A cost-benefit analysis published in The Lancet Oncology (May 2020;21[5]:664-670) compared the prices and clinical benefit of cancer drugs in the US vs Europe.
Both the US and European countries are faced with the challenge of increasing cancer drug prices. National authorities in European countries are often involved with negotiating drug prices with manufacturers. The American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO) developed frameworks to evaluate the clinical value of cancer drugs: the ASCO-Value Framework (ASCO-VF) and the ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS).
Kerstin N Vokinger, MD, University of Zurich (Switzerland), and colleagues designed a cost-benefit analysis to evaluate the association between the clinical benefit of approved cancer drugs based on these frameworks and their drug prices in the US and four European countries: England, Switzerland, Germany, and France. Researchers considered all new drugs with initial indications for adult cancers that were approved by the US Food and Drug Administration between January 2009 and December 2017, as well as by the European Medicines Agency up until September 2019.
Dr Vokinger and colleagues assessed clinical benefit using the ASCO-VF and ESMO-MCBS for drugs indicated for solid tumors. They compared monthly drug treatment costs between benefit levels using hierarchical linear regression models. Additionally, they calculated Spearman’s correlation coefficients between costs and benefit levels for individual countries.
In total, the analysis included 65 drugs, 47 (72%) of which were approved for solid tumors and 18 (28%) of which were approved for hematologic malignancies. Researchers found that the monthly drug treatment costs in the US were an average of 2.31-times higher than in the assessed European countries.
Furthermore, they found that there were no significant associations between monthly treatment costs for solid tumors and clinical benefit in all assessed countries. This trend was observed using the ESMO-MCBS (P = .16 for the US, P = .98 for England, P = .54 for Switzerland, P = .52 for Germany, and P = .40 for France) and for all assessed countries except for France using the ASCO-VF (P = .56 for the US, P = .47 for England, P = .26 for Switzerland, P = .23 for Germany, and P = .037 for France).
In their concluding remarks, authors of the study wrote that, “Cancer drugs with low or uncertain clinical benefit might be prioritized for price negotiations,” adding that value frameworks could help identify drugs that provide high clinical benefit that should be made rapidly available across countries.—Zachary Bessette
