Research suggests that cancer is the most dreaded condition, ranking ahead of Alzheimer’s, heart disease, and stroke. [1, 2] For health technology assessment (HTA) organizations that evaluate medical therapies and technologies to help inform coverage and reimbursement decisions, cancer poses a special challenge. The issue is particularly important given the abundance of new high-priced therapies in oncology, the growing health and economic burden of cancer, and the proliferation of HTA organizations worldwide.
In a new paper, published today in Health Affairs, my colleagues, James Chambers, Sarah Bliss and I highlight examples of HTA and cancer’s exceptionalism.  Some countries have created separate HTA pathways for cancer treatment, while others have eased access or created exceptions to ease access to cancer treatment. In the United Kingdom, Canada, Australia, and elsewhere, authorities have sometimes bent their own rules to cover cancer drugs despite poor cost-effectiveness. In the United States, unique Medicare rules favor off-label coverage of cancer drugs.
An enduring challenge for health technology assessment organizations is whether and how to grant special status to cancer. We argue that in the United States, HTA bodies are unlikely to employ explicit cost-effectiveness considerations to determine the value of cancer therapies, despite the appeal of such a strategy. Instead, they are likely to pay more attention to personalized medicine, so as to limit access to those patients most likely to benefit, and tie payment more directly to patient outcomes.
- Peter J. Neumann, Sc.D
1. Georges J, Benson JM, Wikler EW, Weldon KJ, Baumgart M, Jansen S, et al. Key findings from a five country survey of public attitudes about Alzheimer’s disease. Poster presented at: Alzheimer’s Association International Conference; 2011 Jul 16; Paris.
2. Zikmund-Fisher BJ, Fagerlin A, Ubel PA. Risky feelings: why a 6% risk of cancer does not always feel like 6%. Patient Educ Couns. 2010;81 Suppl: S87–93
3. Neumann PJ, Bliss SK, Chambers JD. Therapies For Advanced Cancers Pose A Special Challenge For Health Technology Assessment Organizations In Many Countries. Health Affairs 2012; 31(4):700-708