OBJECTIVES: Development of innovative new oncology agents with premium pricing presents challenges to payers as they seek to balance clinical need with cost-effectiveness. An analysis was performed on health technology assessments (HTA) in 2020, conducted by NICE (England and Wales), SMC (Scotland), PBAC (Australia), and CADTH (Canada).

METHODS: Oncology treatments approved by the European Medicines Agency and assessed by NICE, SMC, PBAC, and CADTH were reviewed, and the HTA decisions analysed. The analysis was conducted using an in-house oncology HTA database describing the key clinical and economic data used to support over 1,200 HTA decisions.

RESULTS: In 2020, NICE published guidance for 27 oncology treatments, of which 93% were recommended, an increase from 92% in 2019 and 86% in 2018. The majority of treatments with positive recommendations (19 of 25) were recommended with a commercial arrangement, while six were recommended through the Cancer Drugs Fund (CDF), a smaller proportion than those recommended through the CDF in 2019.

SMC published guidance for 24 oncology treatments in 2020; all were recommended, of which 37.5% were restricted recommendations. CADTH conditionally recommended 75% of 24 treatments, mostly based on cost-effectiveness being improved to an acceptable level, while a further 8% were recommended unconditionally. PBAC published 16 HTAs in 2020, of which 69% received a positive recommendation.

CONCLUSIONS: The majority of oncology treatments received a positive recommendation in all countries. In England and Wales, inclusion of a commercial arrangement was a key factor in facilitating a positive recommendation while cost-effectiveness considerations were also a factor in Canada. PBAC issued the highest number of negative recommendations followed by CADTH. There was limited agreement on the treatments with negative recommendations with only one treatment not recommended by both PBAC and CADTH. The main driver of the negative recommendation in both assessments was uncertainty in clinical benefit.