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Post H, Schutte T, van Oijen M, van Laarhoven H, Hollak C. Time to reimbursement of novel anticancer drugs in Europe: a case study of seven European countries. ESMO Open 2023; 8:101208. [PMID: 37030113 PMCID: PMC10163159 DOI: 10.1016/j.esmoop.2023.101208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Time to reimbursement (TTR) of new anticancer medicines differs between countries and contributes to unequal access. We aimed to investigate TTR of new anticancer medicines and explore factors influencing the reimbursement process in seven high-income European countries. MATERIALS AND METHODS We carried out a retrospective case study of anticancer medicines with European Union Market Access (EU-MA) and a positive Committee for Medicinal Products for Human Use opinion from 2016 until 2021 with subsequent national reimbursement approval (NRA). The National Health Technology Assessment (HTA) and reimbursement websites of Germany, France, UK, the Netherlands, Belgium, Norway and Switzerland were used to identify TTR, defined as time from EU-MA to NRA. Additionally, we investigated medication-, country-, indication- and pharma-related factors potentially influencing TTR. RESULTS Thirty-five medicines were identified for which TTR ranged from -81 days to 2320 days (median 407 days). At data cut-off, 16 (46%) were reimbursed in all seven countries. Overall, the shortest TTR was in Germany (median 3 days, all medicines reimbursed <5 days). The time limit for reimbursement of 180 days stated by the Council of European Communities after the EU-MA (EU Transparency Directive) was met for 100% of included medicines in Germany, 51% in France, 29% in the UK and the Netherlands, 14% in Switzerland, 6% in Norway and 3% in Belgium. The TTR was significantly different between countries (P < 0.001). In multivariate analysis, factors associated with shorter TTR were higher gross domestic product (GDP), absence of a pre-assessment procedure and submission by a big pharmaceutical company. CONCLUSIONS TTR of anticancer medicines varies significantly between seven high-income European countries and leads to inequality in access. Among explored medication-, country-, indication- and pharma-related factors we found that a high GDP, the absence of a pre-assessment procedure and submission by big pharmaceutical companies were associated with shorter TTR.
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Cost and public reimbursement of cancer medicines in the UK and the Republic of Ireland. Ir J Med Sci 2022; 192:541-548. [PMID: 35449390 DOI: 10.1007/s11845-022-02990-3] [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: 10/26/2021] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION/AIMS There are disparities in the availability of systemic anticancer therapies (SACTs) globally. We set out to investigate the cost and reimbursement of SACTs in the United Kingdom (UK) and the Republic of Ireland (ROI) in conjunction with efficacy and licensing authority decisions in the United States (US) and the European Union (EU). METHODS We sought data pertaining to licensing in the EU, reimbursement in ROI/UK and cost/efficacy of SACTs licensed by the Food and Drug Administration (FDA) between January 2015 and May 2021. Independent samples t tests, chi-square test and Pearson's correlation were used for statistical analysis. RESULTS We identified that the majority of FDA-approved regimens are licensed by the European Medicines Agency (EMA) (n = 91, 67.9%). However, only a minority of these are currently reimbursed in the UK (n = 60, 45%) or the ROI (n = 28, 21%) as of the 1st of May 2021. In addition, only a minority of regimens have demonstrated a statistically significant OS benefit (n = 54, 40%). There was no association between cost of regimens and either the presence (t = 0.846, p = 0.40) or duration of OS benefit (t = - 0.84, p = 0.64). CONCLUSIONS Our study highlights that many licensed systemic anticancer treatments are not currently reimbursed in ROI/UK. The high cost of these medicines is independent of the presence of an OS benefit. Collaboration between regulatory agencies, governments and industry partners is needed to ensure health expenditure is directed towards the most effective treatments.
