department of Palliative, Rehabilitational, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA;
| | - Ethan B. Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; (T.A.L.); (C.D.F.); (V.V.); (D.P.); (P.D.); (B.D.M.)
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Fischer A, Dewatripont M, Goldman M. [What is the fair price of innovative therapy?]. Med Sci (Paris) 2020; 36:389-393. [PMID: 32356716 DOI: 10.1051/medsci/2020059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Comment préserver l’accessibilité aux nouveaux médicaments pour tous les patients qui en ont besoin ? La question se pose à la lumière des prix exorbitants auxquels les thérapies géniques, mais aussi les biothérapies et de nouvelles molécules chimiques, sont commercialisées. L’analyse montre qu’à court/moyen terme, l’arrivée sur le marché d’un nombre croissant de nouveaux traitements à haute valeur ajoutée mais à des prix très élevés deviendra insoutenable pour les organismes payeurs qui sous-tendent notre système de santé. Les arguments de rentabilité invoqués par les sociétés pharmaceutiques pour justifier les prix proposés sont à tout le moins contestables, d’autant plus qu’ils ne sont pas documentés de façon transparente et que cette industrie jouit déjà de marges bénéficiaires considérables, en comparaison de celles d’autres secteurs du monde économique. Quant aux promesses de guérison définitive assurée par certains traitements, il faudra encore attendre quelques années pour en vérifier le fondement. À l’aube d’une réforme qui apparaît incontournable, nous formulons plusieurs propositions pour faire avancer le débat, en particulier : (1) mettre en œuvre la résolution avancée par plusieurs états membres de l’Organisation mondiale de la santé (OMS) pour assurer la transparence des coûts de développement des nouveaux médicaments ; (2) imposer une clause de prix raisonnable dans les accords qui régissent le transfert de technologies entre les institutions académiques soutenues par des fonds publics et les entreprises privées ; (3) instituer une instance européenne commune de négociation des prix des médicaments adaptée aux conditions socioéconomiques de chaque pays ; (4) conditionner le remboursement des traitements innovants à leur commercialisation par des entreprises - ou des filiales de celles-ci - répondant à des normes certifiant leur responsabilité sociétale et (5) développer en Europe des partenariats public-privé à but non lucratif, pour la création de quelques unités de production de biothérapies et thérapies géniques. L’objectif général de ces mesures serait de fixer un cadre qui permette de définir des prix qui garantissent un juste retour de l’investissement public vers le système de santé tout en assurant pour les entreprises un profit d’un niveau conforme au marché et une incitation suffisante à investir dans les domaines prioritaires pour la santé publique.
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Affiliation(s)
- Alain Fischer
- Collège de France, Assistance Publique des Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Unité d'Immunologie-Hématologie Pédiatrique, Imagine Institute, Inserm UMR 1163, 75015 Paris, France
| | - Mathias Dewatripont
- Ecares, Solvay Brussels School of Economics and Management, Université libre de Bruxelles, Belgique - I3h Institute, Université libre de Bruxelles, Belgique
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Lucroy MD, Suckow MA. Predictive modeling for cancer drug discovery using canine models. Expert Opin Drug Discov 2020; 15:731-738. [PMID: 32176534 DOI: 10.1080/17460441.2020.1739644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Rodent models of cancer lack many features associated with the disease in humans. Because dogs closely share an environment with humans, as well as comparable pathophysiology of cancer, they represent a powerful model with which to study novel approaches to cancer treatment. AREAS COVERED The authors summarize the weaknesses of rodent models of cancer and the ongoing need for better animal models with which to study potential therapeutic approaches. The homology of cancer in dogs and humans is described, along with examples specific to several common cancer types. EXPERT OPINION Laboratory mice and rats will continue to play a central role in cancer research; however, because of a variety of limitations, pet dogs with spontaneous cancer offer unique opportunities for research and should be included in the preclinical development of therapeutic compounds. Environmental homology between dogs and humans, along with biological and molecular similarities present circumstances that strengthen the translational rigor of studies conducted using canine patients. Progress will depend on a sufficient number of dogs to be diagnosed with cancer and available for use in studies; and essential to this will be the availability of enhanced resources for diagnosis of cancer in canine patients and reliable coordination between research scientists, veterinarians, and physicians.
