Cost effectiveness of innovative anti-cancer drugs and reimbursement decisions in China

• Published in: Health policy and technology 2023-06, Vol.12 (2), p.100742, Article 100742
• Main Authors: Wen, Jiaxin, Li, Mincai, Jiang, Yawen
• Format: Article
• Language: English
• Subjects: Anti-cancer drugs; China; Cost-effectiveness; Reimbursement decisions
• ISSN: 2211-8837; 2211-8845
• DOI: 10.1016/j.hlpt.2023.100742

•ICERs of anti-cancer drugs were not associated with reimbursement coverage in China.•Incremental QALYs were positively associated with coverage.•Patient population size by cancer type were positively associated with coverage.•Acquisition costs were negatively associated with coverage.•Value-based coverage consideration of anti-cancer drugs should be reinforced. Becoming the bottleneck of patient access to new drugs, the reimbursement coverage process in China started to engage health economic evaluations. This study aimed to quantify the potential impacts of cost-effectiveness profiles on reimbursement coverage in China. Cost and effectiveness measures of both reimbursable and non-reimbursable indications of newly covered anti-cancer drugs from 2017 to 2021 were collected from the literature since official documents were not accessible. The measures included incremental costs-effectiveness ratios (ICERs), incremental quality-adjusted life years (QALYs), incremental costs, acquisition costs, population sizes of target patient groups, availability of overall survival evidence in clinical trials, the language of literature, country of origin of the drug, and the year of initial coverage. Logistic regressions were used to examine the impacts of cost and effectiveness measures. Seventy-four anti-cancer drugs were newly covered from 2017 to 2021. We identified 64 and eight ICERs of reimbursable and non-reimbursable indications of the newly covered anti-cancer drugs. Of note, nine reimbursable indications of the newly covered anti-cancer drugs did not have corresponding literature evidence. The regression results suggested that ICER was not associated with reimbursement coverage. By contrast, incremental QALYs and patient population size by cancer type were positively associated with coverage, while acquisition costs were negatively associated with coverage. Clinical benefits, acquisition costs, and the disease burden of the target population associated with new anti-cancer drugs are likely important considerations of reimbursement decisions in China. However, the importance of value-based pricing should be reinforced and investigated in the future when official documents become accessible. Access to new health technologies through reimbursement is critical to the public. Since 2017, Chinese healthcare and health insurance agencies have adopted health technology appraisals to expedite reimbursement decisions of new drugs, among which anti-cancer drugs accounted