Correlation Between Extension Survival Benefits and Incremental Costs of Oncology Drugs in Portugal: A Cross-Sectional, Regression Analysis
Author(s)
Catarina Ribeiro, MSc1, Carlota Teles, MSc2, Beatriz Costa, MSc2, Ricardo Amaral, MSc2, Diogo Mendes, PhD2, Carlos Alves, PhD1.
1Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal, 2Clevidence, Oeiras, Portugal.
1Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal, 2Clevidence, Oeiras, Portugal.
OBJECTIVES: The limited resources of the Portuguese National Health Service make it relevant to understand how costs of oncology drugs relate with their clinical benefits [1,2]. This study aims to assess whether the incremental costs of oncology medicines in Portugal are correlated with improvements in survival outcomes.
METHODS: Reimbursement reports of oncology medicines published by INFARMED, IP between 2018 and 2024 were analysed. Data on intervention and comparator(s), magnitude of added therapeutic value (ATV), type and quality of evidence supporting the decision, overall survival (OS) and progression-free survival (PFS) (medians and hazard ratios [HRs]) were retrieved [3,4]. Public drug prices were collected from portal BASE (public contracts repository). Relationship between OS and PFS improvement (estimated as % of median survival extension and HRs) and incremental treatment costs (until disease progression or death) was assessed through linear regression models. Regression coefficients (β) and coefficients of determination (R2) were estimated. Reimbursement year, magnitude of ATV, type (RCT vs. non-RCT) and quality of evidence were additional covariates assessed in models.
RESULTS: Out of 70 reports, 36 assessed therapeutic value based on OS and 34based on PFS. No correlation between OS (β: 0,64 [-1,50; 0,28]; R2: 0,825) and PFS (β : 0,03 [-0,38; 0,43]; R2: 0,230)median survival improvements and incremental treatment costs was identified. A statistically significant relationship was observed between PFS improvement assessed through HR and incremental costs (β: 4,77 [1,94; 7,59]; R2: 0,492),, but not for OS (β: 0,15; [-0,39 to 0,10]; R2: 0,758).. An inverse relationship between quality of evidence and incremental costs was found when PFS was assessed through HR.
CONCLUSIONS: These findings do not support a consistent correlation between improvement of survival outcomes and incremental costs of oncology drugs. The potential lack of value-based cancer drug prices may represent a possible barrier to market access in Portugal.
METHODS: Reimbursement reports of oncology medicines published by INFARMED, IP between 2018 and 2024 were analysed. Data on intervention and comparator(s), magnitude of added therapeutic value (ATV), type and quality of evidence supporting the decision, overall survival (OS) and progression-free survival (PFS) (medians and hazard ratios [HRs]) were retrieved [3,4]. Public drug prices were collected from portal BASE (public contracts repository). Relationship between OS and PFS improvement (estimated as % of median survival extension and HRs) and incremental treatment costs (until disease progression or death) was assessed through linear regression models. Regression coefficients (β) and coefficients of determination (R2) were estimated. Reimbursement year, magnitude of ATV, type (RCT vs. non-RCT) and quality of evidence were additional covariates assessed in models.
RESULTS: Out of 70 reports, 36 assessed therapeutic value based on OS and 34based on PFS. No correlation between OS (β: 0,64 [-1,50; 0,28]; R2: 0,825) and PFS (β : 0,03 [-0,38; 0,43]; R2: 0,230)median survival improvements and incremental treatment costs was identified. A statistically significant relationship was observed between PFS improvement assessed through HR and incremental costs (β: 4,77 [1,94; 7,59]; R2: 0,492),, but not for OS (β: 0,15; [-0,39 to 0,10]; R2: 0,758).. An inverse relationship between quality of evidence and incremental costs was found when PFS was assessed through HR.
CONCLUSIONS: These findings do not support a consistent correlation between improvement of survival outcomes and incremental costs of oncology drugs. The potential lack of value-based cancer drug prices may represent a possible barrier to market access in Portugal.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO64
Topic
Clinical Outcomes, Health Policy & Regulatory, Health Technology Assessment
Topic Subcategory
Clinical Outcomes Assessment, Comparative Effectiveness or Efficacy
Disease
Oncology