1
|
Cronin TK, Ronayne C, O'Donovan N, McGuinness E, Cooke K, Dennehy M, Dennehy C, Power DG, Cahill MR, Collins DC, Connolly RM, Bambury RM, Mykytiv V, Higgins MJ, Noonan SA, O'Reilly S. The impact of expanded access programs for systemic anticancer therapy in an Irish cancer centre. Ir J Med Sci 2024:10.1007/s11845-024-03701-w. [PMID: 38806877 DOI: 10.1007/s11845-024-03701-w] [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: 06/07/2023] [Accepted: 05/02/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Expanded access programs (EAPs) allow cancer patients with unmet clinical need to obtain access to pre-authorisation treatments. There is no standardised process for implementing these programs nationally, and real-world data on their impact is lacking. AIMS This study aimed to evaluate the prevalence of such EAPs and their impact in a cancer centre. METHODS Data relating to adult cancer patients treated via EAPs from 2011 to 2021 in three Cork university hospitals was collated. Descriptive statistics were employed to get an overview of the impact these programs currently have on cancer care provision. RESULTS We identified 193 patients who accessed EAPs during the study period, availing of 33 separate drugs for a total of 50 different cancer indications. The prevalence of EAP usage was shown to have been trending upwards in recent years with a total of 189 programs being accessed throughout the period. Drugs provided were from a number of different anti-cancer drug classes, particularly targeted therapies (n = 18) and immune checkpoint inhibitors (n = 17). Cancers from a wide range of both solid and liquid tumour types were treated with EAP drugs, and patients treated were from across a broad spectrum of ages (26-82, SD 11.99). CONCLUSIONS EAPs have an increasing role in accessing novel cancer therapies in our community and by extension nationally. Equity of EAP access would be facilitated by a national registry of available agents which we have established. Assessment of their benefits and toxicities would be enhanced by the requirement for a real-world database as a condition of EAP approval.
Collapse
Affiliation(s)
- Timothy K Cronin
- School of Medicine and Health, University College Cork, Cork, Ireland.
| | | | - Niamh O'Donovan
- South Infirmary Victoria University Hospital, Old Blackrock Road, Cork, Ireland
| | - Eimear McGuinness
- South Infirmary Victoria University Hospital, Old Blackrock Road, Cork, Ireland
| | - Katie Cooke
- South Infirmary Victoria University Hospital, Old Blackrock Road, Cork, Ireland
| | - Maeve Dennehy
- Mercy University Hospital, Grenville Place, Cork, Ireland
| | | | - Derek G Power
- Cork University Hospital, Wilton, Cork, Ireland
- Mercy University Hospital, Grenville Place, Cork, Ireland
- Cancer Research @ UCC, University College Cork, Cork, Ireland
| | - Mary R Cahill
- Cork University Hospital, Wilton, Cork, Ireland
- Cancer Research @ UCC, University College Cork, Cork, Ireland
| | - Dearbhaile C Collins
- Cork University Hospital, Wilton, Cork, Ireland
- Cancer Research @ UCC, University College Cork, Cork, Ireland
| | - Roisin M Connolly
- Cork University Hospital, Wilton, Cork, Ireland
- Cancer Research @ UCC, University College Cork, Cork, Ireland
| | - Richard M Bambury
- Cork University Hospital, Wilton, Cork, Ireland
- Cancer Research @ UCC, University College Cork, Cork, Ireland
| | - Vitaliy Mykytiv
- Cork University Hospital, Wilton, Cork, Ireland
- Cancer Research @ UCC, University College Cork, Cork, Ireland
| | | | - Sinéad A Noonan
- Cork University Hospital, Wilton, Cork, Ireland
- Cancer Research @ UCC, University College Cork, Cork, Ireland
| | - Seamus O'Reilly
- Cork University Hospital, Wilton, Cork, Ireland
- Cancer Research @ UCC, University College Cork, Cork, Ireland
| |
Collapse
|
2
|
