I was quoted in a recent article pharmaceutical technology Title “Targeted therapies to join chemo as backbone of oncology treatment”. An excerpt is below:
Although payers could theoretically prioritize chemotherapy over the use of targeted therapies because of the lower price, Jason Shafrin, senior managing director of FTI’s Center for Healthcare Economics and Policy, says reducing costs is not payers’ overall goal. “It’s also about using resources in the best way to improve patient health outcomes; the payer’s decision will depend on the benefit-to-cost ratio of the therapy,” he says.
In the US, Shafrin believes that private payers are generally more likely to allocate funding to high-cost oncology treatments — including drugs greenlit through accelerated approval pathways — than drugs in other areas, such as heart disease. This is mostly due to the intense severity of many of the cancer’s symptoms, as well as their “immediate and life-threatening consequences.”
However, Shaffrin acknowledges a mismatch between the risk appetite of patients and payers. “Many patients will take a risk on a treatment with potential benefit, but payers often want to know that the drug definitely works before they will reimburse,” he says.
Shafrin also notes the importance of considering the cost of a therapy at both the patient and system-wide level. “Many targeted cancer treatments are high-cost, but they are often only suitable for small patient populations that express a specific biomarker,” he says. “Because you use these treatments only in a small group of patients, the total cost of the system is not necessarily as high as, for example, a cardiovascular drug that you would use in a larger population,” says Shafrin.
According to Shafrin, the level of conservatism displayed in payer decisions may also depend on geography. “In Germany, payers are quite strict about cancer therapy reimbursement, as these drugs often must show an OS benefit to gain coverage.” He compares this to the approach of US payers, who he says are increasingly open to accepting established surrogate endpoints as evidence of efficacy.
As companies increasingly focus their attention on creating oncology drugs that are more convenient for patients, Shafrin does not believe administration route will significantly impact payer decisions going forward.
You can read the full article here.
