New Anticancer Drugs: Reliably Assessing "Value" While Addressing High Prices.

Autor: Stewart DJ; Division of Medical Oncology, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.; Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada.; Life Saving Therapies Network, Ottawa, ON K1H 5E6, Canada., Bradford JP; Life Saving Therapies Network, Ottawa, ON K1H 5E6, Canada., Sehdev S; Division of Medical Oncology, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.; Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada.; Life Saving Therapies Network, Ottawa, ON K1H 5E6, Canada., Ramsay T; Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada., Navani V; Division of Medical Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada., Rawson NSB; Canadian Health Policy Institute, Toronto, ON M5V 0A4, Canada.; Macdonald-Laurier Institute, Ottawa, ON K1N 7Z2, Canada., Jiang DM; University of Toronto, Toronto, ON M5S 3H2, Canada.; Princess Margaret Cancer Center, Toronto, ON M5G 2M9, Canada., Gotfrit J; Division of Medical Oncology, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.; Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada., Wheatley-Price P; Division of Medical Oncology, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.; Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada.; Life Saving Therapies Network, Ottawa, ON K1H 5E6, Canada., Liu G; University of Toronto, Toronto, ON M5S 3H2, Canada.; Princess Margaret Cancer Center, Toronto, ON M5G 2M9, Canada., Kaplan A; University of Toronto, Toronto, ON M5S 3H2, Canada.; Family Physicians Airway Group of Canada, Markham, ON L3R 9X9, Canada., Spadafora S; Algoma District Cancer Program, Sault Ste Marie, ON P6B 0A8, Canada., Goodman SG; University of Toronto, Toronto, ON M5S 3H2, Canada.; St. Michael's Hospital, Unity Health Toronto, and Peter Munk Cardiac Centre, University Health Network, Toronto, ON M5B 1W8, Canada., Auer RAC; Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada.; Department of Surgery, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada., Batist G; Life Saving Therapies Network, Ottawa, ON K1H 5E6, Canada.; Centre for Translational Research, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
Jazyk: angličtina
Zdroj: Current oncology (Toronto, Ont.) [Curr Oncol] 2024 Apr 28; Vol. 31 (5), pp. 2453-2480. Date of Electronic Publication: 2024 Apr 28.
DOI: 10.3390/curroncol31050184
Abstrakt: Countries face challenges in paying for new drugs. High prices are driven in part by exploding drug development costs, which, in turn, are driven by essential but excessive regulation. Burdensome regulation also delays drug development, and this can translate into thousands of life-years lost. We need system-wide reform that will enable less expensive, faster drug development. The speed with which COVID-19 vaccines and AIDS therapies were developed indicates this is possible if governments prioritize it. Countries also differ in how they value drugs, and generally, those willing to pay more have better, faster access. Canada is used as an example to illustrate how "incremental cost-effectiveness ratios" (ICERs) based on measures such as gains in "quality-adjusted life-years" (QALYs) may be used to determine a drug's value but are often problematic, imprecise assessments. Generally, ICER/QALY estimates inadequately consider the impact of patient crossover or long post-progression survival, therapy benefits in distinct subpopulations, positive impacts of the therapy on other healthcare or societal costs, how much governments willingly might pay for other things, etc. Furthermore, a QALY value should be higher for a lethal or uncommon disease than for a common, nonlethal disease. Compared to international comparators, Canada is particularly ineffective in initiating public funding for essential new medications. Addressing these disparities demands urgent reform.
Databáze: MEDLINE
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