Is the cost-effectiveness threshold cost-effective in cancer therapy?

Abstract

Introduction: To compare availability of innovative cancer drugs in countries with established cost-effectiveness threshold (Great Britain, Czech Republic, Sweden and Poland) and where this criterion is not used (Germany, France, Italy), and to assess the relationship between the reimbursement system and the expenditures and health outcomes. Methods: The analysis of reimbursement decisions concerning innovative cancer drugs approved by the European Medicines Agency in the years 2012-2013 and the available data concerning incidence, 5-year relative survival rate and the treatment costs of breast, lung, colon and prostate cancer. Results: The assessment included 19 innovative drugs. Most of them were covered by reimbursement in countries without a cost-effectiveness threshold — 80.7%, compared to the countries with a cost-effectiveness threshold — 59.6% (48.7% including Poland). Three products were financed in all reimbursement systems, with the exception of Poland: Perjeta, Xalkori and Xtandi. In countries without the cost-effectiveness threshold the health outcomes expressed as 5-year relative survival were better compared to EU in general or to most of countries which use the cost-effectiveness threshold, whereas expenditures per capita in most cancers were diversified — large (15-27 €, Germany) or similar to the countries with the cost-effectiveness threshold (6-13 €, France and Italy). In Poland for most evaluated cancers the lowest 5-year relative survival was noted, with the lowest expenditure per capita (5-9 €) simultaneously. Conclusions: The percentage of reimbursed innovative cancer drugs is higher in countries without the cost-effectiveness threshold, where better health outcomes are observed. Limited access to innovative therapies resulting from restrictive financial criteria may have a significant impact on health outcomes in cancer treatment.