New analysis shows HTA organizations may frequently restrict access to cancer treatments

In health care, who should decide value? In many industrialized countries with single-payer health systems, the answer is “the government.”

A new analysis by Avalere, posted on the website of Pharmaceutical Research and Manufacturers of America, illustrates the negative impact this answer has on patient access to care, writes Randy Burkholder, vice president of policy and research at PhRMA.

After medicines have been approved for marketing (for example, by the European Medicines Agency), many countries – like the UK, Germany, France and Canada – rely on external health technology assessment (HTA) organizations to guide their decisions on the value of medicines. Avalere looked at the HTA reports in these four countries to determine how often they supported coverage of cancer medicines. Of 329 oncology assessments from 2013 to 2017, only 29% resulted in positive recommendations without coverage restrictions. The other 71% recommended restricted coverage or did not recommend coverage at all. The study also found that HTA reports are increasingly recommending utilization restrictions (such as restricting coverage to specific patient subpopulations) on such treatments.