International Journal of Health Policy and Management

International Journal of Health Policy and Management

Scoping Review of International Experience of a Dedicated Fund to Support Patient Access to Cancer Drugs: Policy Implications for Thailand

Document Type : Review Article

Authors
Parnnaphat Luksameesate
Osot Nerapusee
Chanthawat Patikorn
Puree Anantachoti
Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
10.34172/ijhpm.2023.7768
Abstract
Background
Access to high-cost cancer drugs is an unsolved problem globally. The dedicated drugs fund is attractive and feasible. This study reviewed currently implemented dedicated drugs fund worldwide to inform policy implications for Thailand.

Methods
A scoping review was conducted to identify countries currently implementing dedicated funds for cancer drugs. We searched electronic databases, PubMed and Embase, from 2010 to May 2021, Google and Google Scholar in August 2021, and government websites up to April 2022. The structure, management, cost containment strategies, and impact of dedicated funds were summarized and compared across the identified countries and Thailand.

Results
Out of 218 nations, Hong Kong, England, and Italy have established dedicated cancer drugs fund (CDF), primarily funded by their governments. Funds in England and Italy operate within annual budget limits. Hong Kong relies on an endowment fund. In England and Italy, pharmaceutical companies contribute proportionally to cover overspending as per risk-sharing agreements, while cost-sharing is not required. Hong Kong implements cost-sharing based on a patient’s family income. England and Italy employ a parallel pathway, utilizing the same drug selection committee to determine whether innovative drugs belong in the regular pharmaceutical benefits package or the dedicated drugs fund. Hong Kong follows a sequential pathway, allowing drugs to be considered for the dedicated funds after a negative decision. These countries use the fund for 5-11 years, making administrative adjustments to ensure sustainability.

Conclusion
The dedicated drugs fund is an effective strategy to improve access to non-reimbursable high-cost drugs in Thailand. Robust evaluation of the fund itself and funded drugs are recommended for policy-makers’ better decisionmaking. Learning from other countries can offer promising solutions. Health insurers need to balance providing cancer treatments with overall system preparedness.

Highlights

 

Commentary Published on this Paper

 

  • Establishing a Dedicated Fund to Improve Patient Access to Cancer Medicines: Key Considerations and Policy Implications for Thailand; Comment on “Scoping Review of International Experience of a Dedicated Fund to Support Patient Access to Cancer Drugs: Policy Implications for Thailand”

        Abstract | PDF

 

Authors' Response to the Commentary

 

  • TIs It Time for a Thai Cancer Drug Fund? From Global Evidence to Collaborative Action – A Response to Recent Commentary

