Negative Decision Research Articles

VS 03 - BN Laparoscopic Excision of Aortic Schwannoma

Abstract Background This video presentation describes a laparoscopic approach to the excision of a large retroperitoneal cyst in a 39 year old female presenting with generalised abdominal pain. The patient had a background of Type 2 Diabetes, as well as a laparoscopic hysterectomy. Method The patient presented acutely with the above symptoms. CT and MRI both confirmed a large retroperitoneal cyst measuring 8x9cm. EUS was performed showed a thin walled cyst and a normal pancreas. FNA cytology was benign, hydatid serology was negative Results MDT decision was to go ahead with formal surgical resection. Laparoscopic excision of the cyst was performed, demonstrating that the pancreas was displaced anteriorly, with the coeliac axis displaced to the right. The cyst did not involve the pancreas or adrenal gland. Post operative histology found the cyst to be an aortic schwannoma. Conclusion This video demonstrates the complex retroperitoneal dissection that can be performed laparoscopically. The patient was discharged on post op day 8 with surveillance follow up

(In)credibly queer? Assessments of asylum claims based on sexual orientation

AbstractPurposeQueer asylum‐seekers should be given an opportunity to have their claim evaluated in a fair and unbiased manner. Despite this, research shows they risk having their claims rejected based on stereotypes about sexual minorities. In the present study, we investigated how the Finnish Immigration Service evaluated credibility in asylum claims lodged by sexual minorities.MethodsWe analysed 68 negative asylum decisions to assess the arguments made to reject the asylum claim. To do this, we developed a detailed coding scheme to investigate the specific themes and credibility indicators cited in the asylum decisions.ResultsWe found that the asylum claims were most often rejected because the applicant's account of their sexual orientation was not found to be sufficiently detailed, consistent, or plausible. Officials appeared to hold assumptions around sexual identity development and interpersonal relationships that are partially unsupported by established psychological science.ConclusionsAssessments of SOGI claims would benefit from a greater consideration of the factors affecting queer asylum applicants' ability to describe their claims, including cross‐cultural differences in understandings of sexuality, variability in human behaviour, and practical barriers within the asylum procedure.

An attribution of value framework for combination treatments

The use of cost-effectiveness methods to support policy decisions has become well established but difficulties can arise when evaluating a new treatment which is indicated to be used in combination with an established "backbone treatment." If the latter has been priced close to the decision maker's willingness to pay threshold, this may mean that there is no headroom for the new treatment to demonstrate value, at any price, even if the combination is clinically effective. Without a mechanism for attributing value to component treatments within a combination therapy, the health system risks generating negative funding decisions for combinations of proven clinical benefit to patients. The aim of this work was to define a value attribution methodology which could be used to allocate value between the components of any combination treatment. The framework is grounded in the standard decision rules of cost-effectiveness analysis and provides solutions according to key features of the problem: perfect/imperfect information about component treatment monotherapy effects and balanced/unbalanced market power between their manufacturers. The share of incremental value varies depending on whether there is perfect/imperfect information and balance/imbalance of market power, with some scenarios requiring the manufacturers to negotiate a share of the incremental value within a range defined by the framework. It is possible to define a framework that is independent of price and focuses on benefits expressed as Quality-Adjusted Life-Year (QALY) gains (and/or QALY equivalents for cost-savings), a standard metric used by many HTA agencies to evaluate novel treatments.

Application of a Machine Learning Predictive Model for Recurrent Acute Pancreatitis.

Acute pancreatitis is the main cause of hospitalization for pancreatic disease. Some patients tend to have recurrent episodes after experiencing an episode of acute pancreatitis. This study aimed to construct predictive models for recurrent acute pancreatitis (RAP). A total of 531 patients who were hospitalized for the first episode of acute pancreatitis at the Affiliated Hospital of Southwest Medical University from January 2018 to December 2019 were enrolled in the study. We confirmed whether the patients had a second episode until December 31, 2021, through an electronic medical record system and telephone or WeChat follow-up. Clinical and follow-up data of patients were collected and randomly allocated to the training and test sets at a ratio of 7:3. The training set was used to select the best model, and the selected model was tested with the test set. The area under the receiver operating characteristic curves, sensitivity, specificity, positive predictive value, negative predictive value, accuracy, decision curve, and calibration plots were used to assess the efficacy of the models. Shapley additive explanation values were used to explain the model. Considering multiple indices, XGBoost was the best model. The area under the receiver operating characteristic curves, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the XGBoost model in the test set were 0.779, 0.763, 0.883, 0.647, 0.341, and 0.922, respectively. According to the Shapley additive explanation values, drinking, smoking, higher levels of triglyceride, and the occurrence of ANC are associated with RAP. The XGBoost model shows good performance in predicting RAP, which may help identify high-risk patients.

