The Impasse on Overall Survival in Oncology Reimbursement Decision-Making: How Can We Resolve This?

Michael Patrick Lux, 1 Oriana Ciani, 2 William CN Dunlop, 3 Andrea Ferris, 4 Michael Friedlander 5 1Department of Gynecology and Obstetrics, Frauenklinik St. Louise Paderborn, St. Josefs-Krankenhaus Salzkotten, Frauen- und Kinderklinik St. Louise Paderborn, Paderborn, Germany; 2Centre for Research...

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Autores principales:	Lux MP, Ciani O, Dunlop WCN, Ferris A, Friedlander M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	drug approval endpoint determination medical oncology quality of life surrogate endpoint uncertainty Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/7141aa4bc7d84c90867649d7c0dedaf4
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spelling	oai:doaj.org-article:7141aa4bc7d84c90867649d7c0dedaf42021-11-11T18:22:26ZThe Impasse on Overall Survival in Oncology Reimbursement Decision-Making: How Can We Resolve This?1179-1322https://doaj.org/article/7141aa4bc7d84c90867649d7c0dedaf42021-11-01T00:00:00Zhttps://www.dovepress.com/the-impasse-on-overall-survival-in-oncology-reimbursement-decision-mak-peer-reviewed-fulltext-article-CMARhttps://doaj.org/toc/1179-1322Michael Patrick Lux, 1 Oriana Ciani, 2 William CN Dunlop, 3 Andrea Ferris, 4 Michael Friedlander 5 1Department of Gynecology and Obstetrics, Frauenklinik St. Louise Paderborn, St. Josefs-Krankenhaus Salzkotten, Frauen- und Kinderklinik St. Louise Paderborn, Paderborn, Germany; 2Centre for Research on Health and Social Care Management, SDA Bocconi, Milan, Italy; 3AstraZeneca, City House, Cambridge, UK; 4LUNGevity Foundation, Bethesda, MD, USA; 5Prince of Wales Clinical School, University of New South Wales and Department of Medical Oncology, The Prince of Wales Hospital, Sydney, NSW, AustraliaCorrespondence: Michael Patrick LuxDepartment of Gynecology and Obstetrics, Frauenklinik St. Louise, Husener Str. 81, Paderborn, 33098, GermanyTel +49 5251 864121Email m.lux@vincenz.deAbstract: Mature overall survival (OS) data are often unavailable at the time of regulatory and reimbursement decisions for a new cancer treatment. For patients with early-stage cancers treated with potentially curative treatments, demonstrating an OS benefit may take years and may be confounded by subsequent lines of therapy or crossover to the investigational treatment. For patients with advanced-stage cancers, mature OS data may be available but difficult to interpret for similar reasons. There are strong opinions about approval and reimbursement in the absence of mature OS data, with concerns over delay in patient access set against concerns about uncertainty in long-term benefit. This position paper reflects our individual views as patient advocate, clinician or health economist on one aspect of this debate. We look at payer decisions in the absence of mature OS data, considering when and how non-OS trial outcomes could inform decision-making and how uncertainty can be addressed beyond the trial, supporting these views with evidence from the literature. We consider when it is reasonable for payers to expect or not expect mature OS data at the initial reimbursement decision (based on criteria such as cancer stage and treatment efficacy) acknowledging that there are settings in which mature OS data are expected. We propose flexible strategies for generating and appraising patient-relevant evidence, including context-relevant endpoints and quality of life measures, when survival rates are good and mature OS data are not expected. We note that fair reimbursement is important; this means valuing patient benefit as shown through prespecified endpoints and reappraising if there is ongoing uncertainty or failure to show a sustained benefit. We suggest that reimbursement systems continue to evolve to align with scientific advances, because innovation is only meaningful if readily accessible to patients. The proposed strategies have the potential to promote thorough assessment of potential benefit to patients and lead to timely access to effective medicines.Keywords: drug approval, endpoint determination, medical oncology, quality of life, surrogate endpoint, uncertaintyLux MPCiani ODunlop WCNFerris AFriedlander MDove Medical Pressarticledrug approvalendpoint determinationmedical oncologyquality of lifesurrogate endpointuncertaintyNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCancer Management and Research, Vol Volume 13, Pp 8457-8471 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	drug approval endpoint determination medical oncology quality of life surrogate endpoint uncertainty Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	drug approval endpoint determination medical oncology quality of life surrogate endpoint uncertainty Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Lux MP Ciani O Dunlop WCN Ferris A Friedlander M The Impasse on Overall Survival in Oncology Reimbursement Decision-Making: How Can We Resolve This?
