Health Economics

Research focus

The Health Economics Group has a primary focus on obtaining a better understanding of the cost-effectiveness of cancer biomarkers and of decision making regarding the adoption of new cancer therapies.

Subprojects

Jiyeon Kang completed her PhD thesis entitled “Improving economic evaluation and decision-making for oncology drugs using real-world data”. She built a unique database of 229 oncology appraisals undertaken by the UK-based National Institute for Health and Care Excellence (NICE) during 2011-2021, drawing on the evidence submission made by manufacturers, the independent report of the Evidence Review Group and the final guidance issued by the Appraisal Committee. Her thesis included papers detailing how real-world data has been used to inform decision making, a paper testing a series of hypotheses regarding the use and acceptability of real-world data in NICE appraisals, and an analysis comparing the use of data in appraisals of targeted cancer therapies and nontargeted cancer therapies.

Another project has focused on the use of health economic information to inform decision making regarding the adoption of new health technologies. This included a study of how molecular targeted therapies and immune checkpoint inhibitors for the treatment of non-small cell lung cancer have been assessed.

Important results

Managed Access Agreements are being used increasingly as a means of improving access to treatments where the evidence of clinical effectiveness is too uncertain for NICE to recommend routine commissioning. The Cancer Drugs Fund (CDF) was introduced in England in 2016 to give patients access to these potentially valuable treatments. The CDF provides the drugs for several years while additional data are collected before a final review of the drug takes place. An analysis of the first twenty-four drugs to exit the CDF highlighted the important role played by longer follow-up of patients in the original clinical trials used to support the introduction of these drugs and the very limited role played by the data collected from patients receiving the drugs provided through the CDF. This is an important finding given the widespread enthusiasm for using real world data to inform drug reimbursement decisions.

Clear differences were observed between the appraisal of checkpoint inhibitors and that of molecular targeted therapies, at least in the context of nonsmall cell cancers. These differences derive from the more limited clinical data and the more restricted application of targeted medicines.

Future plans

Future work will involve further analysis of the rich oncology drug database, particularly focusing on the maturity of overall survival data and its impact on economic evaluation and decision making. It is planned to extend the work on molecular targeted therapies and immune checkpoint inhibitors from non-small cell lung cancer to all cancers where these treatments have been introduced. A further project will explore the economic evaluation of Antibody Drug Conjugates.