Adunlin Georges, Ferreri Stefanie P, Dong Jenny, Freeman Maisha Kelly
Samford University.
Innov Pharm. 2019 Aug 8;10(3). doi: 10.24926/iip.v10i3.1799. eCollection 2019.
Significant progress has taken place in the field of cancer immunotherapy in recent years. Cancer immunotherapy, particularly immune checkpoint inhibitors, have shown rather dramatic results and are believed to have completely transformed the field of oncology. However, these transformational therapies are more expensive than previous cancer therapies. As more cancer immunotherapy agents are being developed, with some already being marketed, it is important to consider how economic constraints will shape health policy and value assessment related to these agents. A number of strategies have been suggested to alleviate the price burden and the ensuing concerns about the sustainability of publicly funded healthcare systems. Among these strategies, value-based pricing (VBP) for innovative drugs dominates the headlines in the field of oncology. The specifics of how VBP may be implemented in the United States is still unclear. Nonetheless, policy reform and economic considerations will have to be incorporated into the planning of VBP. The objective of this paper is multifold: (i) to identify the factors affecting the impact of cancer immunotherapy on healthcare cost; (ii) to critically appraise current approaches used to assess the value of novel cancer therapies; (iii) to assess the methodological challenges associated with the economic evaluation of cancer immunotherapy. As the health care system in the U.S transitions toward a value-based model, the need for a formal value assessment framework is warranted in cancer immunotherapy.
近年来，癌症免疫治疗领域取得了重大进展。癌症免疫治疗，尤其是免疫检查点抑制剂，已显示出相当显著的效果，并被认为彻底改变了肿瘤学领域。然而，这些变革性疗法比以往的癌症治疗方法更昂贵。随着越来越多的癌症免疫治疗药物被研发出来，其中一些已经上市，考虑经济限制将如何影响与这些药物相关的卫生政策和价值评估就显得尤为重要。人们已经提出了一些策略来减轻价格负担以及随之而来的对公共资助医疗系统可持续性的担忧。在这些策略中，创新药物的基于价值的定价（VBP）在肿瘤学领域成为头条新闻。VBP在美国具体如何实施仍不明确。尽管如此，政策改革和经济考量必须纳入VBP的规划中。本文的目的是多方面的：（i）确定影响癌症免疫治疗对医疗成本影响的因素；（ii）批判性地评估目前用于评估新型癌症治疗价值的方法；（iii）评估与癌症免疫治疗经济评估相关的方法学挑战。随着美国医疗系统向基于价值的模式转变，癌症免疫治疗需要一个正式的价值评估框架。
