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 five countries examined where healthcare agencies adopt more rigid cost-effectiveness 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 nine new cancer drugs in five 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 five 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 cost-effectiveness metric or threshold.

“As health systems around the world grapple with macroeconomic pressures and the demand for expanded access and improved outcomes, different countries have adopted their own approaches to making reimbursement decisions about specific drugs, especially cancer treatments,” says Murray Aitken, executive director, IMS Institute for Healthcare Informatics. “Given the range of reimbursement approaches being used, it’s critically important to better understand the impact on patient care and the overall economics within the respective health systems.”

Key findings of the study include:

  • Fewer new cancer drugs are reimbursed in the CPQ countries examined. While all nine cancer drugs included in the study were reimbursed in the five non-CPQ countries, with the exception of one treatment in Spain, reimbursement was denied for at least three of the nine cancer drugs in four of the five CPQ countries. In contrast, most countries in both groups reimburse most approved non-cancer products.
  • Countries applying CPQ methodologies may achieve less for cancer patients. While drugs are only one component of total cancer spend, CPQ countries may disproportionately target drug costs compared to other healthcare interventions. Medicines tend to account for relatively higher shares of overall costs for breast and prostate cancers, where slow-progressing tumors often require multiple years of drug therapy. Drug costs are relatively lower for lung cancer, which is associated with extensive surgeries and inpatient care, short survival times and high hospital care costs. As a result, the care processes that displace spending on new drugs may be less clinically effective and cost effective.
  • CPQ analyses are subject to many uncertainties and inconsistencies. Key inputs to the cost-effectiveness assessment of a cancer drug in CPQ countries can vary widely and include proposed price, quality-of-life (QoL) metrics and survival gains, measured as progression-free survival and overall survival. However, these determinations can be subjective and QoL data in particular may not be available, consistent or captured in specific measuring instruments.
  • CPQ countries, particularly those within the U.K., may have both lower cancer drug spending and lower survival rates. Across the 10 countries examined, cancer drug spend per new cancer patient is consistently lower in CPQ than in non-CPQ countries, and lowest in the U.K., which includes the CPQ countries of England and Scotland. The U.K. also has the lowest survival rate in four of six common cancers – breast, kidney, lung and prostate. The correlation between CPQ countries and levels of cancer drug spending and survival rates is notable, even with differences from factors that include stage at diagnosis, time to referral to a specialist, as well as effectiveness of surgical and other interventions.

The full report, including a detailed description of the methodology, is available at www.theimsinstitute.org. This report is based on an IMS Consulting Group analysis that was funded by Janssen Pharmaceuticals, Inc. The interpretation of the results of the analysis and preparation of this report were undertaken independently by the IMS Institute for Healthcare Informatics, also with funding by Janssen.

About IMS Health

IMS Health (NYSE:IMS) is a leading global information and technology services company providing clients in the healthcare industry with comprehensive solutions to measure and improve their performance. By applying sophisticated analytics and proprietary application suites hosted on the IMS One™ intelligent cloud, the company connects more than 10 petabytes of complex healthcare data on diseases, treatments, costs and outcomes to help its clients run their operations more efficiently. More than 10,000 employees drive results for over 5,000 healthcare clients across 100 countries, drawing on information from 100,000 suppliers and insights from more than 55 billion healthcare transactions processed annually. Customers include pharmaceutical, consumer health and medical device manufacturers and distributors, providers, payers, government agencies, policymakers, researchers and the financial community.

As a global leader in protecting individual patient privacy, IMS Health uses anonymous healthcare data to deliver critical, real-world disease and treatment insights. These insights help biotech and pharmaceutical companies, medical researchers, government agencies, payers and other healthcare stakeholders to identify unmet treatment needs and understand the effectiveness and value of pharmaceutical products in improving overall health outcomes. Additional information is available at www.imshealth.com.

About the IMS Institute for Healthcare Informatics

The IMS Institute for Healthcare Informatics provides key policy setters and decision makers in the global health sector with unique and transformational insights into healthcare dynamics derived from granular analysis of information. It is a research-driven entity with a worldwide reach that collaborates with external healthcare experts from across academia and the public and private sectors to objectively apply IMS Health’s proprietary global information and analytical assets. More information about the IMS Institute can be found at: http://www.theimsinstitute.org.

IMS HealthTor ConstantinoMedia Relations+1.484.567.6732tconstantino@us.imshealth.com

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