Martin T, Rioufol C, Favier B, Martelli N, Madelaine I, Chouaid C, Borget I. Impact of Early Access Reform on Oncology Innovation in France: Approvals, Patients, and Costs. BioDrugs 2024; 38:465-475. [PMID: 38643301 DOI: 10.1007/s40259-024-00658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND An ambitious reform of the early access (EA) process was set up in July 2021 in France, aiming to simplify procedures and accelerate access to innovative drugs. OBJECTIVE This study analyzes the characteristics of oncology drug approvals through the EA process and its impact on real-life data for oncology patients. METHODS The number and characteristics of EA demands concerning oncology drugs submitted to the National Health Authority (HAS, Haute Autorité de Santé) were reviewed until 31 December 2022. A longitudinal retrospective study on patients treated with an EA oncology drug between 1 January 2019 and 31 December 2022 was also performed using the French nationwide claims database (Systeme National des Données de Santé [SNDS]) to assess the impact of the reform on the number of indications and patients, and the costs. RESULTS Among 110 published decisions, the HAS granted 88 (80%) EA indications within 70 days of assessment on average, including 46 (52%) in oncology (67% in solid tumors and 33% in hematological malignancies). Approved indications were mostly supported by randomized phase III trials (67%), whereas refused EA relied more on non-randomized (57%) trials. Overall survival was the primary endpoint of 28% of EA approvals versus none of denied EAs. In the SNDS data, the annual number of patients with cancer treated with an EA drug increased from 3137 patients in 2019 to 18,341 in 2022 (+ 484%), whereas the number of indications rose from 12 to 62, mainly in oncohematology (n = 17), lung (n = 12), digestive (n = 9) and breast cancer (n = 9). Reimbursement costs for EA treatments surged from €42 to €526 million (+ 1159%). CONCLUSION The French EA reform contributed to enabling rapid access to innovations in a wide range of indications for oncology patients. However, the findings highlight ongoing challenges in financial sustainability, warranting continued evaluation and adjustments.
Collapse
Affiliation(s)
- Tess Martin
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015, Paris, France.
- GRADES, Faculty of Pharmacy, Paris-Saclay University, 17 Av. des Sciences, 91400, Orsay, France.
| | - Catherine Rioufol
- Pharmacy Department, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France
- EA3738, CICLY, UCBL1, Lyon, France
| | - Bertrand Favier
- Pharmacy Department, Centre Léon Bérard, 28 rue Laennec, 69008, Lyon, France
| | - Nicolas Martelli
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015, Paris, France
- GRADES, Faculty of Pharmacy, Paris-Saclay University, 17 Av. des Sciences, 91400, Orsay, France
| | - Isabelle Madelaine
- Société Française de Pharmacie Oncologique [SFPO], Pharmacy Department, Saint-Louis Hospital, AP-HP, 1 Avenue Vellefaux, 75010, Paris, France
| | - Christos Chouaid
- Service de Pneumologie, CHI Créteil, Créteil, France
- Inserm U955, UPEC, IMRB, Créteil, France
| | - Isabelle Borget
- Biostatistics and Epidemiology Office, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- CESP U1018, Oncostat, Labeled Ligue Contre le Cancer, Inserm, Université Paris-Saclay, Villejuif, France
| |
Collapse
|
3
|
Vancoppenolle JM, Franzen N, Koole SN, Retèl VP, van Harten WH. Differences in time to patient access to innovative cancer medicines in six European countries. Int J Cancer 2024; 154:886-894. [PMID: 37864395 DOI: 10.1002/ijc.34753] [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: 07/14/2023] [Revised: 09/01/2023] [Accepted: 09/19/2023] [Indexed: 10/22/2023]
Abstract
Patients across Europe face inequity regarding access to anticancer medicines. While access is typically evaluated through reimbursement status or sales data, patients can receive first access through early access programs (EAPs) or off-label use. This study aims to assess the time to patient access at the hospital level, considering different indications and countries. (Pre-)registered access to six innovative medicines (Olaparib, Niraparib, Ipilimumab, Osimeritinib, Nivolumab and Ibritunib) was measured using a cross-sectional survey. First patient access to medicines and indications were collected using the hospital databases. Nineteen hospitals from Hungary, Italy, the Netherlands, Belgium, Switzerland and France participated. Analysis showed that some hospitals achieved patient access before national reimbursement, primarily through EAPs. The average time from EMA-approval to patient access for these medicines was 2.1 years (Range: -0.9-7.1 years). Hospitals in Italy and France had faster access compared to Hungary and Belgium. Variation was also found within countries, with specialized hospitals (x̄: -0.9 years; SD: 2.0) more likely to provide patient access prior to national reimbursement than general hospitals (x̄: 0.4 years; SD: 2.9). Contextual differences were observed, with EAPs or off-label use being more prevalent in Switzerland than Hungary. Recent EMA-approved indications and drug combinations reached patients at a later stage. Substantial variation in patient access time was observed between and within countries. Improving pricing and reimbursement timelines, fostering collaboration between national health authorities and market authorization holders, and implementing nationally harmonized, data-generating EAPs can enhance timely and equitable patient access to innovative cancer treatments in Europe.
Collapse
Affiliation(s)
- Julie M Vancoppenolle
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department Health Technology and Services Research Technical Medical Centre, University of Twente, Enschede, The Netherlands
- The European Fair Pricing Network, Amsterdam, The Netherlands
| | - Nora Franzen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department Health Technology and Services Research Technical Medical Centre, University of Twente, Enschede, The Netherlands
- The European Fair Pricing Network, Amsterdam, The Netherlands
| | - Simone N Koole
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Valesca P Retèl
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Erasmus School of Health Policy & Management Health Technology Assessment (HTA), Erasmus University Rotterdam, The Netherlands
| | - Wim H van Harten
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department Health Technology and Services Research Technical Medical Centre, University of Twente, Enschede, The Netherlands
- The European Fair Pricing Network, Amsterdam, The Netherlands
- Organization of European Cancer Institutes (OECI), Brussels, Belgium
| |
Collapse
|
4
|
Grumberg V, Cotté FE, Giroux-Leprieur E, Gaudin AF, Lebbé C, Borget I. Clinical benefit of anti-PD-(L)1 immunotherapies in advanced cancer in France: a population-based estimate from 2014 to 2021. ESMO Open 2024; 9:102240. [PMID: 38335904 PMCID: PMC10937192 DOI: 10.1016/j.esmoop.2024.102240] [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: 07/24/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND In France, the potential benefit of new treatments is initially evaluated by the Haute Autorité de Santé to determine reimbursement and pricing, but rarely afterwards. Although immunotherapies (ITs) have considerably improved the survival of patients, few data are available on their long-term benefit at a population-treated level. The present retrospective study aimed to assess the clinical benefit of ITs compared to the previous standards of care (SoCs) in France from 2014 to 2021. MATERIALS AND METHODS To do this, we analyzed all ITs from the anti-programmed cell death protein 1/programmed death-ligand 1 [anti-PD-(L)1] class used in monotherapy or in association with another treatment available in early access or reimbursed in France between 2014 and 2021, regardless of indication. The number of patients initiating an IT was retrieved by year, drug and indication. Using extrapolated Kaplan-Meier curves, utility scores and the population treated, the clinical benefit was expressed as the number of deaths prevented (DP), life-years (LYs) and quality-adjusted life years (QALYs) gained compared to previous SoC. RESULTS Across the period, five ITs were marketed in 21 indications related to eight primary tumor sites. Between 2014 and 2021, 132 924 patients initiated an IT. By December 2021, 16 173 (13 804-17 141) deaths were delayed compared to previous SoC, mainly in lung cancer. Compared to their SoC, ITs provided a gain of 37 316 (33 581-41 048) additional LYs and 27 709 (23 784-30 450) additional QALYs. Lung cancer was the driver indication with 70.6% of LYs and 68.4% of QALYs gained followed by melanoma with 18.7% and 20.4% of the gain, respectively. CONCLUSIONS Significant gains in DP, LYs and QALYs have been observed in France following the introduction of ITs.