Interrater agreement and variability in visual reading of [18F] flutemetamol PET images.

The purpose of this study was to validate the concordance of visual ratings of [18F] flutemetamol amyloid positron emission tomography (PET) images and to investigate the correlation between the agreement of each rater and the Centiloid (CL) scale. A total of 192 participants, clinically classified as cognitively normal (CN) (n = 59), mild cognitive impairment (MCI) (n = 65), Alzheimer's disease (AD) (n = 55), or non-AD dementia (n = 13), participated in this study. Three experts conducted visual ratings of the amyloid PET images for all 192 patients, assigning a confidence level to each rating on a three-point scale (certain, probable, or neither). The positive or negative determination of amyloid PET results was made by majority vote. The CL value was calculated using the CapAIBL pipeline. Overall, 101 images were determined to be positive, and 91 images were negative. Of the 101 positive images, the three raters were in complete agreement for 92 images and in disagreement for 9 images. Of the 91 negative images, the three raters were in complete agreement for 75 images and in disagreement for 16 images. Interrater reliability among the three experts was particularly high, with both Fleiss' kappa and Conger's kappa measuring 0.83 (0.76-0.89). The CL values of the unanimous positive group were significantly greater than those of the other groups, whereas the CL values of the unanimous negative group were significantly lower than those of the other groups. Images with rater disagreement had intermediate CLs. In cases with a high confidence level, the positive or negative visual ratings were in almost complete agreement. However, as confidence levels decreased, experts' visual ratings became more variable. The lower the confidence level was, the greater the number of cases with disagreement in the visual ratings. Three experts independently rated 192 amyloid PET images, achieving a high level of interrater agreement. However, in patients with intermediate amyloid accumulation, visual ratings varied. Therefore, determining positive and negative decisions in these patients should be performed with caution.

Baseline 18F-FDG PET Radiomics Predicting Therapeutic Efficacy of Diffuse Large B-Cell Lymphoma after R-CHOP (-Like) Therapy.

Objective: This study aimed to predict therapeutic efficacy among diffuse large B-cell lymphoma (DLBCL) after R-CHOP (-like) therapy using baseline 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) radiomics. Methods: A total of 239 patients with DLBCL were enrolled in this study, with 82 patients having refractory/relapsed disease. The radiomics signatures were developed using a stacking ensemble approach. The efficacy of the radiomics signatures, the National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI), conventional PET parameters model, and their combinations in assessing refractory/relapse risk were evaluated using receiver operating characteristic (ROC) curves, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and decision curve analysis. Results: The stacking model, along with the integrated model that combines stacking with the NCCN-IPI and SDmax (the distance between the two lesions farthest apart, normalized to the patient's body surface area), showed remarkable predictive capabilities with a high area under the curve (AUC), sensitivity, specificity, PPV, NPV, accuracy, and significant net benefit of the AUC (NB-AUC). Although no significant differences were observed between the combined and stacking models in terms of the AUC in either the training cohort (AUC: 0.992 vs. 0.985, p = 0.139) or the testing cohort (AUC: 0.768 vs. 0.781, p = 0.668), the integrated model exhibited higher values for sensitivity, PPV, NPV, accuracy, and NB-AUC than the stacking model. Conclusion: Baseline PET radiomics could predict therapeutic efficacy in DLBCL after R-CHOP (-like) therapy, with improved predictive performance when incorporating clinical features and SDmax.

A Systematic Analysis of Read-Across Adaptations in Testing Proposal Evaluations by the European Chemicals Agency.

