Belgium - Report of Health Care Knowledge Centre Questions Added Value of Innovative Oncology Medicines
On 5 July 2021, KCE, the Belgian Health Care Knowledge Centre, published a report discussing the benefits and costs of innovative oncology medicines in Belgium between 2004 and 2017 (the Report – A summary of the Report can be found here). KCE tried to determine whether a selection of innovative oncological medicines that entered the market in the relevant period offered added value for the Belgian patient population and whether the resulting cost reflected an efficient use of the available resources.
KCE studied 40 oncology medicines used for the treatment of 12 cancer indications, 9 of which were limited to metastatic cancer. The effect of treatment on survival and the budgetary impact were analysed on the basis of observational data taken from the Belgian Cancer Registry, reimbursement data generated from the Inter-Mutualistic Agency (IMA) and patient survival data obtained from the Crossroads Bank for Social Security. The data analysis was complemented with a review of relevant literature.
The study outcome was somewhat surprising in that for only half of the indications some improvement in survival was observed. Moreover, almost all indications gave rise to large increases in gross medicine expenditure. On this basis, the Report questioned the effectiveness and cost-benefit ratio of the indications that were responsible for a strong increase in expenditure without a clear improvement in survival. The Report also described the effects of the studied medicines on quality of life as uncertain. It attributed the lack of evidence to the supposedly substandard measurement and reporting of quality of life in clinical trials for cancer medication.
The Report’s negative findings, combined with the KCE’s well-known aversion for Managed Entry Agreements and confidential price arrangements which the Report again highlights, created fertile ground for the pharmaceutical sector’s critics both inside and outside the healthcare sector.
While the Report should be looked at closely and is likely to inform policies to improve the measurement of the performance of reimbursed cancer medication (with the implication that medicines which fail to deliver will be removed more quickly from the list of reimbursed medicine), the Report exhibits some significant weaknesses which suggest that overly pessimistic conclusions are unwarranted. For example, the Report is based in large part on outdated and incomplete data. The study period started in another oncological era, 17 years ago, and fails to take account of innovations of the last four years in a rapidly evolving field of research. In addition, for 9 out of 12 cancer types studied, only patients in stage IV at the time of diagnosis (suffering from metastatic cancer) were considered.
Accordingly, the Report does not tally with the significant recent successes registered in Belgium in the fight against cancer. To illustrate, in the last two decades, the overall survival rate for breast cancer five years after treatment has increased from 85% to 91%. Similarly, the number of lung cancer patients still alive one year after diagnosis is ten times higher now compared to the figure for 1995. For metastatic skin cancer, the number of patients still alive five years after diagnosis has also increased tenfold, from 5 to 50%. These results are due in large part to new medication.
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