Collapse
Affiliation(s)
- V Grumberg
- Bristol Myers Squibb France, Rueil-Malmaison; Oncostat, U1018, CESP, Inserm, Paris-Saclay University, 'Ligue Contre le Cancer' Team, Villejuif.
| | - F-E Cotté
- Bristol Myers Squibb France, Rueil-Malmaison
| | - E Giroux-Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, Paris-Saclay University, UVSQ, EA4340, APHP-Hôpital Ambroise Paré, Boulogne Billancourt
| | - A-F Gaudin
- Bristol Myers Squibb France, Rueil-Malmaison
| | - C Lebbé
- Université Paris Cite, APHP Dermato-oncology, Cancer Institute APHP Nord Paris Cité, INSERM U976, Saint Louis Hospital, Paris
| | - I Borget
- Oncostat, U1018, CESP, Inserm, Paris-Saclay University, 'Ligue Contre le Cancer' Team, Villejuif; Biostatistics and Epidemiology Office, Gustave Roussy, Paris-Saclay University, Villejuif, France
| |
Collapse
|
5
|
Jommi C, Pantellini F, Giuliani G, Cavazza M. Impatto economico di 14 programmi di uso compassionevole dei farmaci in Italia, nella prospettiva del Servizio Sanitario Nazionale. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2024; 11:115-123. [PMID: 38803470 PMCID: PMC11129630 DOI: 10.33393/grhta.2024.2735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/27/2024] [Indexed: 05/29/2024] Open
Abstract
Background: Compassionate use programs (CUP) for medicines allow patients, not recruited in trials, accessing medicines before marketing approval. The evidence on the economic impact of CUP is limited to one paper that did not include the possible long-term economic impact of medicines used in CUP compared to alternative treatments, like avoided hospitalization costs. This paper aims at covering this information gap, updating and integrating the existing evidence, with a cost analysis in the perspective of the Italian National Health Service (SSN). Methods: Data were retrieved from the Roche CUP Database, the peer-reviewed literature (e.g. published cost-effectiveness studies, if any), the gray literature (e.g. regional documents for the alternative treatment cost) and unpublished data (e.g. cost-effectiveness analysis provided for price and reimbursement negotiation for medicines in CUP). Results: We retrieved data from 14 CUPs and 3,485 patients (70% affected by tumors) (Jan 2015-August 2022). The alternative treatment mean cost per patient ranged from € 11.1 k to € 18.8 k. The net economic benefit ranged from € 47 million to € 75 million (€ 13.5 k-€ 21.5 k per patient). Avoiding alternative treatments mostly contributes to the economic benefit. The long-term economic impact accounted for 20/30% of the net economic impact. The net economic benefit for cancer drugs ranged from € 12.6 million to € 40.0 million. Conclusions: Despite research limitations, this paper provides additional evidence on the economic impact of CUP in Italy. This could represent the first step of a broader analysis of the economic impact of early access schemes for drugs.
