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Cost-effectiveness evidence on approved cancer drugs in Ireland: the limits of data availability and implications for public accountability

Author

Listed:
  • Suaad Almajed

    (School of Medicine Trinity College)

  • Nora Alotaibi

    (School of Medicine Trinity College)

  • Sana Zulfiqar

    (School of Medicine Trinity College)

  • Zahraa Dhuhaibawi

    (School of Medicine Trinity College)

  • Niall O’Rourke

    (School of Medicine Trinity College)

  • Richard Gaule

    (School of Medicine Trinity College)

  • Caoimhe Byrne

    (School of Medicine Trinity College)

  • Aaron M. Barry

    (School of Medicine Trinity College)

  • Dylan Keeley

    (School of Medicine Trinity College)

  • James F. O’Mahony

    (School of Medicine Trinity College)

Abstract

Background We surveyed evidence published by Ireland’s National Centre for Pharmacoeconomics (NCPE) on the cost-effectiveness of cancer drugs approved for funding within the Irish public healthcare system. The purpose is threefold: to assess the completeness and clarity of publicly available cost-effectiveness data of such therapies; to provide summary estimates of that data; to consider the implications of constraints on data availability for accountability regarding healthcare resource allocation. Methods The National Cancer Control Programme lists 91 drug-indication pairs approved between June 2012 and July 2020. Records were retrieved from the NCPE website for each drug-indication pair, including, where available, health technology assessment (HTA) summary reports. We assessed what cost-effectiveness data regarding approved interventions is available, aggregated it and considered the consequences of reporting constraints. Results Among the 91 drug-indication pairs 61 were reimbursed following full HTA, 22 after a rapid review process and 8 have no corresponding NCPE record. Of the 61 where an HTA report was available, 41 presented costs and quality-adjusted life-year (QALY) estimates of the interventions compared. Cost estimates and corresponding incremental cost-effectiveness ratios (ICERs) are based on prices on application for reimbursement. Reimbursed prices are not published. Aggregating over the drug-indication pairs for which data is available, we find a mean incremental health gain of 0.85 QALY and an aggregate ICER of €100,295/QALY, which exceeds Ireland’s cost-effectiveness threshold of €45,000/QALY. Conclusion Reimbursement applications by pharmaceutical manufacturers for cancer drugs typically exceed Ireland’s cost-effectiveness threshold, often by a considerable margin. On aggregate, the additional total net cost of new drugs relative to current treatments needs to be more than halved for the prices sought on application to be justified for reimbursement. Commercial confidentiality regarding prices and cost-effectiveness upon reimbursement compromises accountability regarding the fair and efficient allocation of scarce healthcare resources.

Suggested Citation

  • Suaad Almajed & Nora Alotaibi & Sana Zulfiqar & Zahraa Dhuhaibawi & Niall O’Rourke & Richard Gaule & Caoimhe Byrne & Aaron M. Barry & Dylan Keeley & James F. O’Mahony, 2022. "Cost-effectiveness evidence on approved cancer drugs in Ireland: the limits of data availability and implications for public accountability," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(3), pages 375-431, April.
    • Handle: RePEc:spr:eujhec:v:23:y:2022:i:3:d:10.1007_s10198-021-01365-2
    DOI: 10.1007/s10198-021-01365-2
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    References listed on IDEAS

    as
    1. Laura McCullagh & Michael Barry, 2016. "The Pharmacoeconomic Evaluation Process in Ireland," PharmacoEconomics, Springer, vol. 34(12), pages 1267-1276, December.
    2. Susanne Schmitz & Laura McCullagh & Roisin Adams & Michael Barry & Cathal Walsh, 2016. "Identifying and Revealing the Importance of Decision-Making Criteria for Health Technology Assessment: A Retrospective Analysis of Reimbursement Recommendations in Ireland," PharmacoEconomics, Springer, vol. 34(9), pages 925-937, September.
    3. James O’Mahony & Diarmuid Coughlan, 2016. "The Irish Cost-Effectiveness Threshold: Does it Support Rational Rationing or Might it Lead to Unintended Harm to Ireland’s Health System?," PharmacoEconomics, Springer, vol. 34(1), pages 5-11, January.
    4. Felicity Lamrock & Laura McCullagh & Lesley Tilson & Michael Barry, 2020. "A retrospective analysis of budget impact models submitted to the National Centre for Pharmacoeconomics in Ireland," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(6), pages 895-901, August.
    5. Adrian Towse & Michele Pistollato & Jorge Mestre-Ferrandiz & Zeba Khan & Satyin Kaura & Louis Garrison, 2015. "European Union Pharmaceutical Markets: A Case for Differential Pricing?," International Journal of the Economics of Business, Taylor & Francis Journals, vol. 22(2), pages 263-275, July.
    6. James F. O’Mahony & Diarmuid Coughlan, 2016. "The Irish Cost-Effectiveness Threshold: Does it Support Rational Rationing or Might it Lead to Unintended Harm to Ireland’s Health System?," PharmacoEconomics, Springer, vol. 34(1), pages 5-11, January.
    7. Cara Usher & Laura McCullagh & Lesley Tilson & Michael Barry, 2019. "Analysis of Health Technology Assessments of Orphan Drugs in Ireland from 2012 to 2017," PharmacoEconomics - Open, Springer, vol. 3(4), pages 583-589, December.
    8. Laura McCullagh & Susanne Schmitz & Michael Barry & Cathal Walsh, 2017. "Examining the Feasibility and Utility of Estimating Partial Expected Value of Perfect Information (via a Nonparametric Approach) as Part of the Reimbursement Decision-Making Process in Ireland: Applic," PharmacoEconomics, Springer, vol. 35(11), pages 1177-1185, November.
    9. Sabine Vogler & Kenneth R. Paterson, 2017. "Can Price Transparency Contribute to More Affordable Patient Access to Medicines?," PharmacoEconomics - Open, Springer, vol. 1(3), pages 145-147, September.
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    More about this item

    Keywords

    Cost-effectiveness; Policy oversight; Resource allocation; Transparency;
    All these keywords.

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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