An important element of the European Union's "Registration, Evaluation, Authorisation and Restriction of Chemicals" (REACH) regulation is the evaluation by the European Chemicals Agency (ECHA) of testing proposals submitted by the registrants to address data gaps in standard REACH information requirements. The registrants may propose adaptations, and ECHA evaluates the reasoning and issues a written decision. Read-across is a common adaptation type, yet it is widely assumed that ECHA often does not agree that the justifications are adequate to waive standard testing requirements. From 2008 to August 2023, a total of 2,630 Testing Proposals were submitted to ECHA; of these, 1,538 had published decisions that were systematically evaluated in this study. Each document was manually reviewed, and information extracted for further analyses. Read-across hypotheses were standardized into 17 assessment elements (AEs); each submission was classified as to the AEs relied upon by the registrants and by ECHA. Data was analyzed for patterns and associations. Testing Proposal Evaluations (TPEs) with adaptations comprised 23% (353) of the total; analogue (168) or group (136) read-across adaptations were most common. Of 304 read-across-containing TPEs, 49% were accepted; the odds of acceptance were significantly greater for group read-across submissions. The data was analyzed by Annex (i.e., tonnage), test guideline study, read-across hypothesis AEs, as well as target and source substance types and their structural similarity. While most ECHA decisions with both positive and negative decisions on whether the proposed read-across was adequate were context-specific, a number of significant associations were identified that influence the odds of acceptance. Overall, this analysis provides an unbiased overview of 15 years of experience with testing proposal-specific read-across adaptations by both registrants and ECHA. These data will inform future submissions as they identify most critical AEs to increase the odds of read-across acceptance.

Climate litigation and financial markets: A disciplinary effect?

Climate litigation has witnessed a surge in recent decades, raising questions about its economic and financial implications. This paper investigates the disciplinary effect of climate litigation on corporations, focusing on stock price movements for targeted firms and their industry peers in response to announcements of lawsuit filings and negative court decisions. By using a combined event study and panel regression methodology for 77 lawsuit filings and 19 negative decisions that occurred between 2005 and 2021 in North America or Europe, we find that market reactions are quite limited. On average, lawsuit filings do not lead to stock price declines for targeted entities and their industry peers, indicating a lack of perceived financial threat by financial markets. Negative court rulings, while slightly affecting targets, do not result in spillovers to industry peers. However, nuances emerge, revealing that an increased frequency of lawsuits filings generates stronger stock declines for the industry around new filings. Regarding claims, legal actions seeking compensatory damages result in more negative stock returns when initiated. Also, lawsuits brought by individuals and NGOs, as opposed to government bodies, lead to stronger negative market reactions towards targets and peers around both filings and negative decisions. In the end, despite attracting significant media attention, our findings suggest that the disciplinary effect of climate litigation has been relatively weak thus far.

Linking Reimbursement to Patient Benefits for Advanced Therapy Medicinal Products and Other High-Cost Innovations: Policy Recommendations for Outcomes-Based Agreements in Europe

ObjectivesHealth technology assessment (HTA) of advanced therapy medicinal products (ATMPs), such as high-cost and one-time cell and gene therapies, is particularly challenging. Outcomes-based agreements (OBAs) are a potential solution to mitigate the risks while providing access to patients but are not widely used across Europe. This study aimed to develop policy recommendations to support the acceptability and implementation of OBAs in Europe. MethodsA policy sandbox approach was used to engage with stakeholders and explore how HTA organizations can support reimbursement decisions regarding OBAs for ATMPs. A panel of 38 experts from across the European region was convened in 2 workshops, representing payers, HTA organizations, patients, registries, and an industry trade body. ResultsPolicy recommendations were developed to support the appropriate consideration of OBAs for reimbursing highly uncertain technologies, such as ATMPs. If a positive HTA recommendation cannot be made at the proposed price, then a simple price discount reflecting the uncertainty is preferred over complex solutions such as OBAs. If an OBA is pursued, it should be designed collaboratively with all stakeholders to understand data collection feasibility and minimize burden to patients and providers. Payers are encouraged to approach OBAs as a tool for informed decision making, including a readiness to make negative reimbursement decisions based on unfavorable evidence. ConclusionsThe study presents a policy framework for using OBAs in reimbursement decisions. OBAs must be carefully designed, focusing on appropriateness and the burden of implementation. The relevant authorities should be committed to making decisions in light of the resulting evidence.