Collapse
Affiliation(s)
- Claudio Jommi
- Dipartimento di Scienze del Farmaco, Università del Piemonte Orientale, Novara - Italy
| | | | | | - Marianna Cavazza
- Cergas, SDA Bocconi School of Management, Università Bocconi, Milano - Italy
| |
Collapse
|
6
|
Jacquet E, Pham F, Taouk B, Kerouani-Lafaye G, Monard A, Brunel L, Albin N. Access to innovation through clinical trials and the national early access program for patients with lung cancer in France: focus on atezolizumab and durvalumab. Cancer Chemother Pharmacol 2023; 92:223-228. [PMID: 37439816 DOI: 10.1007/s00280-023-04556-1] [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: 04/20/2023] [Accepted: 06/12/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE Tumor genomic profiling and PD-L1 testing mean lung cancer management can be tackled through a personalized approach. Targeted therapies and immunotherapy are necessary to improve survival and preserve the patients' quality of life. Early access to innovation before marketing authorization (MA) is possible in France through clinical trials and an early-access program called a Temporary Authorization for Use (ATU), which is a unique regulatory system in Europe. This study aims to assess the impact of early access to innovation through clinical trials and ATUs in thoracic oncology. METHODS Data from clinical trials between 2018 and 2021 and ATUs between 2005 and 2019 were collected internally and assessed for drugs in thoracic oncology, with specific focus on 2 ATUs, respectively, atezolizumab and durvalumab. RESULTS From 2018 to 2021, the National Agency for the Safety of Medicines and Health Products authorized 145 clinical trials in lung cancer. Between 2005 and 2019, 19 drugs obtained an EU MA or an MA extension for a therapeutic indication in lung cancer. During this period, 11 of these drugs were granted an ATU, corresponding to 6851 patients treated. Of this total number of patients, data were collected for 33.1% and 71.2%, who received durvalumab and atezolizumab, respectively. Real-life efficacy data were consistent with the clinical trial data. CONCLUSION Over the past 15 years, clinical trials and the French early access program have allowed considerable early access to therapeutic innovation in real life for patients, especially in thoracic oncology.
Collapse
Affiliation(s)
- Emmanuelle Jacquet
- Department of Oncohematology, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Fiona Pham
- Oncology Hematology and Cell Therapy Department, French National Agency for Safety of Medicines and Health Products ANSM, 147 Boulevard Anatole France, Saint-Denis, France
- Department of Pharmacy, Centre Hospitalo-Universitaire Hôpital Henri Mondor Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Billy Taouk
- Oncology Hematology and Cell Therapy Department, French National Agency for Safety of Medicines and Health Products ANSM, 147 Boulevard Anatole France, Saint-Denis, France
| | - Ghania Kerouani-Lafaye
- Oncology Hematology and Cell Therapy Department, French National Agency for Safety of Medicines and Health Products ANSM, 147 Boulevard Anatole France, Saint-Denis, France
| | - Adrien Monard
- Oncology Hematology and Cell Therapy Department, French National Agency for Safety of Medicines and Health Products ANSM, 147 Boulevard Anatole France, Saint-Denis, France
- Department of Oncohematology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Liora Brunel
- Oncology Hematology and Cell Therapy Department, French National Agency for Safety of Medicines and Health Products ANSM, 147 Boulevard Anatole France, Saint-Denis, France
| | - Nicolas Albin
- Oncology Hematology and Cell Therapy Department, French National Agency for Safety of Medicines and Health Products ANSM, 147 Boulevard Anatole France, Saint-Denis, France.
- Department of Oncohematology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France.
