International variability in the reimbursement of cancer drugs by publically funded drug programs

  • P. K. Cheema University of Toronto, Toronto, Ontario, Canada
  • S. Gavura Cancer Care Ontario
  • M. Migus Deeth Williams Wall LLP, Toronto, Ontario, Canada
  • B. Godman Division of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
  • L. Yeung Cancer Care Ontario
  • M. E Trudeau Sunnybrook Health Sciences Centre/Odette Cancer Centre, Ontario, Canada, and University of Toronto, Department of Medicine, Toronto, Ontario

Abstract

Purpose

Evaluate inter-country variability in the reimbursement of publically funded cancer drugs, and identify factors such as cost containment measures that may contribute to variability.

Methods

As of February 28, 2010, licensed indications for 10 cancer drugs (bevacizumab, bortezomib, cetuximab, erlotinib, imatinib, pemetrexed, rituximab, sorafenib, sunitinib, and trastuzumab) were obtained from the drug registries of 6 licensing authorities corresponding to 13 countries or regions: Australia, Canada (Ontario), England, Finland, France, Italy, Germany, Japan, New Zealand, the Netherlands, Scotland, Sweden, and the United States (Medicare Parts B and D). Number of licensed indications reimbursed by public payers and the use of cost containment measures were obtained by survey of health authorities involved in reimbursement and through public documents.

Results

The 48 identified licensed indications varied between agencies (range: 36–44 indications). Finland, France, Germany, Sweden, and the United States reimbursed the highest percentage of indications (range: 90%–100%). Canada (54%), Australia (46%), Scotland (40%), England (38%), and New Zealand (25%) reimbursed the least. All 5 countries with the lowest rate of reimbursement incorporated a cost-effectiveness analysis into reimbursement decisions and rejected submissions for reimbursement mainly because of lack of cost effectiveness; in New Zealand, lack of cost effectiveness was the second leading cause of rejection after excessive cost. In 9 countries, risk-sharing agreements were used to contain costs. Indications initially not recommended for reimbursement (9 in Australia, 5 in Canada, and 3 in England, New Zealand, and Scotland) were subsequently approved with risk-sharing agreements or special pricing arrangements.

Conclusions

Reimbursement of publically funded cancer drugs varies globally. The cause is multifactorial.

Author Biographies

P. K. Cheema, University of Toronto, Toronto, Ontario, Canada
BSc, Master of Biotechnology, MD, FRCPC
S. Gavura, Cancer Care Ontario
Director, Provincial Drug Reimbursement Programs, Cancer Care Ontario
M. Migus, Deeth Williams Wall LLP, Toronto, Ontario, Canada

BSc, Master of Biotechnology, LLB

Associate Lawyer

B. Godman, Division of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
BSc, PhD
L. Yeung, Cancer Care Ontario

BSc, Phm, MBA

Manager, Provincial Drug Reimbursement Programs, Cancer Care Ontario

M. E Trudeau, Sunnybrook Health Sciences Centre/Odette Cancer Centre, Ontario, Canada, and University of Toronto, Department of Medicine, Toronto, Ontario

BSc, MA, MD, FRCPC

Head, division of medical oncology/hematology, Sunnybrook Health Sciences Centre

Head, systemic therapy program, Odette Cancer Centre

Professor, department of medicine, faculty of medicine, University of Toronto

Associate member, Institute of Medical Science, University of Toronto

Co-chair, breast cancer site group, Cancer Care Ontario

How to Cite
Cheema, P. K., Gavura, S., Migus, M., Godman, B., Yeung, L., & Trudeau, M. E. (1). International variability in the reimbursement of cancer drugs by publically funded drug programs. Current Oncology, 19(3), e165-176. https://doi.org/10.3747/co.19.946
Section
Medical Oncology