ON THE ISSUE OF INCREASING PUBLIC CONFIDENCE IN THE JUDICIAL SYSTEM

Trust in the judicial system is an important indicator of the quality of the administration of justice. Kazakhstan's world ranking remains insufficient and needs constant improvement. Kazakhstan is currently working to improve public confidence in the court and the judicial system. Resonant publications in the mass media and social networks also testify to the low trust of society. The reasons for such distrust are internal problems that have acquired a systemic nature. As judicial practice and pre-trial conversations show, there is a common practice in courts among judges, the execution of an oral order by the management of the court or a higher court. Such behavior of judges consists in the presence of administrative levers of pressure on the judge. There are several such levers. The first way to put pressure on a judge is to evaluate his professional activity. If a judge has overturned decisions by higher courts and certain violations of judicial ethics, the Commission on the Quality of the Administration of Justice may make a negative decision. The second method of administrative levers of pressure on the judge is to bring the judge to disciplinary responsibility by reviewing the judge's personal file in the Judicial Jury. If a judge has overturned decisions by higher courts and certain violations of judicial ethics, the Judicial Jury may also make a negative decision. All these levers force the judge to make decisions that are beneficial to the higher court or the leadership of the court, thereby undermining the foundations of justice. To this end, it is important to take a number of important measures. The first of which is the selection of personnel for the judicial system. The second is to eradicate the practice of holding judges accountable for a cancelled or amended decision.

Reproducing displaceability in the Greek asylum accommodation system and its margins

Since 2015–2016, in the context of the so-called ‘refugee crisis’, new asylum policies altered the landscape of accommodation, housing, displacement, and (il)legalisation in Greece. This paper aims to explore the impact that the reception system established in 2016 has on everyday accommodation and urban experiences of refugees as regards their relationships with space and social connections. In doing so, it brings to the forefront the concept of ‘displaceability’ as an ongoing, non-linear, and relational sociospatial process, interrelated with housing precarity and illegalisation, through which the connections between people and places are ruptured. The paper, first, focuses on how processes and experiences of displaceability emerge for those entitled to asylum accommodation in Greece. Secondly, it examines how displaceability also concerns displaced people found at the margins of accommodation after their asylum claim has been processed, including both the cases of recognised beneficiaries of international protection and refugees with a negative decision. Thirdly, it discusses aspects of the experiences of those outside the reception system and accommodation sites, such as people arriving in Athens through informal and unregistered mobilities. The paper is based on research conducted in metropolitan Athens, Greece, as part of the TRAFIG Horizon 2020 research project.

The nomination of Rev. Kazimierz Rolewski as bishop of Katowice and the reasons for the refusal

Rev. Kazimierz Rolewski (1887–1936) — parish priest in the Archdiocese of Poznań, rector of the theological seminary, and radio preacher — remains an inspiring figure to this day, as evidenced by the ongoing beatification process. Many people remember him as a priest who refused to accept the episcopal nobleness. This article refers to this common opinion in light of the Vatican archives. It is an attempt to highlight the important character traits of the discussed figure, especially his humility and sincerity. Based on the source analysis method, the article presents facts about Rev. Rolewski before and after the proposal to take over the bishopric of Katowice. This article presents the genesis of the interest in the parish priest from Ostrów Wielkopolski as a candidate for the diocesan bishop in 1925–1926. It describes the circumstances of the negative decision made at the apostolic nunciature in Warsaw. The above piece, which attempts to highlight the character traits important for the discussed character — his humility and honesty — fills the current biographical gap of Rev. Rolewski.

Examining the Effect of Depicting a Patient Affected by a Negative Reimbursement Decision in Healthcare on Public Disagreement with the Decision.

The availability of increasingly advanced and expensive new health technologies puts considerable pressure on publicly financed healthcare systems. Decisions to not-or no longer-reimburse a health technology from public funding may become inevitable. Nonetheless, policymakers are often pressured to amend or revoke negative reimbursement decisions due to the public disagreement that typically follows such decisions. Public disagreement may be reinforced by the publication of pictures of individual patients in the media. Our aim was to assess the effect of depicting a patient affected by a negative reimbursement decision on public disagreement with the decision. We conducted a discrete choice experiment in a representative sample of the public (n = 1008) in the Netherlands and assessed the likelihood of respondents' disagreement with policymakers' decision to not reimburse a new pharmaceutical for one of two patient groups. We presented a picture of one of the patients affected by the decision for one patient group and "no picture available" for the other group. The groups were described on the basis of patients' age, health-related quality of life (HRQOL) and life expectancy (LE) before treatment, and HRQOL and LE gains from treatment. We applied random-intercept logit regression models to analyze the data. Our results indicate that respondents were more likely to disagree with the negative reimbursement decision when a picture of an affected patient was presented. Consistent with findings from other empirical studies, respondents were also more likely to disagree with the decision when patients were relatively young, had high levels of HRQOL and LE before treatment, and large LE gains from treatment. This study provides evidence for the effect of depicting individual, affected patients on public disagreement with negative reimbursement decisions in healthcare. Policymakers would do well to be aware of this effect so that they can anticipate it and implement policies to mitigate associated risks.