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Vanderpuye-Orgle J, Erim D, Qian Y, Boyne DJ, Cheung WY, Bebb G, Shah A, Pericleous L, Maruszczak M, Brenner DR. Estimating the Impact of Delayed Access to Oncology Drugs on Patient Outcomes in Canada. Oncol Ther 2022; 10:195-210. [PMID: 35230672 PMCID: PMC8886863 DOI: 10.1007/s40487-022-00187-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/21/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction New requirements in Canada’s pricing processes for patented drugs may exacerbate delays in regulatory and reimbursement reviews. This study seeks to better understand the impact of any additional delays on non-small cell lung cancer (NSCLC) patients by measuring the following: (a) durations and outcomes of regulatory and reimbursement reviews of NSCLC drugs in Canada and reference countries; (b) delays in Canada’s reviews of three NSCLC drugs (nivolumab, afatinib, and pemetrexed [NAP]); and (c) estimating clinical, patient, and economic impacts of delays in Canada’s reviews on access to NAP. Methods Information from the Context Matters database and the literature (2005–2020) was used to evaluate the durations and outcomes of reimbursement reviews of NSCLC drugs in Canada and comparator countries. Public information was used to assess delays in Canada’s reviews of NAP. Empirical modeling with data from the literature and the Southern Alberta Lung Cancer database was used to estimate the impact of delays in Canada’s NAP reviews on patients (i.e., as losses in person-years of life and quality-adjusted life-years [QALYs]). Results Regulatory and reimbursement reviews in countries of interest take 12–18 months. In Canada, reviews of NSCLC drugs took 216 days (median), with a 24% rejection rate (mean = 19%). Delays in NAP reviews ranged from 5 to 94 days at Health Canada, 0–80 days at CADTH/pCODR, and 12–797 days in Canadian provinces. These delays may have affected 6400 patients, who lost up to 1740 person-years of life and 1122 QALYs (valued at CA$112 million). Conclusion Changes to Canada’s prescription drug pricing processes may prolong reviews. Supplementary Information The online version contains supplementary material available at 10.1007/s40487-022-00187-3.
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Affiliation(s)
| | - Daniel Erim
- Advanced Analytics, HEOR and RWE, Parexel International, Billerica, MA, USA
| | - Yi Qian
- Amgen Inc, Thousand Oaks, CA, USA
| | - Devon J Boyne
- Department of Oncology, University of Calgary, Calgary, AB, Canada
- Oncology Outcomes (O2) Initiative, University of Calgary, Calgary, AB, Canada
| | - Winson Y Cheung
- Department of Oncology, University of Calgary, Calgary, AB, Canada
- Oncology Outcomes (O2) Initiative, University of Calgary, Calgary, AB, Canada
| | - Gwyn Bebb
- Amgen Inc, Thousand Oaks, CA, USA
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | | | | | | | - Darren R Brenner
- Department of Oncology, University of Calgary, Calgary, AB, Canada
- Oncology Outcomes (O2) Initiative, University of Calgary, Calgary, AB, Canada
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Corbacho B, Drummond M, Santos R, Jones E, Borràs JM, Mestre-Ferrandiz J, Espín J, Henry N, Prat A. Does the use of health technology assessment have an impact on the utilisation of health care resources? Evidence from two European countries. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:621-634. [PMID: 32026155 PMCID: PMC7214388 DOI: 10.1007/s10198-020-01160-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 01/16/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES A centralised approach to health technology assessment (HTA) may facilitate optimal use of HTA resources. A regional approach may increase the chances of local implementation of recommendations. This study aimed to compare assessment procedures in England (centralised HTA approach) with Spain (regional HTA approach) discussing key challenges and opportunities from both approaches. METHODS We compared technology assessments of anticancer medicines in the two jurisdictions from 2008 to 2015. To assess the implementation of HTA recommendations, we assessed trends in medicine usage using regression methods. We used IQVIA data, from 2011 to 2016, for a sample of 11 medicines. We used CatSalut data from Catalonia to assess the implementation of local recommendations. RESULTS In England, 66 assessments were undertaken by the National Institute for Health and Care Excellence (NICE), using a standardised methodology. In Spain, there were 79 reports undertaken by a range of bodies using a shared process and coordinated through the GENESIS collaboration; the assessment methods used varied substantially. Overall, the recommendations in the two jurisdictions were similar. Regression analyses indicate that where there is a positive recommendation by HTA bodies, the usage of the medicine responds most strongly (p < 0.001) in Catalonia (4.892), followed by England (3.120) and Spain (1.693). CONCLUSIONS This study suggests that medicine utilisation does respond to the positive recommendations of HTA bodies. However, if HTA capacity is organised primarily regionally, considerable effort may be required in coordination, to ensure consistent and rigorous assessments and adequate implementation of HTA findings.
