French Health Authority Appraisals of Economic Evaluations in Early-Stage Solid Cancers

Speaker(s)

Sambuc C1, Tehard B2, Seguier C2, Midy F2, Chevalier J2, Roze S3
1Vyoo Agency, Villeurbanne, Paris, France, 2Vyoo Agency, Paris, 75, France, 3Vyoo Agency, VILLEURBANNE, 69, France

Presentation Documents

OBJECTIVES: In France, the Commission for Economic and Public Health Evaluation (CEESP) appraises the validity of the incremental cost-effectiveness ratio (ICER) assessed by the manufacturers. The economic analysis is considered as valid if there are no mention of major uncertainty or reservation. In the last period, the trend in solid tumor treatments, especially immunotherapies, has been to move treatment lines up to the adjuvant or neoadjuvant stage, challenging economic evaluation.

The aim is to analyze the CEESP opinions relating to early-stage cancer treatments to discuss issues raised by these evaluations.

METHODS: Using the Vyoo Agency database, economic opinions published regarding adjuvant, peri-adjuvant or neoadjuvant oncology treatments were reviewed.

RESULTS: Since 2019, 11 economic opinions have been published regarding adjuvant/neoadjuvant treatments for 6 tumor localizations.

ICER was validated in 64% of cases (7/11). Three analyses were invalidated due to major reservations concerning the integration of relevant comparators (1), an unsuitable type of model (1), the lack of demonstration of the proportional risk hypothesis (1) and an irrelevant methodology to estimate the utility scores (1). One analysis was invalidated due to a major uncertainty. Modelling the evolution of advanced disease (cost, utility, or transition) generates 32% of reserves.

Compared to the ICER appraised by the CEESP in advanced-stage oncology over the same period, the validation rates are comparable.

However, the average validated ICER was much lower (€30,861/QALY vs. €197,065/QALY) as is variability (€12,544/QALY to €49,572/QALY vs. €47,333/QALY to €339,880/QALY).

CONCLUSIONS: The economic evaluation of adjuvant/neoadjuvant cancer treatments is characterized by a high number of validated ICER, 64% versus 57% for all indications combined, comparable to that observed in economic opinions regarding advanced solid tumors. Compared to advanced stage, lower level, and variability of ICER were observed. The modeling of disease evolution especially at advanced stages was a challenge.

Code

HTA256

Topic

Health Technology Assessment

Topic Subcategory

Decision & Deliberative Processes

Disease

No Additional Disease & Conditions/Specialized Treatment Areas, Oncology