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Cost and public reimbursement of cancer medicines in the UK and the Republic of Ireland

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Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

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Abstract’

Introduction/aims

There are disparities in the availability of systemic anticancer therapies (SACTs) globally. We set out to investigate the cost and reimbursement of SACTs in the United Kingdom (UK) and the Republic of Ireland (ROI) in conjunction with efficacy and licensing authority decisions in the United States (US) and the European Union (EU).

Methods

We sought data pertaining to licensing in the EU, reimbursement in ROI/UK and cost/efficacy of SACTs licensed by the Food and Drug Administration (FDA) between January 2015 and May 2021. Independent samples t tests, chi-square test and Pearson’s correlation were used for statistical analysis.

Results

We identified that the majority of FDA-approved regimens are licensed by the European Medicines Agency (EMA) (n = 91, 67.9%). However, only a minority of these are currently reimbursed in the UK (n = 60, 45%) or the ROI (n = 28, 21%) as of the 1st of May 2021. In addition, only a minority of regimens have demonstrated a statistically significant OS benefit (n = 54, 40%). There was no association between cost of regimens and either the presence (t = 0.846, p = 0.40) or duration of OS benefit (t =  − 0.84, p = 0.64).

Conclusions

Our study highlights that many licensed systemic anticancer treatments are not currently reimbursed in ROI/UK. The high cost of these medicines is independent of the presence of an OS benefit. Collaboration between regulatory agencies, governments and industry partners is needed to ensure health expenditure is directed towards the most effective treatments.

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Change history

  • 29 April 2022

    The author family name has been change to O'Reilly to correct the citation online.

Abbreviations

ADC:

Antibody-drug conjugates

BRAF:

B-Raf proto-oncogene

CDF:

Cancer Drugs Fund

EMA:

European Medicines Agency

DOH:

Department of Health

FDA:

Food and Drug Association

GDP:

Gross domestic product

HSE:

Health Service Executive

ICI:

Immune checkpoint inhibitors

IPHA:

Irish Pharmaceutical Healthcare Association

NCPE:

National Centre for Pharmacoeconomics

NHS:

National Health Service

NICE:

National Institute for Clinical Excellence

ORR:

Overall response rate

OS:

Overall survival

pCR:

Pathological complete response

PFS:

Progression-free survival

QOL:

Quality of life

R&D:

Research and development

RCT:

Randomised controlled trials

ROI:

Republic of Ireland

SACT:

Systemic anticancer treatment

TKI:

Tyrosine kinase inhibitor

UK:

United Kingdom

US:

United States

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Authors and Affiliations

  1. Department of Medical Oncology, Cork University Hospital, Wilton, Co. Cork, Republic of Ireland

    David O’Reilly, Bojan Macanovic, Sinead A. Noonan, Roisin M. Connolly, Derek G. Power, Richard M. Bambury, Seamus O’Reilly & Dearbhaile Catherine Collins

  2. Department of Medical Oncology, University Hospital Limerick, Dooradoyle, Co. Limerick, Republic of Ireland

    Ronan McLaughlin

  3. Department of Pharmacy, Cork University Hospital, Wilton, Co. Cork, Republic of Ireland

    Cian Ronayne

  4. National Cancer Control Programme, King’s Inn House, Dublin 1, Republic of Ireland

    Anne Marie De Frein

  5. Cancer Research, UCC, University College Cork, Co. Cork, Republic of Ireland

    Roisin M. Connolly & Dearbhaile Catherine Collins

  6. School of Medicine, University College Cork, Co. Cork, Republic of Ireland

    Ryan W. Chu

Authors
  1. David O’Reilly
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  2. Ronan McLaughlin
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Corresponding author

Correspondence to David O’Reilly.

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Ethical approval

As per our local ethical guidelines, ethical approval was not required for this study.

Conflict of interest

DOR has received educational grants from Pfizer and Servier. RB has received educational grants from Pfizer, Astellas and Jannsen. He is co-founder of Portable Medical Technology. SOR has received consultant fees from Astrazeneca, travel expenses from Astrazeneca, Pfizer, Novartis, Roche and honoraria from Novartis, Roche, Pfizer. DCC has received consultant fees from Genmab, MSD; research funding from Pfizer; travel expenses from Roche, MSD, Genmab; and honoraria from Amgen, Pfizer, Roche, MSD. RC has received an unrestricted educational grant from Pfizer. SN is a former employee of MSD and has received honoraria from Pfizer and meeting registration expenses from Pfizer, MSD and Roche.

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O’Reilly, D., McLaughlin, R., Ronayne, C. et al. Cost and public reimbursement of cancer medicines in the UK and the Republic of Ireland. Ir J Med Sci 192, 541–548 (2023). https://doi.org/10.1007/s11845-022-02990-3

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  • DOI: https://doi.org/10.1007/s11845-022-02990-3

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