Abstract
BackgroundLittle comparative evidence is available on utilisation of cancer medicines in different countries and its determinants. The aim of this study was to develop a statistical model to test the correlation between utilisation and possible determinants in selected European countries.MethodsA sample of 31 medicines for cancer treatment that obtained EU-wide marketing authorisation between 2000 and 2012 was selected. Annual data on medicines’ utilisation covering the in- and out-patient public sectors were obtained from national authorities between 2008 and 2013. Possible determinants of utilisation were extracted from HTA reports and complemented by contacts with key informants. A longitudinal mixed effect model was fitted to test possible determinants of medicines utilisation in Belgium, Scotland and Sweden.ResultsIn the all-country model, the number of indications reimbursed positively correlated with increased consumption of medicines [one indication 2.6, 95% CI (1.8–3.6); two indications 2.4, 95% CI (1.4–4.3); three indications 4.9, 95% CI (2.2–10.9); all P < 0.01], years since EU-wide marketing authorisation [1.2, 95% CI (1.02–1.4); p < 0.05], price per DDD [0.9, 95% CI (0.998–0.999), P < 0.01], and Prescrire rating [0.5, 95% CI (0.3–0.9), P < 0.05] after adjusting for time and other covariates.ConclusionsIn this study, the most important correlates of increased utilisation in a sample of cancer medicines introduced in the past 15 years were: medicines coverage and time since marketing authorisation. Prices had a negative effect on consumption in Belgium and Sweden. The positive impact of financial MEAs in Scotland suggests that the latter may remove the regressive effect of list prices on consumption.
Highlights
Managing the introduction of new, high-priced cancer medicines is a challenge for countries at all levels of development
While important differences exist in the way individual countries implement health technology assessment (HTA), they all include in their analysis and decision-making process information on the efficacy and effectiveness and, to different extents, information on the price of the new medicine
Using the anatomic therapeutic chemical (ATC) search function for European Public Assessment Reports available from the website of the European Medicines Agency (EMA), all antineoplastic (ATC-L01) and endocrine (ATC-L02) medicines authorised in the European Union (EU) and the European Economic Area countries (Iceland, Liechtenstein and Norway) were identified
Summary
Managing the introduction of new, high-priced cancer medicines is a challenge for countries at all levels of development. While important differences exist in the way individual countries implement HTA, they all include in their analysis and decision-making process information on the efficacy and effectiveness and, to different extents, information on the price of the new medicine. Results In the all-country model, the number of indications reimbursed positively correlated with increased consumption of medicines [one indication 2.6, 95% CI (1.8–3.6); two indications 2.4, 95% CI (1.4–4.3); three indications 4.9, 95% CI (2.2–10.9); all P \ 0.01], years since EU-wide marketing authorisation [1.2, 95% CI (1.02–1.4); p \ 0.05], price per DDD [0.9, 95% CI (0.998–0.999), Electronic supplementary material The online version of this article (doi:10.1007/s10198-016-0855-5) contains supplementary material, which is available to authorized users
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