Global variations in reimbursement of new cancer therapeutics: Improving access through risk-sharing agreements.

Abstract

6050 Background: The cost of cancer treatments are rising globally. We examined access to new cancer therapeutics among various countries to identify innovative strategies to increase reimbursement when cost is a concern. Methods: We surveyed England (ENG), Scotland (SCO), France (FRA), Italy (ITA), Germany (DEU), Netherlands (NLD), Finland (FIN), Sweden (SWE), Australia (AUS), New Zealand (NZL) and Canada (Province of Ontario) (CAN), regarding their respective reimbursement decisions for 10 cancer therapeutics (Bevacizumab, Bortezomib, Cetuximab, Erlotinib, Imatinib, Pemetrexed, Rituximab, Sorafenib, Sunitinib and Traztuzumab) to determine access as of December 31, 2009, indications reimbursed and new approaches to purchasing, e.g., risk-sharing arrangements (RSAs). RSAs were defined as either price volume agreements, volume caps, patient access schemes involving free drug, or payment by results based on outcomes. If health authorities quoted ‘special pricing arrangements’ (SPAs) for reasons of confidentiality, this was taken to include RSAs. Results: 67% of countries implemented a RSA for ≥ 1 cancer therapeutic studied. ENG, SCO, FRA, ITA, AUS implemented them nationally. SWE and CAN implemented them regionally/provincially. Countries that factor disease severity in reimbursement decisions (FIN, FRA, and SWE) and/or strong price negotiations or rebates (FRA, ITA, DEU) reimbursed a median average of 100% (range 90%, 100%) of 42 identified licensed indications (FRA 90%; ITA, FIN, DEU and SWE 100%). Countries/provinces where the main driver for reimbursement is cost effectiveness, reimbursed a median average of 49% (range 26%, 88%) (NLD 88%; AUS 55%; CAN 52%; ENG 45%; SCO 40%; NZL 26%). Health authorities in 5 of these countries had a high rate of rejecting initial submissions due to excessive costs (NZL 87%; AUS 71%; SCO 61%; ENG and CAN 50%). Applying RSAs to the rejected submissions led to approval of 2 indications in SCO, 3 in ENG, and SPAs led to approval of 4 indications in CAN and 9 in AUS. Conclusions: Access to innovative cancer therapeutics is highly variable globally. RSAs appear to enhance reimbursement where there are concerns with costs for new cancer agents. No significant financial relationships to disclose.