New study finds substantial differences in health technology assessment of cancer drugs in high-income countries
A new cross-sectional study of health technology assessment (HTA) for cancer drugs across the G7 and Oceania high-income countries reports discordance in funding decisions, despite similar assessment criteria. The findings underscore the importance of efforts towards international alignment between HTA organisations to ensure high-value cancer medicines are accessible to patients and ultimately to improve health outcomes.
A new study published at the start of this June in Lancet Oncology has found substantial differences in cancer drug funding decisions across economically comparable high-income countries, despite similar health technology assessment (HTA) criteria. The study was conducted by Kristina Jenei of the London School of Economics and Political Science (LSE) and Bishal Gyawali, Associate Professor of Oncology and Public Health Sciences of Queen’s University, Kingston, Canada, and underscores the importance for ongoing initiatives for international alignment between HTA organisations to ensure improved access to high-value cancer medicines, and deprioritization of low-value cancer medicines, to ultimately improve health outcomes.
Senior author Bishal Gyawali explained:
“Health Technology Assessment for cancer drugs may seem straightforward at the first glance because most countries look at similar parameters such as efficacy, cost-effectiveness, etc. However, our study found that there are several nuances and differences in how these are interpreted, and this will provide opportunity for countries to learn from each other.”
The eight economically similar high-income countries studied were England, Canada, France, Germany, Italy, Japan, New Zealand and Australia. The researchers found the countries employ overlapping funding assessment criteria, e.g., all countries consider the therapeutic benefit of a drug and most consider whether a drug is cost effective and the budget implications of funding a drug on their health system. Despite the overlapping criteria, the researchers found there were significant discrepancies in funding decisions.
- Of the best-selling cancer drugs across a variety of cancer types, Germany was found to fund all of them; followed by Italy with 94%; Japan with 82%; then England, Canada, France and Australia with 79%; and New Zealand funded just 35%.
- In a separate analysis looking at funding for cancer drugs determined by an independent body (the European Society of Medical Oncology) to have marginal benefit, Germany funded 83%; Japan 67%; France 50%; Italy 39%; Canada 28%; England and Australia 17%; whilst New Zealand did not fund any cancer medicines with marginal benefit.
The discordance raises important questions around whether the similar assessment criteria are being given varying weight by different assessment bodies or whether other factors are implicated. The authors stress that their findings highlight the importance of transparency in funding decisions.
“Our study results will help facilitate collaboration and streamlining of HTA efforts across G7 countries,” asserted first author Kristina Jenei. “Our findings can be used in efforts to compare and strengthen existing health technology assessments between countries given HTA’s central role in determining access to medicines, and ultimately outcomes, for patients.”
Jenei continued: “But as cancer treatment and evidence becomes more complex, existing methods may need to be adapted.” For example, as Jenei noted, for now, “England is the only country in our study that had a mechanism to fund drugs temporarily through the Cancer Drug Fund while collecting better evidence on their ‘real-world effectiveness’” — an approach that may be expected to grow.
Notably the researchers found that the cancer drugs with the lowest degree of clinical benefit were recommended for funding in the high-income countries studied only 38% of the time, despite all being approved in the US. This highlights the facts that drugs with a marginal degree of benefit are often not recommended in other jurisdictions, even if they have the stamp of US Food and Drug Administration (FDA) approval and that the drugs on which the US spends the most are not always reimbursed in other countries.
Bishal Gyawali commented:
“Importantly, our study shows that just because a cancer drug is approved by the US FDA doesn’t automatically mean that it is an important drug that other countries should spend their resources on. Although all the cancer drugs that provide minimal clinical benefit were approved by the FDA, most countries didn’t reimburse a majority of these — New Zealand reimbursed 0% of these. These lessons are important for several low- and middle-income countries in the world without an HTA agency where FDA approval is considered synonymous to high quality.”