International HTA Experience with Targeted Therapy Approvals for Lung Cancer

Abstract

OBJECTIVES: The aim of this study was to compare the listing success rates and time incurred to listing of recently approved lung cancer medications across Australia, Canada and England. METHODS: A comparison between the three countries was performed with respect to the listing status, time incurred for listing and differences in recommendations made for cost effectiveness. Major uncertainties and limitations that compromise health technology assessment (HTA) recommendations were identified. RESULTS: The listing success rate was found to be low across all three countries (33% Canada, 17% England and 8% Australia). Across the HTA agencies' reviews, comparators were either dissimilar or altered for effectiveness and/or economic analysis. Overall, limited evidence was found for all indications, and uncertainties were identified due to indirect analyses (70%) and survival extrapolation (100%). Although most of the indications were concluded to be not cost effective, some were subsequently listed (47%) at a reduced price and/or with a specific access programme. CONCLUSIONS: This study demonstrated a low listing success rate for novel lung therapies internationally within different HTA jurisdictions. Major uncertainties that are resistant to available solutions seem to be common across different countries; thus, international solutions would be beneficial.