Health technology assessment of cancer drugs in Canada, the United Kingdom and Australia: should the United States take notice?

Cancer remains a global problem, with 7.5 million deaths annually, making it responsible for approximately 13% of deaths from all causes. Cancer also becomes more prevalent as the population ages, making it a major health policy challenge for many countries around the world. However, the encouraging news is that the number of cancer-related deaths has stabilized in many countries. At least part of this success may be attributed to improved diagnosis, early intervention strategies and the development of a newer class of anticancer agents, collectively called "targeted therapies", that are more specific in inhibiting key pathways in tumour genesis. However, these newer drugs are associated with a higher cost. As a result, expenditures for agents and cancer in general have been rising rapidly, far beyond the rate of inflation. Some view this as threatening the very health care systems themselves, which are integral to the modern social contract. Different countries have adopted unique mechanisms to facilitate patient access to these newer agents, with the intent of ensuring value for money and sustainability. In this review, cancer care policies and mechanisms for patient access to new drugs will be discussed and compared between select countries. Given its position as a country that allows free pharmaceutical pricing and multi-payer health insurance, the USA will be the reference country and will be compared with the UK, Canada and Australia, three countries with socialized health care systems and active health technology assessment programmes.