IMS Health Study: Reimbursement Approaches Based on Cost-Per-Quality-Adjusted-Life-Year Measures Rather Than Drug Effectivene...
March 27 2015 - 5:55PM
Business Wire
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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