OBJECTIVES: Besides being associated with a negative impact on patients’ lives and a low 5-year survival rate[1], stage IV (metastatic) breast cancer is accompanied with high treatment costs. The objective of this research was to analyse recent HTA decisions on metastatic breast cancer of different national HTA bodies worldwide and investigate reasons for variances in their decision making.  

METHODS: Reimbursement decisions for metastatic breast cancer treatments across various national HTA bodies published between January 2013 and May 2015 were analysed. Factors such as variations in treatment guidelines, different disease mutations, specific lines of therapy or if the drug was a single or add-on treatment were not considered. Each HTA decision was analysed according to the following criteria: clinical value, survival benefit, price, ICER (where applicable), toxicity and quality of life. Treatments were not compared with each other, but the HTA evaluation of each treatment was considered across the single countries.

RESULTS: A review of 5 breast cancer medications recently assessed independently across 9 HTA authorities (6 European HTA bodies, Canada, Australia, Japan) showed that generally, drugs with sufficient proof of clinical value were nationally reimbursed. Positive reimbursement decisions for all treatments were made in Germany and France, while NICE and SMC only gave negative opinions. Most common reasons for non-approvals or restrictions were “lack of cost effectiveness” and “lack of clinical value” in respectively 10 and 3 of the HTA submissions.

 CONCLUSIONS: HTA decisions for metastatic breast cancer treatments differ across countries, with some appearing to be more willing to reimburse medications. Clinical effectiveness was the most important decision factor for 5 countries, whereas cost-effectiveness was more relevant to the remaining 4 HTA bodies. With novel medications for metastatic breast cancer coming to market in the next years[2], certain criteria for HTA assessments might need to be re-defined.