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Affiliation(s)
- Michael D Lucroy
- Vice President, Oncology, Torigen Pharmaceuticals, Inc , Farmington, CT, USA
| | - Mark A Suckow
- Department of Biomedical Engineering, University of Kentucky , Lexington, KY, USA
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Cortes J, Perez-García JM, Llombart-Cussac A, Curigliano G, El Saghir NS, Cardoso F, Barrios CH, Wagle S, Roman J, Harbeck N, Eniu A, Kaufman PA, Tabernero J, García-Estévez L, Schmid P, Arribas J. Enhancing global access to cancer medicines. CA Cancer J Clin 2020; 70:105-124. [PMID: 32068901 DOI: 10.3322/caac.21597] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Globally, cancer is the second leading cause of death, with numbers greatly exceeding those for human immunodeficiency virus/acquired immunodeficiency syndrome, tuberculosis, and malaria combined. Limited access to timely diagnosis, to affordable, effective treatment, and to high-quality care are just some of the factors that lead to disparities in cancer survival between countries and within countries. In this article, the authors consider various factors that prevent access to cancer medicines (particularly access to essential cancer medicines). Even if an essential cancer medicine is included on a national medicines list, cost might preclude its use, it might be prescribed or used inappropriately, weak infrastructure might prevent it being accessed by those who could benefit, or quality might not be guaranteed. Potential strategies to address the access problems are discussed, including universal health coverage for essential cancer medicines, fairer methods for pricing cancer medicines, reducing development costs, optimizing regulation, and improving reliability in the global supply chain. Optimizing schedules for cancer therapy could reduce not only costs, but also adverse events, and improve access. More and better biomarkers are required to target patients who are most likely to benefit from cancer medicines. The optimum use of cancer medicines depends on the effective delivery of several services allied to oncology (including laboratory, imaging, surgery, and radiotherapy). Investment is necessary in all aspects of cancer care, from these supportive services to technologies, and the training of health care workers and other staff.
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Affiliation(s)
- Javier Cortes
- IOB Institute of Oncology, Quironsalud Group, Madrid, Spain
- IOB Institute of Oncology, Quironsalud Group, Hospital Quiron, Barcelona, Spain
- Medica Scientia Innovation Research, Barcelona, Spain
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Jose Manuel Perez-García
- IOB Institute of Oncology, Quironsalud Group, Hospital Quiron, Barcelona, Spain
- Medica Scientia Innovation Research, Barcelona, Spain
| | | | | | - Nagi S El Saghir
- Division of Hematology Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Carlos H Barrios
- Oncology Research Center, Hospital Sao Lucas, Porto Alegre, Brazil
| | | | - Javier Roman
- Breast Unit, Gastrointestinal Tumor Unit and Lung Tumor Unit, IOB Institute of Oncology, Quironsalud Group, Madrid, Spain
| | - Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology, University of Munich (LMU), Munich, Germany
| | | | | | - Josep Tabernero
- IOB Institute of Oncology, Quironsalud Group, Hospital Quiron, Barcelona, Spain
- Medical Oncology Department, Vall d'Hebron Institute of Oncology, CIBERONC, Barcelona, Spain
| | | | - Peter Schmid
- Center of Experimental Cancer Medicine, Barts Cancer Institute, St. Bartholomew Breast Cancer Center, St. Bartholomew's Hospital, London, United Kingdom
| | - Joaquín Arribas
- Preclinical Research Program, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- Biomedical Research Oncology Network (CIBERONC), Barcelona, Spain
- Department of Biochemistry and Molecular Biology, Autonomous University of Barcelona, Bellaterra, Spain
- Catalan Institution for Research and Advanced Studies, (ICREA), Barcelona, Spain
