OBJECTIVES: To determine the key drivers and considerations influencing Health Technology Assessment (HTA) outcomes for oncology drugs in Australia, Canada, and the United Kingdom (UK), to provide insight into reimbursement pathways and alleviate uncertainties during the appraisal process across three national HTA agencies.

METHODS: A comprehensive review of all HTA assessments conducted for marketed oncology drugs between January 2022 and June 2023 in respective markets was identified. By leveraging literature reviews of appraisal recommendations, common factors influencing HTA decision-making were assessed to categorize positive, negative, and neutral outcomes.

RESULTS: Of the 150 HTA assessments identified, the most influential factors that impact HTA outcomes were clinical efficacy, economic implications, and disease-related factors. Australia (n=25) demonstrated the highest proportion of positive outcomes overall (76%) driven by economic cost-effectiveness, while clinical efficacy (55%) played a greater role in the UK (n=66). In Canada (n=59), clinical efficacy predominantly contributed to neutral (87%) and negative (100%) outcomes. 61% of cases irrespective of the outcome were attributed to clinical efficacy, which can be further segregated into the following categories, clinical evidence acceptability (67%), comparative efficacy (38%), and comparator choice (>1%). Among positive outcomes, clinical evidence acceptability was the most common sub-factor (53%), and insufficient/uncertain clinical evidence was a determining factor for the negative outcomes overall (50%).

CONCLUSIONS: While HTA agencies exhibit divergent priorities within different markets, the study reveals commonalities in the factors forming the basis for decision-making, namely that the clinical dimension is still a key factor in assessments. Navigating the distinctive socio-political and population-specific needs of each market poses challenges for manufacturers to tailor strategies effectively. By accounting for HTA outcome drivers, stakeholders can better navigate the complex landscape more successfully to ensure improved access to oncology treatments.