Back to the Future: In the Era of Cost-Effectiveness Analysis, Affordability Is a Limiting Factor for Patients' Access to Innovative Cancer Treatments.

BACKGROUND: Over the past 5 years, 55 new anticancer drugs have been launched worldwide. Considering the increasing costs of innovative treatments, both the number and the relevance of cost-effectiveness analyses have increased, meaningfully supporting decision making by stakeholders and policy makers. Notably, cost-effective treatments remain unavailable to patients because they are still unaffordable for a multitude of payers.

OBJECTIVES: To discuss the differences between cost effectiveness and affordability.

METHODS: We reviewed the most relevant data on the divergences between cost effectiveness and affordability. In addition, we included our recommendations to improve patients' access to innovative cancer therapies.

RESULTS: The increasing costs of recently launched antineoplastic drugs, as high as $150 000 per year, represent a major barrier to patients' access to treatments globally. In Brazil, for example, patients' access to innovative treatments depends greatly on whether the individual has private health insurance. In the public health sector, patients' access to cost-effective innovative treatments varies according to the financial capacity of the facility, leading to inequalities within the same healthcare system.

CONCLUSIONS: We conclude that because of the socioeconomic inequality mostly seen in lower and middle-income countries, it is difficult to define a cost-effectiveness threshold by region or a willingness-to-pay threshold affordable to the entire population. We consider that benchmark interventions might help to find an affordable willingness-to-pay threshold, and league table interventions might help policy makers, physicians, and the society to share the decision making.