University of Toronto, Department of Medicine, Toronto, ON.
Curr Oncol. 2012 Jun;19(3):e165-76. doi: 10.3747/co.19.946.
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.
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.
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.
Reimbursement of publically funded cancer drugs varies globally. The cause is multifactorial.
评估公共资金资助的癌症药物报销在国家间的差异，并确定可能导致这种差异的成本控制措施等因素。
截至 2010 年 2 月 28 日，从 6 个许可管理局（对应于 13 个国家或地区）的药物注册处获取了 10 种癌症药物（贝伐单抗、硼替佐米、西妥昔单抗、厄洛替尼、伊马替尼、培美曲塞、利妥昔单抗、索拉非尼、舒尼替尼和曲妥珠单抗）的许可适应证：澳大利亚、加拿大（安大略省）、英国、芬兰、法国、意大利、德国、日本、新西兰、荷兰、苏格兰、瑞典和美国（医疗保险 B 部分和 D 部分）。通过对参与报销的卫生当局进行调查以及通过公共文件获取公共支付者报销的许可适应证数量和使用成本控制措施的信息。
48 个已确定的许可适应证在各机构之间存在差异（范围：36-44 个适应证）。芬兰、法国、德国、瑞典和美国报销的适应证比例最高（范围：90%-100%）。加拿大（54%）、澳大利亚（46%）、苏格兰（40%）、英国（38%）和新西兰（25%）报销的适应证最少。5 个报销率最低的国家均将成本效益分析纳入报销决策中，并主要由于缺乏成本效益而拒绝报销申请；在新西兰，缺乏成本效益是继成本过高之后第二个主要的拒绝理由。在 9 个国家中，使用风险分担协议来控制成本。最初不建议报销的适应证（澳大利亚 9 个，加拿大 5 个，英国、新西兰和苏格兰各 3 个）随后通过风险分担协议或特殊定价安排获得批准。
公共资金资助的癌症药物报销在全球范围内存在差异。原因是多方面的。
