Do value thresholds for oncology drugs differ from nononcology drugs?

In the past decade, many oncologic drugs have been approved that extend life and/or improve patients' quality of life. However, new cancer drugs are often associated with high price and increased medical spending. For example, in 2010, the average annual cost of care for breast cancer in the final stage of disease was reported to be $94,284, and the total estimated cost in the United States was $16.50 billion.

To determine whether value threshold, as defined by the incremental cost-effectiveness ratio (ICER), differed between oncology and other therapeutic areas.

The PubMed database was searched for articles published between January 2003 and December 2013 with calculated ICER for therapeutic drug entities in a specific therapeutic area. The search term used was "ICER" and "United States." From 275 results, only those articles that reported ICERs using quality-adjusted life-years (QALY) were included. In addition, only those articles that used a U.S. payer perspective were retained. Among those, nondrug therapy articles and review articles were excluded. The mean ICER and value threshold for oncologic drugs and nononcologic drugs were evaluated for the analysis.

From 54 articles selected for analysis, 13 pertained to drugs in oncology therapeutics, and the remaining 41 articles addressed ICER for drugs in other therapeutic areas. The mean and median of ICERs calculated for cancer-specific drug intervention was $138,582/QALY and $55,500/QALY, respectively, compared with $49,913/QALY and $31,000/QALY, respectively, for noncancer drugs. Among the cancer drugs, 45.0% had ICERs below $50,000/QALY and 70.0% below $100,000/QALY. In comparison, 72.0% of noncancer drugs showed ICERs below $50,000/QALY, and 90.0% had ICERs below $100,000/QALY. When a specific threshold was mentioned, it was in the range of $100,000-$150,000 in cancer drugs, whereas drugs in other therapeutic areas used traditional threshold value within the range of $50,000-$100,000.

The average ICER reported for cancer drugs was more than 2-fold greater than the average ICER for noncancer drugs. In general, articles that addressed the relative value of oncologic pharmaceuticals used higher value thresholds and reported higher ICERs than articles evaluating noncancer drugs.