        Abstract | PDF

Keywords
Dedicated Fund
High-Cost Drug
Cancer Drug
Global Review
Thailand
  1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. doi:3322/caac.21660
  2. World Health Organization (WHO). Global Health Estimates 2020: Deaths by Cause, Age, Sex, by Country and by Region 2000‐ 2020. https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death. Accessed February 24, 2021.
  3. Strategy and Planning Division Ministry of Public Health. Public Health Statistics A.D. 2021. https://bps.moph.go.th/new_bps/sites/default/files/statistic62.pdf. Accessed February 24, 2021.
  4. Hofmarcher T, Lindgren P, Wilking N, Jönsson B. The cost of cancer in Europe 2018. Eur J Cancer. 2020;129:41-49. doi:1016/j.ejca.2020.01.011
  5. Patikorn C, Taychakhoonavudh S, Sakulbumrungsil R, Ross-Degnan D, Anantachoti P. Financing strategies to facilitate access to high-cost anticancer drugs: a systematic review of the literature. Int J Health Policy Manag. 2022;11(9):1625-1634. doi:34172/ijhpm.2021.138
  6. Patikorn C, Taychakhoonavudh S, Thathong T, Anantachoti P. Patient access to anticancer medicines under public health insurance schemes in Thailand: a mixed methods study. Thai J Pharm Sci. 2019;43(3):168-178.
  7. Saerekul P, Limsakun T, Anantachoti P, Sakulbumrungsil R. Access to medicines for breast, colorectal, and lung cancer in Thailand. Thai J Pharm Sci. 2018;42(4):221-229.
  8. Ettinger DS, Wood DE, Aisner DL, et al. NCCN guidelines insights: non–small cell lung cancer, version 2.2021: featured updates to the NCCN guidelines. J Natl Compr Canc Netw. 2021;19(3):254-266. doi:6004/jnccn.2021.0013
  9. National Cancer Institute, Department of Medical Services, Ministry of Public Health. Guidelines for the Diagnosis and Treatment of Lung Cancer. Bangkok: Kosit Printing; 2015.
  10. Health Intervention and Technology Assessment Program (HITAP) Thailand. Cost-Utility Analysis of Pemetrexed Plus Platinum-Based for the Treatment of Malignant Pleural Mesothelioma Patients. 2017. https://www.hitap.net/documents/172978. Accessed March 22, 2021.
  11. Health Intervention and Technology Assessment (HITAP) Thailand. Cost-Effectiveness Analysis of Temozolomide in the Treatment of Glioblastoma Multiforme and Anaplastic Astrocytoma Patients. 2017. https://www.hitap.net/documents/172978. Accessed March 22, 2021.
  12. Health Intervention and Technology Assessment Program (HITAP) Thailand. Cost-Effectiveness Analysis of Treating Multiple Myeloma Patients Who Do Not Respond Well to Treatments or Relapse with Bortezomib-Based Regimens, Thalidomide-Based Regimens, and Lenalidomide-Based Regimens. 2017. https://www.hitap.net/documents/173069. Accessed March 22, 2021.
  13. Tanvejsilp P, Taychakhoonavudh S, Chaikledkaew U, Chaiyakunapruk N, Ngorsuraches S. Revisiting roles of health technology assessment on drug policy in universal health coverage in Thailand: where are we? And what is next? Value Health Reg Issues. 2019;18:78-82. doi:1016/j.vhri.2018.11.004
  14. Kittirotruji K, Lommuang K, Chumchaiyo C, Taychakhoonavudh S. Use of patient assistance programs (PAPs) to increase access to innovative drugs in Thailand. Current situations and prospects. Value Health. 2018;21(Suppl 2):S20. doi:1016/j.jval.2018.07.158
  15. Pauwels K, Huys I, Casteels M, De Nys K, Simoens S. Market access of cancer drugs in European countries: improving resource allocation. Target Oncol. 2014;9(2):95-110. doi:1007/s11523-013-0301-x
  16. Aggarwal A, Fojo T, Chamberlain C, Davis C, Sullivan R. Do patient access schemes for high-cost cancer drugs deliver value to society?-lessons from the NHS Cancer Drugs Fund. Ann Oncol. 2017;28(8):1738-1750. doi:1093/annonc/mdx110
  17. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473. doi:7326/m18-0850
  18. World Health Organization (WHO). Anatomical Therapeutic Chemical (ATC) Classification. https://www.who.int/tools/atc-ddd-toolkit/atc-classification.
  19. Salcher-Konrad M, Naci H, Davis C. Approval of cancer drugs with uncertain therapeutic value: a comparison of regulatory decisions in Europe and the United States. Milbank Q. 2020;98(4):1219-1256. doi:1111/1468-0009.12476
  20. Godman B, Malmström RE, Diogene E, et al. Are new models needed to optimize the utilization of new medicines to sustain healthcare systems? Expert Rev Clin Pharmacol. 2015;8(1):77-94. doi:1586/17512433.2015.990380
