A review of economic impact of targeted oral anticancer medications

Abstract

There has been a rapid increase in the use of targeted oral anticancer medications (OAMs) in the past decade. As OAMs are often expensive, economic consideration play a significant role in the decision to prescribe, receive or cover them. This paper performs a systematic review of costs or budgetary impact of targeted OAMs to better understand their economic impact on the healthcare system, patients as well as payers. We present our review in a summary table that describes the method and main findings, take into account multiple factors, such as country, analytical approach, cost type, study perspective, timeframe, data sources, study population and care setting when we interpret the results from different papers, and discuss the policy and clinical implications. Our review raises a concern regarding the role of sponsorship on findings of economic analyses as the vast majority of pharmaceutical company-sponsored studies reported cost advantages toward the sponsor's drugs.

Keywords::

• budgetary impact
• cost analysis
• oral anticancer medications
• oral chemotherapy
• targeted therapies

Financial & competing interests disclosure

Y-CT Shih is supported by a grant from the Agency for Healthcare Research and Quality (R01 HS018535), and The University of Chicago Cancer Research Foundation Women's Board. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• A total number of 31 English language research articles have been published on cost or budgetary impact of targeted oral anticancer medications (OAMs).

• Many of the studies support the use of targeted OAMs from a cost perspective because of potential reduction in costs associated administration and managing adverse events.

• Many of the studies were sponsored by pharmaceutical companies and hence the results tend to be in favor of the drug manufactured by the sponsor and should be interpreted with caution. Further, the presentation of budgetary impact in terms of per member per month could mask the cost impact relevant to cancer patients, making it difficult to estimate the financial burden from patients’ perspective.

• Reimbursement policies play a big role in the diffusion of targeted OAMs in the USA. Many states have enacted oral parity laws for oncology drugs, which might lead to even more increase in the development and use of targeted OAMs.

• Patient adherence presents a key clinical challenge associated with the use of targeted OAMs.

• Literature on the indirect cost of targeted OAMs from the societal perspective is limited.

• Molecular testing to select patients for targeted OAMs and its impact on costs is an important area for future research.