Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Sunnybrook Research Institute, Toronto, ON, Canada.
Cancer Med. 2020 Jan;9(1):94-103. doi: 10.1002/cam4.2694. Epub 2019 Nov 11.
Value-based pricing of oncology drugs provides a best estimate for the price of a drug, as it relates to the benefits it provides for individual patients. To date, the impact of value-based pricing to reference cost-effectiveness thresholds (λ) on individual and population-level health benefits remains uncharacterized. The current study examined the potential benefits of value-based pricing by quantifying the incremental net health benefit (INHB) of publicly funded oncology drugs, if funding occurred at manufacturer-submitted price without value-based pricing.
Pan-Canadian Oncology Drug Review (pCODR) submissions were reviewed to identify eligible drug indications from which final economic guidance panel reports were reviewed for incremental costs (ΔC) and quality-adjusted life-years (ΔQALY) from manufacturer-submitted, pCODR lower-limit (pCODR-LL) and upper-limit (pCODR-UL) re-analyzed estimates. Annual number of cases in Ontario for each drug indication was obtained from population databases. Annual QALY gain per drug indication was determined by (ΔQALY × cases). Population QALY gain/loss in the absence of value-based pricing to reference λ was estimated by the INHB: (INHB = [ΔQALY - (ΔC/λ)] × cases).
In total, 34 drug indications (4629 cases) were identified. Annual gain in QALYs for the funded drug indications using manufacturer, pCODR-LL, and pCODR-UL estimates was 1851, 1617, and 1301, respectively. At a λ $100 000/QALY, funding in the absence of value-based pricing resulted in loss of 2311, 2519, and 2604 QALYs. This would result in a provincial net annual loss of 460, 902, and 1303 QALYs.
Despite an annual gain in QALY per funded drug indication, a net loss in QALY for the province, in the absence of value-based pricing, was demonstrated. Supportive evidence exists for value-based pricing toward the promotion of health benefits for the greater population.
肿瘤药物的基于价值的定价为药物价格提供了最佳估计，因为它与药物为个体患者带来的益处有关。迄今为止，基于价值的定价对参考成本效益阈值（λ）对个体和人群健康效益的影响尚未确定。本研究通过量化如果在没有基于价值的定价的情况下按照制造商提交的价格进行公共资助的肿瘤药物的增量净健康效益（INHB），来考察基于价值的定价的潜在收益。
审查泛加拿大肿瘤药物审查（pCODR）提交的内容，以确定合格的药物适应证，然后审查最终经济指导小组报告中的增量成本（ΔC）和质量调整生命年（ΔQALY），这些数据来自制造商提交的、pCODR 下限（pCODR-LL）和上限（pCODR-UL）重新分析的估计值。从人群数据库中获得每个药物适应证在安大略省的年度病例数。通过（ΔQALY×病例数）确定每个药物适应证的年度 QALY 收益。在没有基于价值的定价来参考 λ 的情况下，估计人群中 QALY 的增益/损失，通过 INHB 计算：（INHB=（ΔQALY-（ΔC/λ））×病例数）。
共确定了 34 种药物适应证（4629 例）。使用制造商、pCODR-LL 和 pCODR-UL 估计值，获得资助的药物适应证的年度 QALY 增益分别为 1851、1617 和 1301。在 λ 为 100000 美元/QALY 的情况下，如果没有基于价值的定价进行资助，将会导致损失 2311、2519 和 2604 个 QALY。这将导致该省每年净损失 460、902 和 1303 个 QALY。
尽管每个获得资助的药物适应证的 QALY 都有年度增长，但在没有基于价值的定价的情况下，该省的 QALY 仍出现净损失。这为基于价值的定价提供了支持性证据，有利于促进更大人群的健康效益。
