Relative effectiveness assessments of oncology medicines for pricing and reimbursement decisions in European countries

BACKGROUND: There is a debate on the added clinical value of new, expensive, anticancer treatments. Among European decision makers, the relevance of commonly used endpoints in trials, especially overall survival (OS), progression-free survival (PFS) and quality of life (QoL) varies, leading to the available evidence being valued differently. This research studies the extent to which the value of endpoints for cancer medicines differs among European decision makers.

METHODS: We compared guidelines and relative effectiveness assessments (REAs) of medicines for pricing or reimbursement decisions in England, France, Germany, Netherlands, Poland and Scotland. Anticancer medicines that received marketing authorisation in Europe between 2011-2013 with at least four available national REAs were evaluated. A total of 79 REAs were included.

RESULTS: Health technology assessment (HTA) guidelines indicate a preference for clinically and patient relevant endpoints such as OS and QoL above surrogate endpoints. Most guidelines do not specify whether PFS is considered a surrogate or patient-relevant endpoint. The number of REAs included per jurisdiction varied between 7 (The Netherlands) and 18 (Germany). OS data were included in all REAs and were the preferred endpoint by HTA agencies, but these data were not always mature or robust. QoL data are included in only 54% of the REAs, with a limited impact on the recommendations. PFS data are included in 70% of the REAs, but the extent to which HTA agencies find PFS relevant varies.

CONCLUSIONS: European decision making on relative effectiveness of anticancer medicines is affected by a gap in requested versus available clinical evidence, mainly because the regulator is willing to accept some degree of clinical uncertainty. A multi-stakeholder debate would be essential to align concrete robust evidence requirements in oncology and a collectively shared definition for relevant clinical benefit, which will benefit patients and society in general.