Fair Funding Decisions: Consistency of the Time Horizons Used in the Calculation of Quality-Adjusted Life Years for Therapies for Very Rare Diseases by the National Institute for Health and Care Excellence in England.

The National Institute for Health and Care Excellence (NICE) in England uses quality-adjusted life years (QALYs) to assess the cost-effectiveness of treatments. A QALY is a measure that combines the size of the clinical benefit of a treatment with the time the patient benefits from it, i.e., the time horizon. We wanted to know how consistently QALY gains are calculated at NICE. Therefore, we have analysed information on the time horizons used for the QALY calculations of the concluded evaluations conducted under the Highly Specialised Technologies programme for treatments of very rare diseases at NICE. For treatments with final guidance published by December 2023 (n = 29), a time horizon of median 97.5 years (range: 35 to 125 years) was used to calculate the QALY gains. For most QALY calculations, the accepted time horizon was longer than either the expected treatment duration or the estimated life expectancy. In contrast, for the only technology with a final negative funding decision, i.e., afamelanotide for treating the lifelong chronic disease erythropoietic protoporphyria, a time horizon that was shorter than the expected treatment duration was used. The fairness and consistency of the evaluation process of treatments for very rare diseases at NICE should be reviewed.

Semantic analysis of two-syllabic terms of metrology. Part 2: Risk in measurements and calculations

Prior to the requirement for testing and calibration laboratories to take into account the risk of statistical assumptions, false positive and false negative decisions in international documents, it was found that the methodology of the “Guide to Expressing Measurement Uncertainty” based on the Bayes approach and the Monte Carlo method for calculating probabilistic risk characteristics is not applicable. A later draft revision of the “Manual on the Expression of Measurement Uncertainty” attempted to shift the interpretation of measurement uncertainty from the scattering parameter to the probability distribution. An attempt to contribute to solving the problem of definitional uncertainty in the International Dictionary of Basic and Basic Terms of Metrology was also unsuccessful. In the new version of the dictionary of general statistical terms and probability theory terms, the term measurement uncertainty is excluded, and one of the notes states that “the probability distribution fully describes the probabilistic properties of the uncertainty of the result”. However, due to the new requirements for risk calculations, international documents were urgently put into effect without radical assessments of the inapplicability of the Bayes approach and the Monte Carlo method, the disadvantages were renamed limitations, but there are no specific instructions for calculating risks. Based on the experience of the compositional approach to estimating accuracy, a procedure based on the convolution of probability distributions in the form of a modified reversal formula is recommended, which allows taking into account the definitive uncertainty in the moment approach. It is established that the method of accounting for the definitive uncertainty by convolution of uniform distributions is practically suggested in the text of the “Manual on the expression of measurement uncertainty”, but not used.

The utilisation of a negative pressure wound therapy clinical decision tree in an acute care setting tissue viability service

The utilisation of a negative pressure wound therapy clinical decision tree in an acute care setting tissue viability service

Issues in Clinical Studies Leading to Medical Research Ethics Committee (MREC) Negative Decisions

The rationale behind a Medical Research Ethics Committee (MREC) negative decision is always shared directly with the applicants. However, insight into the review process and common reasons for a negative decision may also be valuable for other researchers, clinical research organizations and people with an interest in MREC processes. To our knowledge Medical Research Ethics Committees (MRECs) do generally not report on the negative decisions they issue and on the underlying rationale for such decisions. Here we give insight into the MREC review process by briefly describing procedures and discussing the negative decisions issued by MREC NedMec in the past five years.

Machine learning for the early prediction of acute respiratory distress syndrome (ARDS) in patients with sepsis in the ICU based on clinical data

