QALY May Stifle Patient Access to Innovative Cancer Drugs

Even as the surge in innovative oncology medicines yields new therapeutic options for a growing number of cancer patients, different approaches to reimbursement by health systems across the globe are likely having an impact both on patient access to transformative treatments and overall care, according to a new report from the IMS Institute for Healthcare Informatics. In 5 countries examined where healthcare agencies adopt more rigid costeffectiveness thresholds to determine reimbursement levels for oncology medicines, the study found that fewer new cancer drugs are being reimbursed, reimbursement decisions are taking longer, and new cancer drugs are being adopted more slowly and at lower rates.

The report — Impact of Cost-per-QALY Reimbursement Criteria on Access to Cancer Drugs — considers the implications of reimbursement for 9 new cancer drugs in 5 countries that have adopted a “cost per quality-adjusted life year” (CPQ) reimbursement approach (England, Scotland, Sweden, Australia and Canada), and compares those results with 5 non-CPQ countries (U.S., France, Germany, Italy and Spain). CPQ methodologies apply a standardized measure of value to determine treatment reimbursement levels, including an analysis of the clinical, social and economic value of a treatment. Non-CPQ approaches primarily assess a new drug’s clinical effectiveness and the health gain for patients, rather than comparing patient outcomes against a standard costeffectiveness metric or threshold.

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