Abstract
BackgroundWe surveyed evidence published by Ireland’s National Centre for Pharmacoeconomics (NCPE) on the cost-effectiveness of cancer drugs approved for funding within the Irish public healthcare system. The purpose is threefold: to assess the completeness and clarity of publicly available cost-effectiveness data of such therapies; to provide summary estimates of that data; to consider the implications of constraints on data availability for accountability regarding healthcare resource allocation.MethodsThe National Cancer Control Programme lists 91 drug-indication pairs approved between June 2012 and July 2020. Records were retrieved from the NCPE website for each drug-indication pair, including, where available, health technology assessment (HTA) summary reports. We assessed what cost-effectiveness data regarding approved interventions is available, aggregated it and considered the consequences of reporting constraints.ResultsAmong the 91 drug-indication pairs 61 were reimbursed following full HTA, 22 after a rapid review process and 8 have no corresponding NCPE record. Of the 61 where an HTA report was available, 41 presented costs and quality-adjusted life-year (QALY) estimates of the interventions compared. Cost estimates and corresponding incremental cost-effectiveness ratios (ICERs) are based on prices on application for reimbursement. Reimbursed prices are not published. Aggregating over the drug-indication pairs for which data is available, we find a mean incremental health gain of 0.85 QALY and an aggregate ICER of €100,295/QALY, which exceeds Ireland’s cost-effectiveness threshold of €45,000/QALY.ConclusionReimbursement applications by pharmaceutical manufacturers for cancer drugs typically exceed Ireland’s cost-effectiveness threshold, often by a considerable margin. On aggregate, the additional total net cost of new drugs relative to current treatments needs to be more than halved for the prices sought on application to be justified for reimbursement. Commercial confidentiality regarding prices and cost-effectiveness upon reimbursement compromises accountability regarding the fair and efficient allocation of scarce healthcare resources.
Highlights
This study considers Ireland’s health technology assessment (HTA) framework for the assessment of cancer drugs and surveys the completeness of the cost-effectiveness evidence made public
We considered each pair separately unless the relevant National Centre for Pharmacoeconomics (NCPE) HTA summary aggregated the cost-effectiveness of the indications together
This includes the basecase incremental cost-effectiveness ratios (ICERs), incremental costs and quality-adjusted life-year (QALY), 5-year gross budget impact and records if costs and QALYs were reported for all the treatment strategies mentioned within the summary
Summary
This study considers Ireland’s health technology assessment (HTA) framework for the assessment of cancer drugs and surveys the completeness of the cost-effectiveness evidence made public It uses this assessment of the constraints. The provision of pharmaceuticals by the HSE is subject to the 2013 Health Act, Schedule 3, Part 3 of which obliges the HSE to consider the costeffectiveness and budget impact of candidate interventions alongside seven other points of consideration [9]. This is manifest in the requirement of manufacturers to submit a pharmacoeconomic evaluation (PE) to the HSE’s Corporate Pharmaceutical Unit when seeking approval for the reimbursement of new therapies. Commercial confidentiality regarding prices and cost-effectiveness upon reimbursement compromises accountability regarding the fair and efficient allocation of scarce healthcare resources
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