  21. Boncz I, Donkáné Verebes E, Oberfrank F, Kásler M. [Assessment of annual health insurance reimbursement for oncology drugs in Hungary]. Magy Onkol. 2010;54(4):283-288. doi:1556/MOnkol.54.2010.4.2
  22. Timmins N. At last, NICE to take over the Cancer Drugs Fund. BMJ. 2016;352:i1324. doi:1136/bmj.i1324
  23. Moye-Holz D, Ewen M, Dreser A, et al. Availability, prices, and affordability of selected essential cancer medicines in a middle-income country - the case of Mexico. BMC Health Serv Res. 2020;20(1):424. doi:1186/s12913-020-05167-9
  24. Apperley JF. Cancer Drugs Fund and chronic myeloid leukemia: an unhappy alliance. Int J Hematol Oncol. 2016;5(1):1-4. doi:4155/ijh.15.26
  25. Sabry-Grant C, Malottki K, Diamantopoulos A. The Cancer Drugs Fund in practice and under the new framework. Pharmacoeconomics. 2019;37(7):953-962. doi:1007/s40273-019-00793-6
  26. Grieve R, Abrams K, Claxton K, et al. Cancer Drugs Fund requires further reform. BMJ. 2016;354:i5090. doi:1136/bmj.i5090
  27. de Oliveira Avellar W, de Melo AC, da Silva CF, Aran V. Cancer research in Brazil: analysis of funding criteria and possible consequences. J Cancer Policy. 2019;20:100184. doi:1016/j.jcpo.2019.100184
  28. Lakdawalla DN, Jena AB, Doctor JN. Careful use of science to advance the debate on the UK Cancer Drugs Fund. JAMA. 2014;311(1):25-26. doi:1001/jama.2013.282839
  29. Littlejohns P, Weale A, Kieslich K, et al. Challenges for the new Cancer Drugs Fund. Lancet Oncol. 2016;17(4):416-418. doi:1016/s1470-2045(16)00100-5
  30. Hopkinson NS. Conservatism and the Cancer Drugs Fund. BMJ. 2017;357:j2451. doi:1136/bmj.j2451
  31. Rajurkar SP, Presant CA, Bosserman LD, McNatt WJ. A copay foundation assistance support program for patients receiving intravenous cancer therapy. J Oncol Pract. 2011;7(2):100-102. doi:1200/jop.2010.000112
  32. Rothwell B, Kiff C, Ling C, Brodtkorb TH. Cost effectiveness of nivolumab in patients with advanced, previously treated squamous and non-squamous non-small-cell lung cancer in England. Pharmacoecon Open. 2021;5(2):251-260. doi:1007/s41669-020-00245-4
  33. Runyan A, Banks J, Bruni DS. Current and future oncology management in the United States. J Manag Care Spec Pharm. 2019;25(2):272-281. doi:18553/jmcp.2019.25.2.272
  34. Gabe J, Chamberlain K, Norris P, Dew K, Madden H, Hodgetts D. The debate about the funding of Herceptin: a case study of 'countervailing powers'. Soc Sci Med. 2012;75(12):2353-2361. doi:1016/j.socscimed.2012.09.009
  35. Stefan DC, Elzawawy AM, Khaled HM, et al. Developing cancer control plans in Africa: examples from five countries. Lancet Oncol. 2013;14(4):e189-e195. doi:1016/s1470-2045(13)70100-1
  36. Dixon P, Chamberlain C, Hollingworth W. Did it matter that the Cancer Drugs Fund was not NICE? A retrospective review. Value Health. 2016;19(6):879-884. doi:1016/j.jval.2016.04.001
  37. Chamberlain C, Collin SM, Hounsome L, Owen-Smith A, Donovan JL, Hollingworth W. Equity of access to treatment on the Cancer Drugs Fund: a missed opportunity for cancer research? J Cancer Policy. 2015;5:25-30. doi:1016/j.jcpo.2015.06.003
  38. Morrell L, Wordsworth S, Schuh A, Middleton MR, Rees S, Barker RW. Correction to: will the reformed Cancer Drugs Fund address the most common types of uncertainty? An analysis of NICE cancer drug appraisals. BMC Health Serv Res. 2019;19(1):198. doi:1186/s12913-019-4039-8
  39. Li EC. Exploring pharmacy and drug policy concerns. J Natl Compr Canc Netw. 2010;8 Suppl 7:S2-S3. doi:6004/jnccn.2010.0131
  40. Kang SY, Sen A, Bai G, Anderson GF. Financial eligibility criteria and medication coverage for independent charity patient assistance programs. JAMA. 2019;322(5):422-429. doi:1001/jama.2019.9943
  41. Duerden M. From a cancer drug fund to value based pricing of drugs. BMJ. 2010;341:c4388. doi:1136/bmj.c4388
  42. Cancer drugs dropped from 'unsustainable' fund list. Nurs Stand. 2015;30(4):10. doi:7748/ns.30.4.10.s11
  43. Chamberlain C, Collin SM, Stephens P, Donovan J, Bahl A, Hollingworth W. Does the Cancer Drugs Fund lead to faster uptake of cost-effective drugs? A time-trend analysis comparing England and Wales. Br J Cancer. 2014;111(9):1693-1702. doi:1038/bjc.2014.86
