Berghuis Anne Margreet Sofie, Koffijberg Hendrik, Terstappen Leonardus Wendelinus Mathias Marie, Sleijfer Stefan, IJzerman Maarten Joost
Health Technology and Services Research, University of Twente, 7500 AE Enschede, The Netherlands.
Medical Cell BioPhysics, University of Twente, 7500 AE Enschede, The Netherlands.
Ecancermedicalscience. 2018 Apr 16;12:825. doi: 10.3332/ecancer.2018.825. eCollection 2018.
For rational decision making, assessing the cost-effectiveness and budget impact of new drugs and comparing the costs of drugs already on the market is required. In addition to value frameworks, such as the American Society of Clinical Oncology Value Framework and the European Society of Medical Oncology-Magnitude of Clinical benefit Scale, this also requires a transparent overview of actual drug prices. While list prices are available, evidence on treatment cost is not. This paper aims to synthesise evidence on the reimbursement and costs of high-cost breast cancer drugs in The Netherlands (NL).
A literature review was performed to identify currently reimbursed breast cancer drugs in the NL. Treatment costs were determined by multiplying list prices with the average length of treatment and dosing schedule.
Comparing list prices to the estimated treatment cost resulted in substantial differences in the ranking of costliness of the drugs. The average mean treatment length was unknown for 11/31 breast cancer drugs (26.2%). The differences in the 15 highest-cost drugs were largest for Bevacizumab, Lapatinib and everolimus, with list prices of €541, €158, €1,168 and estimated treatment cost of €174,400, €18,682 and €31,207, respectively. The lowest-cost (patented) targeted drug is €1,818 more expensive than the highest-cost (off-patent) generic drug according to the estimated drug treatment cost.
A lack of evidence on the reimbursement and cost of high-cost breast cancer drugs complicates rapid and transparent evidence synthesis, necessary to focus strategies aiming to limit the increasing healthcare costs. Interestingly, the findings show that off-patent generics (such as paclitaxel or doxorubicin), although substantially cheaper than patented drugs, are still relatively costly. Extending standardisation and increasing European and national regulations on presenting information on costs per cancer drug is highly recommended.
为了做出合理决策，需要评估新药的成本效益和预算影响，并比较已上市药物的成本。除了价值框架，如美国临床肿瘤学会价值框架和欧洲医学肿瘤学会-临床获益程度量表外，这还需要对实际药品价格进行透明的概述。虽然有标价，但缺乏治疗成本的证据。本文旨在综合荷兰（NL）高成本乳腺癌药物报销和成本的证据。
进行文献综述以确定荷兰目前报销的乳腺癌药物。通过将标价乘以平均治疗长度和给药方案来确定治疗成本。
将标价与估计的治疗成本进行比较，导致药物成本排名存在显著差异。31种乳腺癌药物中有11种（26.2%）的平均治疗长度未知。贝伐单抗、拉帕替尼和依维莫司这15种成本最高的药物差异最大，标价分别为541欧元、158欧元、1168欧元，估计治疗成本分别为174400欧元、18682欧元和31207欧元。根据估计的药物治疗成本，成本最低的（专利）靶向药物比成本最高的（非专利）仿制药贵1818欧元。
缺乏高成本乳腺癌药物报销和成本的证据，使得快速和透明的证据综合变得复杂，而这对于旨在限制不断增加的医疗成本的策略至关重要。有趣的是，研究结果表明，非专利仿制药（如紫杉醇或阿霉素）虽然比专利药物便宜得多，但仍然相对昂贵。强烈建议扩大标准化，并加强欧洲和国家关于提供每种癌症药物成本信息的法规。