| |
Collapse
|
7
|
Luyendijk M, Blommestein H, Uyl-de Groot C, Siesling S, Jager A. Regulatory Approval, Reimbursement, and Clinical Use of Cyclin-Dependent Kinase 4/6 Inhibitors in Metastatic Breast Cancer in the Netherlands. JAMA Netw Open 2023; 6:e2256170. [PMID: 36795415 PMCID: PMC9936344 DOI: 10.1001/jamanetworkopen.2022.56170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
CONCLUSIONS AND RELEVANCE This study found that CDK4/6 inhibitors rapidly reached many eligible patients with metastatic breast cancer and were adopted gradually over time in the Netherlands. Adoption of innovative medicines may be further optimized, and better transparency of the availability of new medicines during different phases of the postapproval access pathway is needed. DESIGN, SETTING, AND PARTICIPANTS This cohort study reviewed approval and reimbursement decisions of the CDK4/6 inhibitors palbociclib, ribociclib, and abemaciclib and estimated the number of patients with metastatic breast cancer who were eligible for these medicines compared with the actual use in clinical practice. The study used nationwide claims data that were obtained from the Dutch Hospital Data. Claims and early access data for patients with hormone receptor-positive and ERBB2 (formerly HER2)-negative metastatic breast cancer who were treated with CDK4/6 inhibitors from November 1, 2016, to December 31, 2021, were included. IMPORTANCE The number of new cancer medicines that are being approved by regulatory agents is increasing exponentially. Yet little is known about the pace at which these medicines reach eligible patients in daily clinical practice during different phases of the postapproval access pathway. MAIN OUTCOMES AND MEASURES Description of the postapproval access pathway, monthly number of patients who were treated with CDK4/6 inhibitors in clinical practice, and estimated number of patients who were eligible for treatment. Aggregated claims data were used, and patient characteristics and outcomes data were not collected. OBJECTIVE To describe the entire postapproval access pathway of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors in the Netherlands, from regulatory approval to reimbursement and to investigate the adoption of these medicines in clinical practice among patients with metastatic breast cancer. RESULTS Three CDK4/6 inhibitors have received European Union-wide regulatory approval for the treatment of HR-positive and ERBB2-negative metastatic breast cancer since November 2016. In the Netherlands, the number of patients who have been treated with these medicines increased to approximately 1847 (based on 1 624 665 claims over the entire study period) from approval to the end of 2021. Reimbursement for these medicines was granted between 9 and 11 months after approval. While awaiting reimbursement decisions, 492 patients received palbociclib, the first approved medicine of this class, via an expanded access program. By the end of the study period, 1616 patients (87%) were treated with palbociclib, whereas 157 patients (7%) received ribociclib, and 74 patients (4%) received abemaciclib. The CKD4/6 inhibitor was combined with an aromatase inhibitor in 708 patients (38%) and with fulvestrant in 1139 patients (62%). The pattern of use over time appeared to be somewhat lower compared with the estimated number of eligible patients (1847 vs 1915 in December 2021), especially in the first 2.5 years after approval.
Collapse
Affiliation(s)
- Marianne Luyendijk
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Hedwig Blommestein
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Carin Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| |
Collapse
|
8
|
Hofmarcher T, Lindgren P, Wilking N. Systemic anti-cancer therapy patterns in advanced non-small cell lung cancer in Europe. J Cancer Policy 2022; 34:100362. [PMID: 36087918 DOI: 10.1016/j.jcpo.2022.100362] [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: 04/02/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Systemic anti-cancer therapy (SACT) is the recommended treatment modality in patients with advanced non-small cell lung cancer (aNSCLC) in clinical guidelines. SACT options in aNSCLC have multiplied in recent years with the introduction of immunotherapy and targeted therapy. This article presents findings from the first comparative analysis of SACT patterns in Europe. METHODS SACT rates in aNSCLC were estimated as the ratio between the number of patients treated with SACT (chemotherapy, immunotherapy, targeted therapy) and the number of potentially eligible patients for SACT in 11 countries (Belgium, Bulgaria, Finland, Hungary, Ireland, Netherlands, Norway, Poland, Portugal, Romania, UK) between 2014 and 2020. Treated patients were estimated by combining national sales volume data of cancer drugs and average drug use per patient based on clinical trials. Potentially eligible patients were estimated from national epidemiological data. RESULTS SACT rates in aNSCLC differed greatly, ranging from around 30 % in Hungary, Poland, and the UK to almost 60 % in Ireland, Norway, and Portugal in 2014. SACT rates seemed to increase over time in most countries, but differences were still large by 2020, ranging from around 40 % in the UK to 75 % or more in Belgium, Norway, and Portugal. Even in countries with the highest SACT rates, far from all patients seemed to receive guideline-recommended SACT options, as underuse of immunotherapy and targeted therapy was common. CONCLUSION Up to 35 % of eligible patients with aNSCLC receives no SACT in certain European countries, although improvements have been achieved over time. The use of immunotherapy and targeted therapy is suboptimal even in countries with high SACT rates, indicating room to improve the quality of care and patient outcomes. POLICY SUMMARY Measuring if and what kind of therapy cancer patients have access to is vital to assess quality of care. The care of aNSCLC patients seems to be suboptimal in Europe, due to factors such as exclusion of patients with moderate performance status from SACT, limited resources for diagnostic testing, long reimbursement timelines and slow adoption of new medicines in clinical practice.
