Objectives: The rising disease burden and high price of new oncology medicines, combined with uncertainty in clinical and economic evidence, have brought substantial challenges to payers and health technology assessment (HTA) in making decisions on coverage. This review intended to comprehensively summarize the significant predictors and their relative importance in HTA decisions for cancer drugs.

Methods: A systematic literature search was performed in MEDLINE and EMBASE databases from inception to July 2020. The studies were eligible for inclusion if they conducted quantitative analysis of HTA related decisions for cancer drugs. The factors with p-values below the confidence level of 0.05 were considered as the statistically significant predictors for HTA decisions and odd ratios were calculated for categorical factors.

Results: A total of 9 studies including 1146 decisions from 6 committees in 6 different countries were eligible to be included for review. Among the included studies. the number of HTA decisions ranged from 17 to 393 (median=75) and most studies (n=6) had no specific restrictions on the types of cancers. From the univariable analysis, improvement on effectiveness and cost-effectiveness were found as the significant predictors for the committees in Australia, Belgium, Korea and Canada. From the multivariable analysis, cost-effectiveness was found as the strongest positive predictor for the recommendations for the committees in England, Korea and Canada. Few of factors related to characteristics of disease and technology were found significantly associated with decisions among the studied committees.

Conclusions: Despite the different drug reimbursement systems and the socioeconomic situations, cost-effectiveness and/or improvement on clinical outcomes seem to be the most important predictors for recommendations of cancer drugs in the majority of committees.

Keywords: Factors, health technology assessment, decision makers, cancer drugs