Abstract
Each country manages access to anticancer drugs differently due to variations in the structure and financing of the health system, but a summary of the various strategies used is absent. This study aimed to review and summarize financing strategies implemented across countries to facilitate access to high-cost anticancer drugs. We conducted a systematic review of articles referenced in PubMed, Embase, and Web of Science through May 12, 2021. Articles published in the English language from 2000 that describe strategies implemented in different countries to facilitate access to high-cost anticancer drugs were included. Letters, news articles, and proposed strategies were excluded. Quality assessment was not performed as we aimed to summarize the strategies. Data were analyzed by thematic analysis. A review protocol was registered at PROSPERO (CRD42018068616). The review included 204 studies from 176 countries. Three themes of financing strategies were identified: (1) Basic pharmaceutical reimbursement and pricing policies, (2) Alternative funding strategies specific to high-cost drugs, and (3) Financial assistance for individual patients. Access in most countries depends mainly on basic pharmaceutical reimbursement policies (165 of 176 countries). Apart from that, high-income countries (HICs) tended to use funding strategies targeting high-cost drugs (72% of HICs vs 0%-24% of the rest), such as managed entry agreements (MEAs) or dedicated funds for high-cost drugs. In contrast, lower-income countries tended to implement financial assistance programs for cancer patients as a tool to increase access (32% of HICs vs 62%-79% of the rest). Many countries have implemented a combination of strategies to increase access to high-cost anticancer drugs. Most low- and middle-income countries utilized placement of anticancer drugs on a national list of essential medicines and patient assistance programs (PAPs) to facilitate access, while many HICs implemented a broader range of strategies.
Highlights
Cancer is a leading cause of death with 9.6 million deaths worldwide in 2018.1 Many effective therapies are available for cancer including surgery, radiation, and anticancer drugs
There were 172 studies describing strategies implemented in high-income countries (HICs), 56 studies in upper middleincome countries (U-MICs), 25 studies in lower middle-income countries (L-MICs), and 11 studies in low-income countries (LICs)
Strategies were organized in the following categories: 1) Basic pharmaceutical reimbursement and pricing policies included features of the basic reimbursement and pricing system in countries tailored to provide access to anticancer drugs to their population; 2) Funding strategies specific to high-cost drugs included add-on strategies used to provide access to high-cost drugs such as orphan or anticancer drugs when the basic pharmaceutical reimbursement and pricing policies are insufficient; 3) Financial assistance for individual patients included addon strategies intended to provide financial support for cancer patients by either government or non-government organizations
Summary
Cancer is a leading cause of death with 9.6 million deaths worldwide in 2018.1 Many effective therapies are available for cancer including surgery, radiation, and anticancer drugs. Healthcare systems face challenges in providing access to anticancer drugs for patients who need them while controlling the overall cost of cancer care which has been increasing rapidly over the past two decades. It was found that the median annual price of anticancer drugs has been increasing from US$12 000 to more than US$120 000 over the past two decades.[2] The recently developed anticancer drugs such as CAR T-cell therapy are even more expensive with treatment cost up to US$500 000 per year.[4] Given the rising costs of anticancer drugs, payers are unlikely to provide unconditional reimbursement as a long-term solution. To stay within a pharmaceutical budget, reimbursements are often restricted to indications that provide demonstrated value for money. Such restrictions can deny access to potentially useful therapy for patients in high need
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