A Time-Trend Economic Analysis of Cancer Drug Trials

Abstract

© AlphaMed Press 2015.Background. Scientific advances have led to the discovery of novel treatments with high prices. The cost to publicly fund high-cost drugs may threaten the sustainability of drug budgets in different health care systems. In oncology, there are concerns that health-benefit gains are diminishing over time andthattheeconomic evidence to support funding decisions is too limited. Methods. To assess the additional costs and benefits gained from oncology drugs over time, we used treatment protocols and efficacy results from U.S. Food and Drug Administration recordsto calculate cost-effectiveness ratios for drugs approved to treat first- and second-line metastatic or advanced breast, colorectal, and non-small cell lung cancer during the years 1994-2013. We assessed reimbursement recommendations reached by health technology assessment agencies in the U.K., Australia, and Canada. Results. Cost-effectiveness ratios were calculated for 50 drugs approved by theU.S. regulator.Themore recent approvalswere often based on surrogate efficacy outcomes and had extremely high costs, often triple the costs of drugs approved in previous years. Over time, the effectiveness gains have increased for some cancer indications; however, for other indications (nonsmall cell lung and second-line colorectal cancer), themagnitude of gains in effectiveness decreased. Reimbursement recommendations for drugs with the highest cost-effectiveness ratios were the most inconsistent. Conclusion. Evaluation oftheclinicalbenefitsthatoncologydrugs offer as a function of their cost has become highly complex, and for some clinical indications, health benefits are diminishing over time.There is an urgent need for better economic evidence from oncology drug trials and systematic processes to inform funding decisions.