Collapse
Affiliation(s)
- Thomas Hofmarcher
- IHE - The Swedish Institute for Health Economics, Råbygatan 2, SE-22361, Lund, Sweden.
| | - Peter Lindgren
- IHE - The Swedish Institute for Health Economics, Råbygatan 2, SE-22361, Lund, Sweden; Karolinska Institutet, Solnavägen 1, SE-17177, Solna, Sweden
| | - Nils Wilking
- Karolinska Institutet, Solnavägen 1, SE-17177, Solna, Sweden
| |
Collapse
|
9
|
Fontrier AM. Market access for medicines treating rare diseases: Association between specialised processes for orphan medicines and funding recommendations. Soc Sci Med 2022; 306:115119. [PMID: 35700552 DOI: 10.1016/j.socscimed.2022.115119] [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: 01/25/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 11/25/2022]
Abstract
Access to medicines treating rare diseases ('orphan medicines') has proven challenging due to high prices and clinical uncertainty. To optimise market access to these medicines, some healthcare systems are implementing specialised pathways and/or processes during marketing authorisation (MA) and/or health technology assessment (HTA). Comparing one setting where these medicines are classed as "orphan" (Scotland) to another where they considered "non-orphan" (Canada), this study aims to explore whether the presence of specialised pathways and processes at MA and HTA levels is associated with more favourable funding recommendations and faster time to market access. A matched sample of 116 medicine-indication pairs with MA approval from 2001 to 2019 in Europe and Canada was identified, and publicly available sources were used for data extraction. Descriptive statistics were used for data analysis. All medicines were commercially marketed in both countries, except one instance in Scotland. In Scotland, more orphan medicines (68.1%) had a favourable HTA recommendation than in Canada (60.4%), while Canada issued more negative HTA recommendations (20.7%) than Scotland (15.5%). Low levels of agreement on HTA recommendations and the main reasons driving recommendations were found between settings. In both countries, medicines with specialised MA approval were less likely to receive negative HTA recommendations than medicines with standard MA. Time to market access was faster in Canada than Scotland, though medicines with specialised MA approval had slower timelines than medicines with standard MA approval in both countries. However, it is unclear whether the presence of orphan designation and HTA specialised processes alone could result in favourable funding recommendations without accounting for other healthcare system-related factors and differences in the decision-making processes across settings. Holistic approaches and better alignment of evidentiary requirements across regulators are needed to optimise access to orphan medicines.
Collapse
Affiliation(s)
- Anna-Maria Fontrier
- Department of Health Policy and LSE Health-Medical Technology Research Group (MTRG), London School of Economics and Political Science, UK.
