OBJECTIVES: Prices of recently launched monoclonal antibodies are high and their
accessibility differs across Europe. Trastuzumab (TRZ) was recommended by payers
for early and advanced breast cancer (BC) in Europe, with differences in the process
and timelines of recommendations. Cetuximab (CTX) for metastatic colorectal cancer
(mCRC) was not recommended in the UK (until June 2009), but accepted under a
price volume agreement scheme with prior authorization in Italy, and without restriction
in France and Germany. These products are funded on top of DRG costs in
France, but not in other countries. We reviewed how such differences might affect
usage of TRZ and CTX in France, Germany, Italy and UK. METHODS: Data on
drug utilization from June 2006 to July 2009 were extracted from the Synovate Oncology
Monitor, an ongoing database tracking prescribing of anti-cancer therapies.
Sample sizes varied between countries and indications, from 1700 to 6200 patients.
RESULTS: Proportions of patients receiving TRZ from July 08 to June 09 ranged
from 9% (UK) to 16% (Italy) in early BC, 12% (Italy) to 19% (France) in first-line
advanced BC and 10% (France) to 34% (Italy) in second-line (irrespective of HER2
screening). For CTX, utilization rates ranged from 0% (UK) to 13% (France) in firstline
and 2% (UK) to 19% (Italy) in second-line. Utilization of TRZ increased over
time in early stage BC. Utilization of CTX was stable in France, increased in Germany
and decreased in Italy. Dosages and patient profiles were comparable across countries.
CONCLUSIONS: Funding on top of DRG does not appear to increase drug uptake.
Health technology assessment conclusions influence utilization strongly. When access
is granted, administrative constraints may reduce first-line utilization to the benefit of
second-line. This should be considered when decisions are made about access to