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Hammerman A, Azran C, Topol Y, Landsberger D, Liebermann N, Siegelmann-Danieli N. Publicly Funded Cancer Care: Are Adjuvant Therapies Prioritized Over Treatment of Metastatic Cancer? The Israeli Experience. JCO Oncol Pract 2023:OP2300213. [PMID: 37967295 DOI: 10.1200/op.23.00213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 09/13/2023] [Accepted: 10/17/2023] [Indexed: 11/17/2023] Open
Abstract
PURPOSE In Israel, a public committee advises which new medications should be reimbursed subject to an annual budget allocation. The committee considers clinical trial outcomes, professional societies' preferences, projected budget impacts, and other social and ethical aspects. The Israeli oncologists' society places a strong emphasis on prioritizing adjuvant therapies because of their potential to advance cure. In 2023, several novel adjuvant therapies were suggested for national funding. Our objective was to ascertain whether Israeli decision makers have embraced the practice of prioritizing budgets for therapies with curative intent over late-disease therapy. METHODS We collected data on all proposed cancer therapies for the 2023 update: indications, treatment settings, European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS) score, and whether accepted for reimbursement. The rates of acceptance were compared between drugs in curative and noncurative settings. Data were extracted from the official Israeli Ministry of Health publications and ESMO-MCBS website. RESULTS Seven of the eight proposed therapies with curative intent received reimbursement approval (88%), in contrast to 11 of the 55 therapies for advanced/metastatic stages (20%). Among all advanced disease therapies with a high ESMO-MCBS score of 4, only four of 16 (25%) secured reimbursement approval. CONCLUSION Our analysis revealed that during the 2023 reimbursement deliberations, Israeli policymakers embraced the prioritization of potentially curative therapies over treatments for incurable cancers, including several interventions that have demonstrated significant improvements in overall survival and/or quality of life. Introducing objective cost-effectiveness measures as a guiding framework for comparing competing medications may offer some resolution to this complex challenge.
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Affiliation(s)
| | - Carmil Azran
- Maccabi Health Services Headquarters, Tel-Aviv, Israel
| | - Yael Topol
- Maccabi Health Services Headquarters, Tel-Aviv, Israel
| | | | | | - Nava Siegelmann-Danieli
- Maccabi Health Services Headquarters, Tel-Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Kiesewetter B, Dafni U, de Vries EGE, Barriuso J, Curigliano G, González-Calle V, Galotti M, Gyawali B, Huntly BJP, Jäger U, Latino NJ, Malcovati L, Oosting SF, Ossenkoppele G, Piccart M, Raderer M, Scarfò L, Trapani D, Zielinski CC, Wester R, Zygoura P, Macintyre E, Cherny NI. ESMO-Magnitude of Clinical Benefit Scale for haematological malignancies (ESMO-MCBS:H) version 1.0. Ann Oncol 2023; 34:734-771. [PMID: 37343663 DOI: 10.1016/j.annonc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND The European Society for Medical Oncology (ESMO)-Magnitude of Clinical Benefit Scale (MCBS) has been accepted as a robust tool to evaluate the magnitude of clinical benefit reported in trials for oncological therapies. However, the ESMO-MCBS hitherto has only been validated for solid tumours. With the rapid development of novel therapies for haematological malignancies, we aimed to develop an ESMO-MCBS version that is specifically designed and validated for haematological malignancies. METHODS ESMO and the European Hematology Association (EHA) initiated a collaboration to develop a version for haematological malignancies (ESMO-MCBS:H). The process incorporated five landmarks: field testing of the ESMO-MCBS version 1.1 (v1.1) to identify shortcomings specific to haematological diseases, drafting of the ESMO-MCBS:H forms, peer review and revision of the draft based on re-scoring (resulting in a second draft), assessment of reasonableness of the scores generated, final review and approval by ESMO and EHA including executive boards. RESULTS Based on the field testing results of 80 haematological trials and extensive review for feasibility and reasonableness, five amendments to ESMO-MCBS were incorporated in the ESMO-MCBS:H addressing the identified shortcomings. These concerned mainly clinical trial endpoints that differ in haematology versus solid oncology and the very indolent nature of nevertheless incurable diseases such as follicular lymphoma, which hampers presentation of mature data. In addition, general changes incorporated in the draft version of the ESMO-MCBS v2 were included, and specific forms for haematological malignancies generated. Here we present the final approved forms of the ESMO-MCBS:H, including instructions. CONCLUSION The haematology-specific version ESMO-MCBS:H allows now full applicability of the scale for evaluating the magnitude of clinical benefit derived from clinical studies in haematological malignancies.
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Affiliation(s)
- B Kiesewetter
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - U Dafni
- Laboratory of Biostatistics, School of Health Sciences, National and Kapodistrian University of Athens, Athens; Frontier Science Foundation-Hellas, Athens, Greece
| | - E G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Barriuso
- The Christie NHS Foundation Trust and Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - G Curigliano
- European Institute of Oncology, IRCCS, Division of Early Drug Development, Milan; Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy
| | - V González-Calle
- Servicio de Hematología, Hospital Universitario de Salamanca-IBSAL, CIBERONC and Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - M Galotti
- ESMO Head Office, Lugano, Switzerland
| | - B Gyawali
- Departments of Oncology, Oncology; Public Health Sciences, Queen's University, Kingston; Division of Cancer Care and Epidemiology, Queen's University, Kingston, Canada
| | - B J P Huntly
- Cambridge Stem Cell Institute, Department of Haematology, University of Cambridge & Cambridge University Hospitals, Cambridge, UK
| | - U Jäger
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | | | - L Malcovati
- Department of Molecular Medicine, University of Pavia, Pavia; Department of Hematology Oncology, IRCCS S. Matteo Hospital Foundation, Pavia, Italy
| | - S F Oosting
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G Ossenkoppele
- Department of Haematology, VU University Medical Center, Amsterdam, The Netherlands
| | - M Piccart
- Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - M Raderer
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - L Scarfò
- Strategic Research Program on CLL, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - D Trapani
- European Institute of Oncology, IRCCS, Division of Early Drug Development, Milan; Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy
| | - C C Zielinski
- Wiener Privatklinik, Central European Academy Cancer Center, Vienna, Austria
| | - R Wester
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - P Zygoura
- Frontier Science Foundation-Hellas, Athens, Greece
| | - E Macintyre
- Onco-hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris; Université Paris Cité, INSERM, CNRS, INEM F-75015, Paris, France
| | - N I Cherny
- Cancer Pain and Palliative Medicine Service, Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel.