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Trotta F, Mayer F, Barone-Adesi F, Esposito I, Punreddy R, Da Cas R, Traversa G, Perrone F, Martini N, Gyawali B, Addis A. Anticancer drug prices and clinical outcomes: a cross-sectional study in Italy. BMJ Open 2019; 9:e033728. [PMID: 31826897 PMCID: PMC6924817 DOI: 10.1136/bmjopen-2019-033728] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate whether the prices of new anticancer drugs correlated with their relative benefit despite negotiation. DESIGN Retrospective cross-sectional study correlating new anticancer drugs prices with clinical outcomes. SETTING We did a retrospective cross-sectional study including all new anticancer drugs approved by the European Medicines Agency (EMA) (2010-2016) and reimbursed in Italy. MAIN OUTCOMES AND MEASURES Information on clinical outcomes-in terms of median overall survival (OS), median progression-free survival (PFS) and objective response rate (ORR)-was extracted from pivotal trials as reported in the European Public Assessment Reports available on the EMA website. Cost of a full course treatment was estimated on negotiated official and discounted prices. Regression coefficients β, their levels of significance p and the coefficients of determination R2 were estimated adjusting by tumour type. RESULTS Overall, 30 new anticancer drugs (with 35 indications) were available for analysis. Where data on OS were available, we observed no correlation between the improvement in median OS (in weeks) and negotiated price (R2=0.067, n=16 drugs for 17 indications). When the clinical outcomes were expressed as improvements in the median PFS or ORR, 25 drugs (29 indications) were available for the analysis, and again, there was no correlation with prices (R2=0.004 and 0.006, respectively). CONCLUSIONS AND RELEVANCE Our results suggest that the prices of anticancer drugs in Italy do not reflect their therapeutic benefit. Drug price negotiations, which is mandatory by law in Italy, do not seem to ensure that prices correlate with clinical benefits provided by the cancer drugs. These results call for further efforts to establish the standard determinants of drug prices available at the time of negotiation. These findings need to be confirmed in other countries where price negotiations are in place. Moreover, further investigations may verify whether outcome data obtained after drug marketing would improve the correlation between prices and therapeutic benefit.
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Affiliation(s)
- Francesco Trotta
- Department of Epidemiology of the Regional Health Service Lazio, Rome, Italy
| | - Flavia Mayer
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Italy
| | | | | | | | - Roberto Da Cas
- National Centre for Epidemiology, Italian National Institute of Health, Rome, Italy
| | - Giuseppe Traversa
- National Centre for Epidemiology, Italian National Institute of Health, Rome, Italy
| | - Francesco Perrone
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Campania, Italy
| | | | | | - Antonio Addis
- Department of Epidemiology of the Regional Health Service Lazio, Rome, Italy
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Huntington SF. Cure at what (systemic) financial cost? Integrating novel therapies into first-line Hodgkin lymphoma treatment. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:252-259. [PMID: 31808838 PMCID: PMC6913455 DOI: 10.1182/hematology.2019000030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Classic Hodgkin lymphoma (cHL) stands out as success story in the field of medical oncology, with multiagent chemotherapy with or without radiation leading to durable remission for most patients. Large-scale clinical trials during the past 40 years have sought to minimize toxicities while maintaining strong efficacy, including efforts to reduce the size of radiation fields, minimize alkylator chemotherapy, reduce the number of chemotherapy cycles, and omit radiation in select populations. The last decade has also ushered in novel therapies, including brentuximab vedotin (BV), that have improved clinical outcomes for patients with cHL resistant to standard cytotoxic therapies. More recently, a large randomized trial compared BV plus chemotherapy with chemotherapy alone for first-line treatment of advanced stage cHL. With ∼24 months of available follow-up, the BV containing regimen was found to be associated with a reduction in the risk of progression, death, or incomplete response to first-line treatment (modified progression-free survival). Whether this early signal of improved efficacy is worth the additional acute toxicities and added drug-related expenses associated with incorporating BV into first-line treatment remains controversial. This chapter provides historical background; reviews the cost-effectiveness of available cHL therapies; and summarizes potential ways to balance innovation, affordability, and patient access to novel therapeutics.
