Market access for cancer drugs and the role of health economics

To resolve the inequitable patient access to cancer drugs, the issue of how to adapt health care and especially hospital budgets to accommodate the introduction of new cancer drug therapies is one of the most important to address. Different countries have attempted to address some of the issues of drug funding in a number of ad hoc ways. However, in order to facilitate faster patient access to new cancer medicines, a comprehensive and coherent approach is needed. Following granting of marketing authorization, an additional process with national price negotiations approval and the granting of reimbursement is taking place. National price negotiations and reimbursement approval have been identified as another area that delays patient access. Cost-effectiveness is one of several factors guiding reimbursement decisions in certain countries. However, only a few countries require a full economic evaluation to support the decision for reimbursement. Cost-effectiveness information is an important part of health technology assessment (HTA) reports published by HTA agencies. A significant number of health economic evaluations related to cancer have been published, in particular in the mid and later part of the period 1990-2005. This can be seen as a sign of the growing importance of economic evaluation and cost-effectiveness. Europe plays a major role in the production of HTAs and economic evaluations. In particular, the UK is the leader in terms of the number of HTA reports produced, driven by the National Institute for Health and Clinical Excellence (NICE). Those countries that lead HTA development (The Netherlands, Spain, Sweden and the UK) are not the leading countries with regards to patient access to cancer drugs (Austria, France, Spain and Switzerland) with the exception of Spain. it can be argued that no obstacle poses more of treat to the optimal uptake of new drugs than the issue of budgetary limitations. Though cancer drugs account for < 15% of the total health care expenditure for cancer (and similar to 5% all drug costs), they are an easily identified target for cost-containment policies. In efforts to manage health care or budgetary costs, health care policy and decision makers may seek to delay or restrict access to new innovative drugs, with unintended consequences for patients.