Background

Traditionally willingness to pay (WTP) for medicines is evaluated through cost-effectiveness analyses, but these, although robust in their outcomes, are complex in their structures and data requirements. A cost per cure analysis is a simpler metric that considers the clinical benefits and economic costs of medicines for curative therapies, and provides insights of the WTP. We aimed to understand the differences in observed WTP for curative therapies across therapeutic areas in France, with a focus on antibacterials, given the high priority antimicrobial resistance has in the healthcare policy agenda in France.

Methods

All medicines approved by the European Medicine’s Agency until December 2020 considered curative and reimbursed for each of their approved indications for adults in France were included. Generics, biosimilars, preventive and chronic treatments not leading to potential cure/eradication, were excluded. For each drug/indication (and genotype/cirrhotic state for Hepatitis C), cure rates were taken from the pivotal trials and the cost of treatment to achieve a cure was calculated using the prescribing information, national published prices including concomitant medication. The cost per cure for each medicine and indication was calculated and analysed per therapeutic area.

Results

24 curative medicines were included. The average cost per cure was €51,494 and included mostly anti-infectives and hemato-oncology therapies. Antibacterials presented the lowest median cost/cure between all therapeutic areas (5,248€; range:1,289€-10,752€). Lymphoma therapies presented the highest cost/cure (median 310,254€; range:794,054€-74,824€), Leukaemia median cost/cure was 172,898€. Antifungals median cost/cure of 20,618€; hepatitis C treatments was 26,374€; tuberculosis multi-drug resistant treatment was 27,674€.

Conclusion

Despite its multiple limitations (list prices, different cure definitions, burden, unmet need and populations affected), this research highlights significant differences in the WTP for curative treatments across different therapeutic areas, which is particularly low for antibacterials. Further research is required to better understand the reasons and implications of such findings.