| |
Collapse
|
10
|
Pham FYV, Jacquet E, Taleb A, Monard A, Kerouani-Lafaye G, Turcry F, Brunel L, Grudé F, Yoldjian I, Sainte-Marie I, Boudali L, Blay JY, Albin N. Survival, cost and added therapeutic benefit of drugs granted early access through the French temporary authorization for use program in solid tumors from 2009 to 2019. Int J Cancer 2022; 151:1345-1354. [PMID: 35603979 PMCID: PMC9540593 DOI: 10.1002/ijc.34129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/21/2022] [Accepted: 04/05/2022] [Indexed: 11/12/2022]
Abstract
Decisions on market authorization (MA) and reimbursement have different durations across countries because of health technology assessment (HTA) procedures and negotiations between manufacturers and national authorities. To overcome this delay, France has implemented a Temporary Authorization for Use (ATU) program that allows early access to drugs before MA, in order to treat patients with unmet medical needs. The objectives of our study were to establish the added therapeutic benefit (ATB) of ATUs for solid tumors and to investigate the correlations between three tools evaluating ATB and survival outcomes and drug costs. Data on ATUs granted from January 2009 to December 2019 to treat solid tumors were analyzed. An assessment of their ATB was conducted using the American Society of Clinical Oncology‐Value Framework (ASCO‐VF), the European Society for Medical Oncology‐Magnitude Clinical Benefit Scale (ESMO‐MCBS) and the French HTA criterion, clinical added value (CAV). The latter score determines reimbursement and national market access. Thirty‐five drugs in 39 indications were granted ATUs. All of them obtained MA and derived a clinical benefit to be reimbursed by the Social Security. Twenty‐eight (71.8%) had CAV compared to preexisting therapies. 24/38 (63.2%) had a 4‐5 ESMO‐MCBS score and 19/33 (57.6%) had an ASCO‐VF score over 45. No correlations were found between cost, PFS, OS, CAV and ASCO‐VF score, while high ESMO‐MCBS scores were correlated to OS. In conclusion, many patients were treated with innovations before MA thanks to ATU, although there are discrepancies between ATB scales, hence the importance of international collaboration in the evaluation of innovative therapies.
Collapse
Affiliation(s)
- Fiona Y-V Pham
- Oncology Hematology and Cell Therapy Department, French National Agency for Safety of Medicines and Health Products ANSM, Saint-Denis, France.,Department of Pharmacy, Centre hospitalo-universitaire Hôpital Henri Mondor Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Emmanuelle Jacquet
- Department of Oncohematology, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Amina Taleb
- Department of Oncology, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Adrien Monard
- Oncology Hematology and Cell Therapy Department, French National Agency for Safety of Medicines and Health Products ANSM, Saint-Denis, France.,Department of Oncohematology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Ghania Kerouani-Lafaye
- Oncology Hematology and Cell Therapy Department, French National Agency for Safety of Medicines and Health Products ANSM, Saint-Denis, France
| | - Florence Turcry
- Oncology Hematology and Cell Therapy Department, French National Agency for Safety of Medicines and Health Products ANSM, Saint-Denis, France
| | - Liora Brunel
- Oncology Hematology and Cell Therapy Department, French National Agency for Safety of Medicines and Health Products ANSM, Saint-Denis, France
| | - Françoise Grudé
- Oncology Hematology and Cell Therapy Department, French National Agency for Safety of Medicines and Health Products ANSM, Saint-Denis, France
| | - Isabelle Yoldjian
- Oncology Hematology and Cell Therapy Department, French National Agency for Safety of Medicines and Health Products ANSM, Saint-Denis, France
| | - Isabelle Sainte-Marie
- Oncology Hematology and Cell Therapy Department, French National Agency for Safety of Medicines and Health Products ANSM, Saint-Denis, France
| | - Lotfi Boudali
- Oncology Hematology and Cell Therapy Department, French National Agency for Safety of Medicines and Health Products ANSM, Saint-Denis, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Nicolas Albin
- Oncology Hematology and Cell Therapy Department, French National Agency for Safety of Medicines and Health Products ANSM, Saint-Denis, France.,Department of Oncohematology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| |
Collapse
|
11
|
Re: Comparative study on anticancer drug access times between FDA, EMA and the French temporary authorisation for use program over 13 years: French temporary authorisation for use (ATU) and early access to therapeutic innovations: there are still many patients slipping through the cracks. Eur J Cancer 2021; 156:217-221. [PMID: 34400059 DOI: 10.1016/j.ejca.2021.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022]
|