[HT2] Influence of HTA and hospital funding systems on patient access to innovative medicines: example of advanced renal cell cancer in Western Europe

[HT2] Influence of HTA and hospital funding systems on patient access to innovative medicines: example of advanced renal cell cancer in Western Europe

2010 Value in health

Toumi, M. | Misset, J. | Jaroslawski, S. | Aballea, S. | Baynton, E. | Lamure, M. | Volume: 13, Issue: 7, Pages: A247, poster, Medicine, Europe,

OBJECTIVES: Prices of recently launched targeted therapies are relatively high and
patient access differs between European countries. Advanced renal cell cancer (aRCC)
is a rare malignancy with poor prognosis for which four such drugs are available:
sunitinib, sorafenib, bevacizumab, and temsirolimus. We investigated relations
between funding decisions of national health authorities and patient access to these
treatments. METHODS: We reviewed Web sites of health authorities in France,
Germany, Italy, and UK. Data on drug utilization from June 2006 to July 2009 were
extracted from the Synovate Oncology Monitor, an ongoing prescription database
based on doctors’ diaries. Total sample size varied between countries, from 7766 to
9463 patients within the year ending 2009 Q2. RESULTS: Sunitinib was granted
restricted recommendation by NICE (UK) in March 2009, but other treatments were
not assessed during study period. All drugs were fi nanced through payment-for-performance
schemes (P4PS) with a registry in Italy. In France, bevacizumab and temsirolimus
were reimbursed on top of DRGs and in Germany only bevacizumab.
Sunitinib was the fi rst line treatment in 62%, 50%, 47%, and 31% of drug-treated
patients in France 2006Q3-2009Q2), Germany, Italy, and UK, respectively, followed
by temsirolimus in France and Germany but sorafenib in Italy. Sorafenib was the most
widely used second line treatment in Germany and Italy. In France, temsirolimus was
used off-label in fi rst line and bevacizumab before funding decision in aRCC was
granted. In UK, many patients remained untreated. CONCLUSIONS: Funding on top
of DRGs in France contributed to early uptake and off-label usage. P4PS were associated
with enhanced drug uptake in Italy. In UK, the lack of assessment by NICE
prevented patient access, which raises concern about the current fi nancing system. The
large differences in patient access to recently approved cancer treatments raise the
issue of equity and health outcomes associated with innovative drugs.