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Cancer Drug Coverage Based on Cost-Effectiveness Restrictive

Approach more common in United Kingdom; can result in restrictions, delays in time-to-coverage

THURSDAY, May 27 (HealthDay News) -- Anticancer drug coverage decisions that take cost-effectiveness into consideration -- common in several European countries -- may result in restrictions and delays in time until coverage is provided, according to research published online May 24 in the Journal of Clinical Oncology.

Anne Mason, of the University of York in the United Kingdom, and colleagues analyzed coverage decisions on all anticancer drugs approved by the U.S. Food and Drug Administration from 2004 to 2008, comparing decisions made by agencies in the United States (Centers for Medicare and Medicaid Services [CMS]; the Department of Veterans Affairs [VA]; and the Regence Group) to those made by health services in the United Kingdom (National Institute for Health and Clinical Excellence [NICE]; Scottish Medicines Consortium [SMC]). Of the 59 new drugs approved by the FDA during that period, only 46 were approved by the European Medicines Agency.

In the United States, all 59 of the FDA-approved drugs were covered by CMS, VA and the Regence Group, mostly without restriction, while fewer than half of the approved drugs were covered in the United Kingdom. The median time-to-coverage of a new drug in the United States was zero days, though some of the coverage decisions made by the Regence Group that involved cost-effectiveness considerations were delayed. The median time-to-coverage was 783 days for NICE, and 231 days for SMC relative to the European Medicines Agency license date.

"We have a choice: do we use science to help us reach consensus on what we are willing to pay for new therapies and innovation, or do we leave individual patients to wrestle with the skyrocketing costs of cancer care and treatment determined by their ability to pay?" writes the author of an accompanying editorial.

A co-author disclosed serving in an advisory role for Regence Blue Shield.

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