In health care, who should decide value? In many industrialized countries with single-payer health systems, the answer is “the government.” A new analysis by Avalere illustrates the negative impact this answer has on patient access to care.
After medicines have been approved for marketing (for example, by the European Medicines Agency), many countries – like the United Kingdom, Germany, France and Canada – rely on external health technology assessment (HTA) organizations to guide their decisions on the value of medicines. Avalere looked at the HTA reports in these four countries to determine how often they supported coverage of cancer medicines. Of 329 oncology assessments from 2013 to 2017, only 29 percent resulted in positive recommendations without coverage restrictions. The other 71 percent recommended restricted coverage or did not recommend coverage at all. The study also found that HTA reports are increasingly recommending utilization restrictions (such as restricting coverage to specific patient subpopulations) on such treatments.
Additional findings include:
- Across all four countries, approximately 16 percent of oncology assessments resulted in a “not recommended” decision.
- In the United Kingdom, only seven of nearly 100 assessments conducted by the National Institute for Clinical Excellence (NICE) resulted in a “recommended” decision.
- HTA recommendations regarding oncology treatments have grown more restrictive over the last four years. Only 16 oncology products were “recommended with restrictions” in 2014; in 2017 that number climbed to 56.
Although HTA recommendations are applied differently by payers across the different countries, they can have profound consequences for patients. We need better answers than the approaches taken in many other countries, which result in patients facing access barriers to important cancer treatments. That’s one reason our sector is putting an unprecedented level of support into the development of better, more patient-centered methods for assessing care value.
Download the full Avalere analysis here.
Randy Burkholder Randy Burkholder is Vice President of Policy and Research at PhRMA. He has over 17 years experience in health care policy, advocacy and communications in the medical technology and pharmaceutical industries.