Evolution of French Economic Opinions Published By the Economic Evaluation and Public Health (CEESP) in Oncology

OBJECTIVES: In France, since 2013, pharmaceutical companies are required to submit an economic analysis to the French National Authority for Health (HAS) for presumed innovative products according to submission criteria updated recently in 2022. The Economic Evaluation and Public Health Committee evaluates the dossier and publishes economic opinions (EOs). This study aimed at synthesizing outcomes of these evaluations in oncology as this therapeutic area is widely represented in this sector.

METHODS: All the EOs released by CEESP were collected until End December 2022. For each opinion, information including therapeutic area, methodological reservation (MR), Incremental Cost-Effectiveness Ratio (ICER ; if multiple ICER were notified in the conclusion, minimum was used), among other variables were extracted.

RESULTS: 106 EOs were identified (including 81% in oncology and 19% in onco-hematology), in which 787 MRs were reported: 441 minor (56%), 291 important (37%) and 55 major (7%). The most frequent requests in oncology was for indication extension (55%) while in onco-hematology it was for inscription (70%). Among all EOs, 39 (37%) reported at least one major reservation (28% in oncology, 9% in hematology), and 47 (44%) evaluations were considered as invalid (65% in onco-hematology and 40% in oncology). The mean ICER published in conclusions was €186,914€/QALY, varying from €7,392/QALY (acute lymphoïd leukemia) to €1,437,359/QALY (melanoma), and varying from €284,826/QALY in 2014-2016 vs. €144,098/QALY in 2017-2019 ( - 49%) vs. €182,001/QALY in 2020-2022 (+ 26%). Overall, in oncology mean ICER seems decrease by 36% between 2014-2016 and 2020-2022 periods in France.

CONCLUSIONS: This analysis shows that in France, in recent evaluations of oncology medicines, it seems to be a trend in which the published ICER is minimized. This could be explained either with the therapeutic environment changes and the appearance of medicines on efficiency frontiers and lead to lower incremental costs differences or with changes in pharmaceutical companies methods.