description	Michael Patrick Lux, 1 Oriana Ciani, 2 William CN Dunlop, 3 Andrea Ferris, 4 Michael Friedlander 5 1Department of Gynecology and Obstetrics, Frauenklinik St. Louise Paderborn, St. Josefs-Krankenhaus Salzkotten, Frauen- und Kinderklinik St. Louise Paderborn, Paderborn, Germany; 2Centre for Research on Health and Social Care Management, SDA Bocconi, Milan, Italy; 3AstraZeneca, City House, Cambridge, UK; 4LUNGevity Foundation, Bethesda, MD, USA; 5Prince of Wales Clinical School, University of New South Wales and Department of Medical Oncology, The Prince of Wales Hospital, Sydney, NSW, AustraliaCorrespondence: Michael Patrick LuxDepartment of Gynecology and Obstetrics, Frauenklinik St. Louise, Husener Str. 81, Paderborn, 33098, GermanyTel +49 5251 864121Email m.lux@vincenz.deAbstract: Mature overall survival (OS) data are often unavailable at the time of regulatory and reimbursement decisions for a new cancer treatment. For patients with early-stage cancers treated with potentially curative treatments, demonstrating an OS benefit may take years and may be confounded by subsequent lines of therapy or crossover to the investigational treatment. For patients with advanced-stage cancers, mature OS data may be available but difficult to interpret for similar reasons. There are strong opinions about approval and reimbursement in the absence of mature OS data, with concerns over delay in patient access set against concerns about uncertainty in long-term benefit. This position paper reflects our individual views as patient advocate, clinician or health economist on one aspect of this debate. We look at payer decisions in the absence of mature OS data, considering when and how non-OS trial outcomes could inform decision-making and how uncertainty can be addressed beyond the trial, supporting these views with evidence from the literature. We consider when it is reasonable for payers to expect or not expect mature OS data at the initial reimbursement decision (based on criteria such as cancer stage and treatment efficacy) acknowledging that there are settings in which mature OS data are expected. We propose flexible strategies for generating and appraising patient-relevant evidence, including context-relevant endpoints and quality of life measures, when survival rates are good and mature OS data are not expected. We note that fair reimbursement is important; this means valuing patient benefit as shown through prespecified endpoints and reappraising if there is ongoing uncertainty or failure to show a sustained benefit. We suggest that reimbursement systems continue to evolve to align with scientific advances, because innovation is only meaningful if readily accessible to patients. The proposed strategies have the potential to promote thorough assessment of potential benefit to patients and lead to timely access to effective medicines.Keywords: drug approval, endpoint determination, medical oncology, quality of life, surrogate endpoint, uncertainty
format	article
author	Lux MP Ciani O Dunlop WCN Ferris A Friedlander M
author_facet	Lux MP Ciani O Dunlop WCN Ferris A Friedlander M
author_sort	Lux MP
title	The Impasse on Overall Survival in Oncology Reimbursement Decision-Making: How Can We Resolve This?
title_short	The Impasse on Overall Survival in Oncology Reimbursement Decision-Making: How Can We Resolve This?
title_full	The Impasse on Overall Survival in Oncology Reimbursement Decision-Making: How Can We Resolve This?
title_fullStr	The Impasse on Overall Survival in Oncology Reimbursement Decision-Making: How Can We Resolve This?
title_full_unstemmed	The Impasse on Overall Survival in Oncology Reimbursement Decision-Making: How Can We Resolve This?
title_sort	impasse on overall survival in oncology reimbursement decision-making: how can we resolve this?
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/7141aa4bc7d84c90867649d7c0dedaf4
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The Impasse on Overall Survival in Oncology Reimbursement Decision-Making: How Can We Resolve This?

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