Abstract
BackgroundReimbursement policies for anti-cancer drugs vary among countries even though they rely on the same clinical evidence. We compared the pattern of publicly funded drug programs and analyzed major factors influencing the differences.MethodsWe investigated reimbursement policies for 19 indications with targeted anti-cancer drugs that are used variably across ten countries. The available incremental cost-effectiveness ratio (ICER) data were retrieved for each indication. Based on the comparison between actual reimbursement decisions and the ICERs, we formulated a reimbursement adequacy index (RAI): calculating the proportion of cost-effective decisions, either reimbursement of cost-effective indications or non-reimbursement of cost-ineffective indications, out of the total number of indications for each country. The relationship between RAI and other indices were analyzed, including governmental dependency on health technology assessment, as well as other parameters for health expenditure. All the data used in this study were gathered from sources publicly available online.ResultsJapan and France were the most likely to reimburse indications (16/19), whereas Sweden and the United Kingdom were the least likely to reimburse them (5/19 and 6/19, respectively). Indications with high cost-effectiveness values were more likely to be reimbursed (ρ = −0.68, P = 0.001). The three countries with high RAI scores each had a healthcare system that was financed by general taxation.ConclusionsAlthough reimbursement policies for anti-cancer drugs vary among countries, we found a strong correlation of reimbursements for those indications with lower ICERs. Countries with healthcare systems financed by general taxation demonstrated greater cost-effectiveness as evidenced by reimbursement decisions of anti-cancer drugs.
Highlights
Reimbursement policies for anti-cancer drugs vary among countries even though they rely on the same clinical evidence
We found a strong correlation of reimbursements for indications with lower incremental cost-effectiveness ratio (ICER) (ρ = −0.68, P = 0.001); the indication with lower ICER was more likely to be reimbursed (Figure 1)
The present study shows that reimbursement policies for anti-cancer drugs vary among countries even though they rely on the same clinical evidence of those drugs
Summary
Reimbursement policies for anti-cancer drugs vary among countries even though they rely on the same clinical evidence. To provide guidelines for such kinds of questions, many countries have adopted evidence-based health technology assessment (HTA) programs that analyze the clinical and cost-effectiveness of selected medical technologies to serve as part of the basis for their recommendations [3,10,11,12]. Using their national assessment programs, France, Germany, and the United Kingdom (UK) have decided not to reimburse erlotinib for first-line treatment of advanced pancreatic cancer, whereas Korea, Japan, and the United States (US) have chosen to reimburse this indication
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