ASSOCIATION BETWEEN ADDED THERAPEUTIC VALUE AND COST-EFFECTIVENESS OF ONCOLOGY MEDICINES ACROSS FIVE EUROPEAN HTA SYSTEMS
Author(s)
Catarina Ribeiro, MSc1, João Soares, MSc2, Diogo Mendes, PhD1, Carlos Alves, PhD1.
1Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal, 2Clevidence, Oeiras, Portugal.
1Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal, 2Clevidence, Oeiras, Portugal.
OBJECTIVES: This study assessed the association between the magnitude of added therapeutic value (ATV) and corresponding incremental cost-effectiveness ratios (ICERs) for oncology medicines approved for public reimbursement.
METHODS: Five European countries (Portugal, France, Italy, Germany and The Netherlands) with established frameworks for the assessment and classification of ATV were included. HTA reports of oncology medicines published between 2018 and 2025 were reviewed to extract ATV classifications and corresponding ICERs (€ per Quality-Adjusted Life Year [QALY]), complemented by an Embase® search for additional data. Associations between ICERs and ATV classifications were assessed using Spearman’s rho and Kendall’s tau, with cluster bootstrap resampling used to estimate confidence intervals in R.
RESULTS: A total of 137 reimbursement reports for 89 oncology medicines with ICER data were included in the analysis. Median ICER values ranged from €33,000/QALY in Italy to €107,227/QALY in France. The association between ATV magnitude and ICER values differed across countries. Italy demonstrated the strongest positive association (ρ = 0.58 (0.04, 0.81); τ = 0.42 (0.00, 0.68)) and was the only country in which the correlation coefficients reached statistical significance. In the remaining countries, associations were weaker (France: ρ = 0.06 (-0.20, 0.31); τ = 0.05 (-0.17, 0.26), Portugal: ρ = 0.03 (-0.54, 0.55); τ = 0.01 (-0.47, 0.46) and Germany: ρ = 0.03 (-0.98, 0.83); τ = -0.04 (-0.96, 0.76)). A negative correlation was observed in the Netherlands (ρ = -0.19 (-0.48, 0.13); τ = -0.15 (-0.38, 0.11)). Confidence intervals were generally wide, reflecting the limited sample sizes available for analysis.
CONCLUSIONS: These findings do not support a consistent association between the magnitude of ATV and ICERs across European HTA systems. The observed variability suggests that clinical and economic assessments may capture distinct dimensions of value, reflecting differences in how national HTA frameworks inform reimbursement decision-making.
METHODS: Five European countries (Portugal, France, Italy, Germany and The Netherlands) with established frameworks for the assessment and classification of ATV were included. HTA reports of oncology medicines published between 2018 and 2025 were reviewed to extract ATV classifications and corresponding ICERs (€ per Quality-Adjusted Life Year [QALY]), complemented by an Embase® search for additional data. Associations between ICERs and ATV classifications were assessed using Spearman’s rho and Kendall’s tau, with cluster bootstrap resampling used to estimate confidence intervals in R.
RESULTS: A total of 137 reimbursement reports for 89 oncology medicines with ICER data were included in the analysis. Median ICER values ranged from €33,000/QALY in Italy to €107,227/QALY in France. The association between ATV magnitude and ICER values differed across countries. Italy demonstrated the strongest positive association (ρ = 0.58 (0.04, 0.81); τ = 0.42 (0.00, 0.68)) and was the only country in which the correlation coefficients reached statistical significance. In the remaining countries, associations were weaker (France: ρ = 0.06 (-0.20, 0.31); τ = 0.05 (-0.17, 0.26), Portugal: ρ = 0.03 (-0.54, 0.55); τ = 0.01 (-0.47, 0.46) and Germany: ρ = 0.03 (-0.98, 0.83); τ = -0.04 (-0.96, 0.76)). A negative correlation was observed in the Netherlands (ρ = -0.19 (-0.48, 0.13); τ = -0.15 (-0.38, 0.11)). Confidence intervals were generally wide, reflecting the limited sample sizes available for analysis.
CONCLUSIONS: These findings do not support a consistent association between the magnitude of ATV and ICERs across European HTA systems. The observed variability suggests that clinical and economic assessments may capture distinct dimensions of value, reflecting differences in how national HTA frameworks inform reimbursement decision-making.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA178
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes, Value Frameworks & Dossier Format
Disease
Oncology