Slides republished with permission from the IMS Institute for Healthcare Informatics. Visit theimsinstitute.org to view the full report, “Developments in Cancer Treatments, Market Dynamics, Patient Access and Value.”
Patient access to new cancer therapies both in the United States and abroad can vary due to regulatory hurdles, priorities in each country’s healthcare system, and budgetary constraints. Examining cancer treatments introduced between 2009 and 2013, the United States offers the broadest access, while countries such as Japan, South Korea, and Spain have fewer than half of these new drugs available to patients.
Access is even more limited in so-called pharmerging countries. In Russia and China, for example, only about a third of these newer therapies are available. Revisions to the World Health Organization (WHO) Essential Medicines List may result in the inclusion of newer targeted therapies and expand drug access in these countries.
Even in developed countries, access to new cancer therapies is not guaranteed, as lack of reimbursement for certain drugs can make them unattainable to many patients. Healthcare systems that employ a cost-effectiveness methodology based on cost per quality-adjusted life year (QALY)-such as those in Australia, Canada, and South Korea-are less likely to pay for new cancer drugs.
With the rise of immunotherapies and targeted agents, drug developers are pursuing therapies that are effective across multiple disease sites. In 2014, of the 88 cancer drugs marketed, 48 were for multiple indications and 40 were for single indications. Many of the single-indication agents are also in phase II/III clinical trials involving other tumor sites and could very well gain further approvals. It is estimated that in 5 years most oncology drugs will be approved for multiple indications.
Drug efficacy is generally not uniform across multiple tumor sites, and per-patient costs may be affected by various drug combinations. As an example, the clinical value of bevacizumab (Avastin) as assessed by the English Cancer Drug Fund (CDF) differs across indications, demonstrating the lack of correlation between price and effectiveness. (Indications for lung cancer and renal cell carcinoma have not been assessed by the CDF.)
A complex set of variables are weighed when a new cancer drug is priced, and the process is complicated by the possibility of multiple indications with differing clinical values depending on tumor site. Pricing strategies that allow separate and distinct prices to be paid for individual patient groups based on the clinical value of a drug for that disease site may be a method preferred by manufacturers and payers.
From 2004 to 2014, countless new drugs hit the market, and patients saw the average duration of response and overall response rates to available therapies increase. Costs associated with cancer treatment rose too. After adjusting for inflation, the price per month of therapy rose by nearly $6,000 during this 10-year span. Total costs per patient for some of the newer agents today range from $36,000 to $98,400.
Out-of-pocket costs for US patients receiving IV cancer drugs increased by 71% between 2012 and 2013. Costs for oral drugs increased by 16% during the same period. The change in out-of-pocket costs have been impacted by insurance plan designs as well as the increase in outpatient facility costs due to the consolidation of smaller group practices into larger hospital systems.