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Affiliation(s)
- Scott F. Huntington
- Department of Internal Medicine, Section of Hematology, Yale University, New Haven, CT
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Wilking N, Bucsics A, Kandolf Sekulovic L, Kobelt G, Laslop A, Makaroff L, Roediger A, Zielinski C. Achieving equal and timely access to innovative anticancer drugs in the European Union (EU): summary of a multidisciplinary CECOG-driven roundtable discussion with a focus on Eastern and South-Eastern EU countries. ESMO Open 2019; 4:e000550. [PMID: 31798977 PMCID: PMC6863652 DOI: 10.1136/esmoopen-2019-000550] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 12/19/2022] Open
Abstract
The Central European Cooperative Oncology Group (CECOG) and ‘ESMO Open—Cancer Horizons’ roundtable discussion brought together stakeholders from several European Union (EU) countries involved in drug development, drug authorisation and reimbursement or otherwise affected by delayed and unequal access to innovative anticancer drugs. The approval process of drugs is well established and access delays can be caused directly or indirectly by national or regional decision-making processes on reimbursement. The two key aspects for those involved in reimbursement decisions are first the level of evidence required to decide and second pricing, which can be challenging for some innovative oncology compounds, especially in Eastern and South-Eastern European countries. Other important factors include: available healthcare budget; the structure and sophistication of healthcare authorities and health technology assessment processes; societal context and political will. From the point of view of the pharmaceutical industry, better alignment between stakeholders in the process and adaptive pathway initiatives is desirable. Key aspects for patients are improved access to clinical trials, preapproval availability and reports on real-world evidence. Restricted access limits oncologists’ daily work in Eastern and South-Eastern EU countries. The roundtable discussion suggested considering the sequencing of regulatory approval and reimbursement decisions together with more flexible contracting as a possible way forward. The panel concluded that early and regular dialogue between all stakeholders including regulators, payers, patient stakeholders and industry is required to improve the situation.
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Affiliation(s)
| | - Anna Bucsics
- Mechanism of Coordinated Access to Orphan Medicinal Products, Vienna, Austria
| | | | | | - Andrea Laslop
- Scientific Office, Austrian Federal Office for Safety in Health Care, Vienna, Austria
| | - Lydia Makaroff
- Fight Bladder Cancer, Chinnor, United Kingdom and World Bladder Cancer Patient Coalition, Brussels, Belgium
| | - Alexander Roediger
- EFPIA Oncology Platform, Brussels, Belgium and Oncology Policy Europe, Middle East, Africa and Canada, MSD, Kriens, Switzerland
| | - Christoph Zielinski
- Central European Cooperative Oncology Group (CECOG) and Vienna Cancer Center, Vienna Hospital Association, Vienna, Austria
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Garattini L, Padula A. Precision medicine and monoclonal antibodies: breach of promise? Croat Med J 2019; 60:284-289. [PMID: 31187957 PMCID: PMC6563176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica (BG), Italy
| | - Anna Padula
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica (BG), Italy
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44
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Orphan Drugs aus Sicht der Arzneimittelkommission der deutschen Ärzteschaft. Internist (Berl) 2019; 60:399-404. [DOI: 10.1007/s00108-019-0578-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Moreno SG, Epstein D. The price of innovation - the role of drug pricing in financing pharmaceutical innovation. A conceptual framework. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2019; 7:1583536. [PMID: 30956782 PMCID: PMC6442120 DOI: 10.1080/20016689.2019.1583536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 06/09/2023]
Abstract
The debate on drug prices has reached new heights with the controversy around the role of prices in promoting innovation. Critics claim that prices of innovative drugs are excessive and argue that lowering prices will not harm the flourishing innovation. On the opposite end, the pharmaceutical industry insists that restrictive pricing policies will have a detrimental impact on their ability to generate innovation. Amid these two divergent positions, this manuscript presents a conceptual framework to better understand the role played by drug prices to influence the ability of pharmaceutical firms to raise money in capital markets and hence finance pharmaceutical innovation. We argue that deviations from established value-based pricing principles, by either firms or payers, will distort access by firms to capital and lead to an undesirable level of innovation in the long term. We hope that this framework helps policy-makers anticipate the impact of their proposals, and ultimately guide policies towards setting optimal drug prices as a means to maximise social welfare.
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Affiliation(s)
- Santiago G. Moreno
- Department of Market Access & Public Affairs, Novartis Pharma AG., Basel, Switzerland
| | - David Epstein
- Department of Applied Economics, University of Granada, Campus de Cartuja, Granada, Spain
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