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Affiliation(s)
- B Corbacho
- York Trials Unit, ARRC Building, Department of Health Sciences, University of York, York, UK.
| | - M Drummond
- Centre for Health Economics, University of York, York, UK
| | - R Santos
- Centre for Health Economics, University of York, York, UK
| | | | - J M Borràs
- Department Clinical Sciences, Universidad de Barcelona, Barcelona, Spain
| | | | - J Espín
- Escuela Andaluza de Salud Publica, Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - N Henry
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- IQVIA, London, UK
| | - A Prat
- Pharmacy and Medicines Department, Servei Catala` de la Salut (CatSalut), Barcelona, Spain
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Torbica A, Fornaro G, Tarricone R, Drummond MF. Do Social Values and Institutional Context Shape the Use of Economic Evaluation in Reimbursement Decisions? An Empirical Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:17-24. [PMID: 31952668 DOI: 10.1016/j.jval.2019.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/01/2019] [Accepted: 11/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To investigate whether the use of economic evaluation (EE) in healthcare decision making is influenced by the social values and institutional context in a given country. METHODS We developed and tested a conceptual framework for the 36 Organisation for Economic Co-operation and Development (OECD) countries. The countries were divided into two groups based on the extent of their use of EE in drug reimbursement. The key social values were efficiency, equity, and personal responsibility, measured in an international survey. Countries were classified based on their institutional context in terms of their general welfare paradigm/type of healthcare system and the administrative tradition to which they belong. We performed correlation tests and ran path analysis regression models to test our hypotheses. RESULTS EE high users included significantly more Beveridge-type systems (50% vs 31%) and fewer Bismarck-type (15% vs 56%). Napoleonic tradition countries seemed to reject personal responsibility in health (r = -0.511, P = .009), whereas Germanic tradition countries embraced it (r = 0.572, P = .003); Anglo-American tradition countries exhibited a significant association with efficiency (r = 0.444, P = .026), whereas Scandinavian tradition countries appeared to reject it as a criterion for rationing in healthcare (r = -0.454, P = .023). No significant direct association was found between social values and use of EE. CONCLUSION Our exploratory analysis suggests that institutional context and, indirectly, social values may play a role in shaping the use of EE in healthcare decision making. Because of the differences among countries in terms of institutional context, which may in part be influenced by social values, it is unlikely that there will ever be a single, harmonious approach to the use of EE.
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Affiliation(s)
- Aleksandra Torbica
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy.
| | - Giulia Fornaro
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
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Access to medicines - a systematic review of the literature. Res Social Adm Pharm 2019; 16:1166-1176. [PMID: 31839584 DOI: 10.1016/j.sapharm.2019.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 12/07/2019] [Accepted: 12/08/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Budgetary constraints and the rising cost of new innovative medicines are the key challenges for access to medicines. Multiple research studies explored diverse dimensions of this topic, however, a thorough and detailed review of existing literature on access to medicines in United Kingdom is lacking. Therefore, the objective of this systematic review of literature was to critically review and analyse the literature pertaining to original research on access to medicines issue in the United Kingdom. This review includes two types of studies: (a) UK centric studies (b) studies comparing UK with the other countries. METHODS A systematic search of articles published between Jan 2008 and October 12, 2018 was conducted according to PRISMA guidelines using the following databases: PubMed, Scopus, Science Direct, and specific journals including BMJ, Lancet, Value in Health, Pharmacoeconomics, Pharmacoeconomics Open, Journal of pharmaceutical policy and practice, Health Policy. RESULTS The searches across all databases and journals resulted in 53 relevant articles. The data extracted from the 53 articles generated key themes. These themes included: Access to Medicines, Health technology assessment (HTA), Pricing and Health technology assessment, Risk Sharing Agreements & Stakeholders involvement/views on reimbursement Process. Subthemes were added under the key themes where applicable. CONCLUSIONS This review systematically evaluated the current literature and identified variability in access to medicines across countries in UK &EU and across different categories of medicines. Medicine licensing and reimbursement environment is continuously evolving and there are challenges as well as opportunities for learning and collaboration among countries which are at different stages of advancement in their systems.
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Torbica A, Tarricone R, Drummond M. Does the approach to economic evaluation in health care depend on culture, values, and institutional context? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:769-774. [PMID: 29209854 DOI: 10.1007/s10198-017-0943-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Aleksandra Torbica
- Centre for Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - Rosanna Tarricone
- Centre for Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy
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Prat A, Gilabert A, Puig-Peiro R, Feliu A, Riba M, Mangues MA, Tabernero J. Letter to the editor regarding the paper by A. Lozano-Blázquez et al. Differences in cancer drug assessment between Spain and the United Kingdom. Eur J Cancer 2016; 67:55-56. [DOI: 10.1016/j.ejca.2016.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/17/2016] [Indexed: 11/25/2022]
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