OBJECTIVES: Prices of recently launched monoclonal antibodies are relatively high
and their accessibility differs between European countries. Bevacizumab (BVZ) was
granted full access in Germany and France, but rejected in UK. It was subject in Italy
to payment by performance with a 50% discount for the first 6 weeks and free after
11 to 15 cycles. In France BVZ is reimbursed to hospitals on top of DRG costs.
METHODS: We reviewed how such differences might affect usage of BVZ 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 database tracking prescribing
of anti-cancer therapies for patients within and across tumours over time.
Total sample size varied between countries, from 7,766 to 9,463 patients within the
year ending 2009 Q2. RESULTS: Metastatic colorectal cancer (mCRC) represents the
first indication for BVZ, accounting for 62% of usage in France, 56% in Germany,
and 75% in Italy. Proportions of mCRC patients receiving BVZ were 18%, 14% and
21% in France, Germany and Italy, over the period Jul 08-Jun 09. Utilization rates
for other tumours (breast, renal cell, brain and non-small cell lung cancer) ranged
from 1% to 6% in France, Germany and Italy. Over the three-year period, overall
utilization was stable in France, increased slowly in Germany and faster in Italy. In
the UK, BVZ was prescribed to fewer than 1% of patients for all tumours. Dosages
used and patient profiles were comparable across countries. CONCLUSIONS:
Funding on top of DRG does not appear to increase drug usage, but contributes to
early uptake. Health technology assessment conclusions influence utilization strongly.
Payment by performance is associated with significant development of drug penetration.
The disparity of access for cancer patients raises the issue of associated outcome