Exploring If a Price Premium Is Requested for Cancer Drugs That Seek Reimbursement on State-Subsidised Schemes in Ireland: An Analysis of Drugs That Have Undergone a Full HTA by the NCPE in Ireland Between 2019 and 2023

OBJECTIVES: A 2023 cross-sectional study found cancer drugs to be, on average, three times more expensive compared with non-cancer drugs in the US, Switzerland and Germany. Our study aimed to investigate whether a price premium exists for cancer drugs that submitted a full health technology assessment (HTA) to the National Centre for Pharmacoeconomics (NCPE) in Ireland compared with non-cancer drugs.

METHODS: Drugs which had undergone a full HTA assessment by the NCPE between 2019 and 2023 were identified. Relevant clinical trial information was extracted from the EMA European Public Assessment Report. Data relating to the HTA, including drug price and estimated treatment course costs, were extracted from the NCPE Technical Summary report. Epidemiological data for Ireland were retrieved from the Global Burden of Disease Study 2019, including incidence, prevalence and mortality rate in Ireland, relevant to the year prior to market launch.

RESULTS: Of the 122 drugs included in the study, 57.4% were cancer drugs and 42.6% were non-cancer drugs. The median treatment course cost [IQR] was higher at €94,000 [€63489, €134320] for cancer drugs, versus €19,671 [€4960, €123144] for non-cancer drugs (p = 0.62). Sensitivity analysis adjusted to 2022 costs showed a mean treatment course cost (SD) of €130,524 (€105,295) and €106,669 (€189,553) for cancer and non-cancer drugs respectively (p = 0.42). The mean incremental QALY gain for cancer drugs was lower compared with non-cancer drugs (gain of 1.22 versus 1.59 respectively, p = 0.47).

CONCLUSIONS: Our results suggest that, on average, estimated treatment course costs of cancer drugs are higher than treatment costs of non-cancer drugs, although a statistically significant difference could not be demonstrated. Conversely, a numerically greater benefit was demonstrated for non-cancer drugs, although this was not statistically significant. Results are suggestive of a cancer drug premium, in the absence of additional benefit, although further research is needed.