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Economic Evaluations of Anticancer Drugs Based on Medico-Administrative Databases: A Systematic Literature Review
Elsa Bouée-Benhamiche1, Philippe Jean Bousquet1, Salah Ghabri2
1Department of Health Data and Assessment, Survey Data Science and Assessment Division, French National Cancer Institute (Institut National du Cancer INCa), 52 Avenue André Morizet, 92100, Boulogne-Billancourt, France.
Background:
Oncology is among the most active therapeutic fields in terms of new drug development projects, with increasingly expensive drugs. The expected clinical benefit and cost effectiveness of these treatments in clinical practice have yet to be fully confirmed. Health medico-administrative databases may be useful for assessing the value of anticancer drugs with real-world data.
Objective:
The objectives of our systematic literature review (SLR) were to analyse economic evaluations of anticancer drugs based on health medico-administrative databases, to assess the quality of these evaluations, and to identify the inputs from such databases that can be used in economic evaluations of anticancer drugs.
Methods:
We performed an SLR by using PubMed and Web of Science articles published from January 2008 to January 2019. The search strategy focused on anticancer drug cost-effectiveness analyses (CEAs)/cost-utility analyses (CUAs) that were entirely based on medico-administrative databases. The review reported the main choices of economic evaluation methods in the analyses. The quality of the articles was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and risk of bias assessment checklists.
Results:
Of the 306 records identified in PubMed, 12 articles were selected, and one additional article was identified through Web of Science. Ten of the 13 articles were CEAs and three were CUAs. Most of the analyses were carried out in North America (n = 11). The economic metric used was the cost per life-year gained (n = 10) or cost per quality-adjusted life-year (n = 3). Reporting of the target analysis population and strategies in the articles was in agreement with the CHEERS guidelines. The structural assumptions underpinning the economic models displayed the poorest reporting quality among the items analysed. Representativeness bias (n = 11) and the issue of censored medical costs (n = 8) were the most frequently analysed risks.
Conclusion:
A comparison of the economic results was not relevant due to the high heterogeneity of the selected studies. Our SLR highlighted the benefits and pitfalls related to the use of medico-administrative databases in the economic evaluations of anticancer drugs.
Insights
This systematic review analyzed economic evaluations of cancer drugs using health databases. It found these databases offer valuable real-world data but require careful assessment of bias and cost reporting for accurate cost-effectiveness analysis.
Area of Science:
- Health Economics
- Oncology Drug Development
- Real-World Evidence
Background:
- Oncology drug development is rapidly advancing with rising costs.
- The clinical benefit and cost-effectiveness of new cancer drugs require validation in real-world settings.
- Health administrative databases offer a valuable resource for assessing anticancer drug value.
Purpose of the Study:
- To systematically review economic evaluations of anticancer drugs utilizing health administrative databases.
- To assess the quality of these economic evaluations.
- To identify key data from administrative databases applicable to economic evaluations.
Main Methods:
- A systematic literature review of studies published between January 2008 and January 2019.
- Searched PubMed and Web of Science for cost-effectiveness analyses (CEAs) and cost-utility analyses (CUAs) based on administrative databases.
- Assessed study quality using CHEERS and risk of bias checklists.
Main Results:
- 13 relevant articles were identified, predominantly cost-effectiveness analyses from North America.
- Common metrics included cost per life-year gained and cost per quality-adjusted life-year.
- Reporting quality was generally good for analysis populations but poor for structural assumptions; representativeness bias and censored costs were frequent concerns.
Conclusions:
- Health administrative databases provide crucial real-world data for economic evaluations of cancer drugs.
- While beneficial, these databases present challenges including representativeness bias and handling censored medical costs.
- Further refinement in reporting and methodology is needed to maximize the utility of administrative data in oncology health economics.
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