BackgroundAcute respiratory distress syndrome (ARDS) is a fatal outcome of severe sepsis. Machine learning models are helpful for accurately predicting ARDS in patients with sepsis at an early stage. ObjectiveWe aim to develop a machine-learning model for predicting ARDS in patients with sepsis in the intensive care unit (ICU). MethodsThe initial clinical data of patients with sepsis admitted to the hospital (including population characteristics, clinical diagnosis, complications, and laboratory tests) were used to predict ARDS, and screen out the crucial variables. After comparing eight different algorithms, namely, XG boost, logistic regression, light GBM, random forest, GaussianNB, complement NB, support vector machine (SVM), and K nearest neighbors (KNN), rebuilding a prediction model with the best one. When remodeling with the best algorithm, 10% was randomly selected to test, and the remaining was trained for cross-validation. Using the area under the curve (AUC), sensitivity, accuracy, specificity, positive and negative predictive value, F1 score, kappa value, and clinical decision curve to evaluate the model's performance. Eventually, the application in the model illustrated by the SHAP package. ResultsTen critical features were screened utilizing the lasso method, namely, PaO2/PAO2, A-aDO2, PO2(T), CRP, gender, PO2, RDW, MCH, SG, and chlorine. The prior ranking of variables demonstrated that PaO2/PAO2 was the most significant variable. Among the eight algorithms, the performance of the Gaussian NB algorithm was significantly better than that of the others. After remodeling with the best algorithm, the AUC in the training and validation sets were 0.777 and 0.770, respectively, and the algorithm performed well in the test set (AUC = 0.781, accuracy = 78.6%, sensitivity = 82.4%, F1 score = 0.824). A comparison of the overlap factors with those of previous models revealed that the model we developed performs better. ConclusionSepsis-associated ARDS can be accurately predicted early via a machine learning model based on existing clinical data. These findings are helpful for accurate identification and improvement of the prognosis in patients with sepsis-associated ARDS.

Nonbinary people in the family context: a systematic review and meta-analysis

Background The present systematic review and meta-analysis explores the family context of nonbinary individuals. Aim The present systematic review and meta-analysis aim to summarize the studies investigating the life experiences of nonbinary people in their family context. Methods The articles included were systematically searched in four scientific databases (i.e. PsychInfo, Pubmed, Scopus, and Web of Science) from March to October 2023. The inclusion criteria encompassed original articles with solely nonbinary participants or studies where nonbinary people were distinguished from the overall sample. We excluded studies with participants identifying outside binary gender without specifying as nonbinary and articles lacking original data. Of the 2837 records identified, 37 articles were included. Results We identified five research themes: (a) family support (n = 16), (b) family reactions (n = 14), (c) disclosure (n = 8), (d) violence and victimization (n = 7), and (e) family functioning, well-being, and mental health (n = 4). In most studies on family reactions to nonbinary gender identity, family members’ negative feelings were prevalent. We used a meta-analytic procedure to compare family support received by nonbinary individuals to both binary transgender people and cisgender people. Findings suggested that nonbinary people perceived less support than both binary (d = 0.18; 6 studies) and cisgender people (d = 0.61; 5 studies). Conclusion Numerous studies indicated positive relationships with siblings who provided significant support. Coming-out experiences exhibited varying results: Some studies reported positive interactions with family members, while others highlighted negative experiences or decisions to hide gender identity in the family context. Most studies indicated a higher incidence of violence and victimization from family members. The present review and meta-analysis underscore the family’s pivotal role in interventions and emphasize the relevance of collaborating with families to promote the well-being and affirmation of nonbinary people.

Scoping Review of International Experience of a Dedicated Fund to Support Patient Access to Cancer Drugs: Policy Implications for Thailand

Background: Access to high-cost cancer drugs is an unsolved problem globally. The dedicated drugs fund is attractive and feasible. This study reviewed currently implemented dedicated drugs fund worldwide to inform policy implications for Thailand. Methods: A scoping review was conducted to identify countries currently implementing dedicated funds for cancer drugs. We searched electronic databases, PubMed and Embase, from 2010 to May 2021, Google and Google Scholar in August 2021, and government websites up to April 2022. The structure, management, cost containment strategies, and impact of dedicated funds were summarized and compared across the identified countries and Thailand. Results: Out of 218 nations, Hong Kong, England, and Italy have established dedicated cancer drugs fund, primarily funded by their governments. Funds in England and Italy operate within annual budget limits. Hong Kong relies on an endowment fund. In England and Italy, pharmaceutical companies contribute proportionally to cover overspending as per risk-sharing agreements, while cost-sharing is not required. Hong Kong implements cost-sharing based on a patient's family income. England and Italy employ a parallel pathway, utilizing the same drug selection committee to determine whether innovative drugs belong in the regular pharmaceutical benefits package or the dedicated drugs fund. Hong Kong follows a sequential pathway, allowing drugs to be considered for the dedicated funds after a negative decision. These countries use the fund for 5-11 years, making administrative adjustments to ensure sustainability. Conclusion: The dedicated drugs fund is an effective strategy to improve access to non-reimbursable high-cost drugs in Thailand. Robust evaluation of the fund itself and funded drugs are recommended for policymakers’ better decision-making. Learning from other countries can offer promising solutions. Health insurers need to balance providing cancer treatments with overall system preparedness.