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Sharman Moser S, Tanser F, Siegelmann-Danieli N, Apter L, Chodick G, Solomon J. The reimbursement process in three national healthcare systems: variation in time to reimbursement of pembrolizumab for metastatic non-small cell lung cancer. J Pharm Policy Pract 2023; 16:22. [PMID: 36797806 PMCID: PMC9936745 DOI: 10.1186/s40545-023-00529-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
In this article, we focus on the reimbursement process, and as an example, characterize the time to reimbursement of pembrolizumab, a PD-1 immune checkpoint inhibitor for treatment of metastatic NSCLC from publicly available websites, in three different healthcare systems: The National Institute for Health and Care Excellence (NICE) in the UK, the Pharmaceutical Benefits Advisory Committee (PBAC) in Australia, and the National Advisory Committee for the Basket of Health Services in Israel, all who have publicly funded health systems which include drug coverage. Our study found that there are substantial differences in time to reimbursement of pembrolizumab for the same conditions in different countries, with NICE and The National Advisory Committee for the Basket of Health Services in Israel approving one condition at the same time, Israel approving two conditions earlier than NICE, and PBAC lagging behind for every condition. These differences could be due to the differences in health policy systems and the many factors that affect reimbursement. Comparing the reimbursement process between different countries can highlight the challenges facing their health systems in early adoption of new treatments.
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Affiliation(s)
- Sarah Sharman Moser
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, 27 Hamered St, 6812509, Tel Aviv, Israel.
| | - Frank Tanser
- grid.36511.300000 0004 0420 4262Lincoln International Institute of Rural Health, Lincoln Medical School, University of Lincoln, Brayford Way, Brayford Pool, Lincoln, LN6 7TS UK
| | - Nava Siegelmann-Danieli
- grid.425380.8Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, 27 Hamered St, 6812509 Tel Aviv, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Apter
- grid.425380.8Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, 27 Hamered St, 6812509 Tel Aviv, Israel ,grid.7489.20000 0004 1937 0511Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gabriel Chodick
- grid.425380.8Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, 27 Hamered St, 6812509 Tel Aviv, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Josie Solomon
- grid.36511.300000 0004 0420 4262The School of Pharmacy, Joseph Banks Laboratories, University of Lincoln, Beevor Street, Lincoln, LN6 7DL UK
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Systemic therapy for early-stage breast cancer: learning from the past to build the future. Nat Rev Clin Oncol 2022; 19:763-774. [PMID: 36253451 PMCID: PMC9575647 DOI: 10.1038/s41571-022-00687-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/23/2022]
Abstract
The treatment of breast cancer has improved dramatically over the past century, from a strictly surgical approach to a coordinated one, including local and systemic therapies. Systemic therapies for early-stage disease were initially tested against observation or placebo only in adjuvant trials. Subsequent clinical trials focusing on treatment ‘fine-tuning’ had a marked increase in cohort size, duration and costs, leading to a growing interest in the neoadjuvant setting in the past decade. Neoadjuvant trial designs have the advantages of enabling the direct evaluation of treatment effects on tumour diameter and offer unique translational research opportunities through the comparative analysis of tumour biology before, during and after treatment. Current technologies enabling the identification of better predictive biomarkers are shaping the new era of (neo)adjuvant trials. An urgent need exists to reinforce collaboration between the pharmaceutical industry and academia to share data and thus establish large databases of biomarker data coupled with patient outcomes that are easily accessible to the scientific community. In this Review, we summarize the evolution of (neo)adjuvant trials from the pre-genomic to the post-genomic era and provide critical insights into how neoadjuvant studies are currently designed, discussing the need for better end points and treatment strategies that are more personalized, including in the post-neoadjuvant setting. Systemic therapies for early-stage disease have been tested in clinical trials for decades. The authors of this Review provide an overview of the evolution of (neo)adjuvant trials from the pre-genomic to the post-genomic era, focusing on design, end points and biomarkers that, together, could enable the delivery of more personalized treatment. Systemic therapy for patients with early-stage breast cancer has dramatically improved over the past eight decades, and the aims and designs of (neo)adjuvant clinical trials have consistently evolved. The transition of clinical trials from the pre-genomic to the post-genomic era has been based on a deeper understanding of disease biology and a higher level of interest in the discovery of molecular markers associated with a response to treatment. The currently adopted approach to the design of neoadjuvant trials requires a new wave of changes, with the implementation of validated end points with more robust predictive associations with survival outcomes and more personalized treatment strategies (escalation and/or de-escalation). The evolution towards a more personalized treatment approach is leading to increasing interest in the post-neoadjuvant setting to investigate new drugs specifically in patients with high-risk disease. Optimizing the efficiency of the search for novel biomarkers that can guide treatment tailoring requires the establishment of large, well-annotated databases of candidate biomarkers linked with clinical outcomes that are also easily accessible to the scientific community. Early sharing of data from clinical trials should be based on joint efforts and reinforced collaboration between the pharmaceutical industry and academic entities.
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