Impact of licensing and reimbursement discrepancies on cancer care in Europe and Canada

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Published: 10 Sep 2017
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Jan McKendrick - PRMA Consulting Ltd, Fleet, UK

Jan McKendrick speaks with ecancer at ESMO 2017 an investigation into the availability of cancer therapies across Europe and Canada, depending on different licensing and reimbursement processes.

She describes how discord in national and international regulation, or communication of regulations, exposes thousands of patients every year to inadequate treatment, and goes on to consider the role of clinicians in preventing patients falling through legislative gaps.

Read more about these findings here.

I think everybody knows that there are different reimbursement systems throughout Europe and Canada and the premise of our study really was could we quantify and understand outcomes and differences better. Nobody has really looked at that systematically, either across cancers or across countries. So our aim was to see could we use the same methodology across countries and see what the differences were between how drugs are licenced and then how they are reimbursed and did those then extend to the differences actually – were they important; were they worth considering? That was the start.

And were they?

They were. So the top line from our study, we looked at eleven European countries and Canada and we found that nearly 200,000 people were impacted by differences between the licensing decision and the reimbursement decision where the reimbursement tends to be a smaller population in some countries. That can be up to 60,000 years of life lost so you would have to say that that would make some people take notice. The other thing we found was quite big differences between the countries and how they approached it so again it makes it important.

In the European countries their systems are rightly very different so every country has a different set of priorities and also a set of criteria about what’s important to their country. So we would expect some differences between countries. Some systems are very centralised, so in France if you have reimbursement you’re on one single national list and that’s it, there’s national access. In some other countries there may be a national decision but there’s also lots of regional variation. So the systems can be very different in that sense but also on how they look at evidence, so whether they look just at clinical effectiveness, whether they look at cost effectiveness and whether they look at budget impact. So we would expect just from process differences that outcomes would differ to some extent but what our study has shown is with the same clinical evidence we’re seeing quite a lot of differences in outcomes. Perhaps they need to be better understood and the reasons for them be better understood. So if I was a patient I think I’d want to know why, why it was different in my country than in another country.

With awareness hopefully comes access.

I think so and I think clinicians have got a very important role to play. The assessments in each country compare drugs with the standard of care in that country which obviously will differ and they will differ in terms of outcomes. But those assessments also drive the standard of care because clinicians only have access to that limited set of drugs. So they have a really important role to play in terms of how that impacts clinical practice day to day.

Seeing as there are plenty of clinicians attending at this conference, what kinds of conversations are you hoping will be started by this poster?

I hope they get more involved. Most of the national HTA systems do have some kind of clinician involvement but just making sure the clinician voice is very clearly heard at those conversations. And they represent the patients as well so making sure those voices are taken into account. And how that impacts their ability to manage patients should be of importance.

I think that covers everything that we were talking about earlier, was there anything that we didn’t get around to?

I don’t think so. Each country will have a different set of priorities. They don’t all have the same ability to pay for drugs so there are some things you would expect to be different across countries but not everything. It makes things like EUnetHTA, the European Health Technology Assessment Network, they’re pushed to some kind of commonality at least in understanding the clinical evidence. I think those things become very important to try and reduce some inequities.