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. 2012 Jun;19(3):e165-76.
doi: 10.3747/co.19.946.

International variability in the reimbursement of cancer drugs by publically funded drug programs

P K Cheema  1 , S Gavura, M Migus, B Godman, L Yeung, M E Trudeau
Affiliations

International variability in the reimbursement of cancer drugs by publically funded drug programs

P K Cheema et al. Curr Oncol. 2012 Jun.

Abstract

Purpose: Evaluate inter-country variability in the reimbursement of publically funded cancer drugs, and identify factors such as cost containment measures that may contribute to variability.

Methods: As of February 28, 2010, licensed indications for 10 cancer drugs (bevacizumab, bortezomib, cetuximab, erlotinib, imatinib, pemetrexed, rituximab, sorafenib, sunitinib, and trastuzumab) were obtained from the drug registries of 6 licensing authorities corresponding to 13 countries or regions: Australia, Canada (Ontario), England, Finland, France, Italy, Germany, Japan, New Zealand, the Netherlands, Scotland, Sweden, and the United States (Medicare Parts B and D). Number of licensed indications reimbursed by public payers and the use of cost containment measures were obtained by survey of health authorities involved in reimbursement and through public documents.

Results: The 48 identified licensed indications varied between agencies (range: 36-44 indications). Finland, France, Germany, Sweden, and the United States reimbursed the highest percentage of indications (range: 90%-100%). Canada (54%), Australia (46%), Scotland (40%), England (38%), and New Zealand (25%) reimbursed the least. All 5 countries with the lowest rate of reimbursement incorporated a cost-effectiveness analysis into reimbursement decisions and rejected submissions for reimbursement mainly because of lack of cost effectiveness; in New Zealand, lack of cost effectiveness was the second leading cause of rejection after excessive cost. In 9 countries, risk-sharing agreements were used to contain costs. Indications initially not recommended for reimbursement (9 in Australia, 5 in Canada, and 3 in England, New Zealand, and Scotland) were subsequently approved with risk-sharing agreements or special pricing arrangements.

Conclusions: Reimbursement of publically funded cancer drugs varies globally. The cause is multifactorial.

Keywords: Reimbursement; cancer; drugs; risk-sharing agreements.

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Figures

FIGURE 1
FIGURE 1
Percentage of all licensed indications (n = 48) reimbursed for 10 cancer drugs as of February 28, 2010.
FIGURE 2
FIGURE 2
Percentage of indications licensed by local agencies [European Medicines Agency, n = 44; U.S. Food and Drug Administration, n = 40; Health Canada, n = 40; Medsafe (N.Z. Medicines and Medical Devices Safety Authority), n = 44; Ministry of Health, Labour and Welfare (Japan), n = 36; and Therapeutic Goods Administration (Australia), n = 44] reimbursed for 10 cancer drugs as of February 28, 2010.
FIGURE 3
FIGURE 3
Number of indications reviewed and not recommended for reimbursement by current advisory committees for 10 cancer drugs as of February 28, 2010, and factors contributing to the indication not being recommended. ced = Committee to Evaluate Drugs (Ontario, Canada); pbac = Pharmaceutical Benefits Advisory Committee (Australia); smc = Scottish Medicines Consortium (Scotland); nice = U.K. National Institute for Health and Clinical Excellence (England); ptac = Pharmacology and Therapeutics Advisory Committee (New Zealand).
FIGURE 4
FIGURE 4
Number of indications for 10 cancer drugs submitted by pharmaceutical companies to public payers for consideration of reimbursement as of February 28, 2010, and the approval rates for those indications with and without risk-sharing agreements (rsas) or special pricing arrangements (spas).
See this image and copyright information in PMC

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