  44. Emmerich N. Calling time on the Cancer Drugs Fund? Funding the NHS in the age of austerity. Br J Hosp Med (Lond). 2015;76(4):186-187. doi:12968/hmed.2015.76.4.186
  45. Howard DH. Drug companies' patient-assistance programs--helping patients or profits? N Engl J Med. 2014;371(2):97-99. doi:1056/NEJMp1401658
  46. Maynard A, Bloor K. The economics of the NHS Cancer Drugs Fund. Appl Health Econ Health Policy. 2011;9(3):137-138. doi:2165/11585750-000000000-00000
  47. McCabe C, Paul A, Fell G, Paulden M. Cancer Drugs Fund 2.0: a missed opportunity? Pharmacoeconomics. 2016;34(7):629-633. doi:1007/s40273-016-0403-2
  48. McGuire A, Drummond M, Martin M, Justo N. End of life or end of the road? Are rising cancer costs sustainable? Is it time to consider alternative incentive and funding schemes? Expert Rev Pharmacoecon Outcomes Res. 2015;15(4):599-605. doi:1586/14737167.2015.1039518
  49. Morrell L, Wordsworth S, Rees S, Barker R. Does the public prefer health gain for cancer patients? A systematic review of public views on cancer and its characteristics. Pharmacoeconomics. 2017;35(8):793-804. doi:1007/s40273-017-0511-7
  50. Legislative Council. Updated Background Brief on Drug Formulary of the Hospital Authority and Drug Subsidies. LC Paper No. CB(4)973/20-21(06). https://www.legco.gov.hk/yr20-21/english/panels/hs/papers/hs20210514cb4-973-6-e.pdf. Accessed November 24, 2021.
  51. Hospital Authority. Items Supported by the Samaritan Fund. https://www.ha.org.hk/haho/ho/sf/SF_Items_en.pdf. Accessed November 11, 2021.
  52. Hospital Authority. Community Care Fund Medical Assistance Programmes. https://www.ha.org.hk/visitor/ha_visitor_index.asp?Parent_ID=10044&Content_ID=206049&Ver=HTML. Accessed November 11, 2021.
  53. Hospital Authority. Items Supported by the CCF Medical Assistance Programmes. https://www.ha.org.hk/haho/ho/ccf/CCF_items_en.pdf. Accessed November 11, 2021.
  54. Roe H. Key changes to cancer care in the UK. Br J Nurs. 2015;24(4):S3. doi:12968/bjon.2015.24.Sup4.S3
  55. NHS England. Cancer Drugs Fund (CDF) Activity Update. https://www.england.nhs.uk/publication/cancer-drugs-fund-cdf-activity-update/#heading-2. Accessed December 3, 2021.
  56. Cancer Research UK. Cancer Drugs Fund (CDF). https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/access-to-treatment/cancer-drugs-fund-cdf. Accessed November 23, 2021.
  57. NICE and the Cancer Drugs Fund--2020 vision? Drug Ther Bull. 2016;54(4):37. doi:1136/dtb.2016.4.0391
  58. Emmerich N. Calling time on the Cancer Drugs Fund? Funding the NHS in the age of austerity. Br J Hosp Med (Lond). 2015;76(4):186-187. doi:12968/hmed.2015.76.4.186
  59. Palù G. AIFA (Italian Medicines Agency). https://projects.gbreports.com/italy-life-sciences-2021/aifa-interview/. Accessed September 20, 2021.
  60. Apolone G, Ardizzoni A, Biondi A, et al. Skip pattern approach toward the early access of innovative anticancer drugs. ESMO Open. 2021;6(4):100227. doi:1016/j.esmoop.2021.100227
  61. Barham L. 2021 Market Access Prospects for Italy. https://pharmaphorum.com/views-analysis-market-access/2021-market-access-prospects-for-italy/. Accessed August 13, 2021.
  62. The World Bank Group. World Bank Open Data. 2021. https://data.worldbank.org. Accessed December 1, 2021.
  63. World Health Organization (WHO). Thailand Medical Products Profile 2019. 2019. https://apps.who.int/iris/bitstream/handle/10665/328915/medicines-profile-tha-eng.pdf?sequence=1&isAllowed=y.
  64. National Health Security Office. National Health Security Office Performance Report 2021. https://www.nhso.go.th/operating_results/50.
  65. Organisation for Economic Co-operation and Development (OECD). Health Spending. https://data.oecd.org/healthres/health-spending.htm#indicator-chart. Accessed December 1, 2021.
  66. Chief Secretary for Administration of the Hong Kong Special Administrative Region. Universal Health Coverage. https://www.cso.gov.hk/eng/blog/blog20180401.htm. Accessed December 3, 2021.
  67. Chang J, Peysakhovich F, Wang W, Zhu J. The UK Health Care System. http://assets.ce.columbia.edu/pdf/actu/actu-uk.pdf. Accessed August 11, 2021.
  68. Tikkanen R, Osborn R, Mossialos E, Djordjevic A, Wharton GA. International Health Care System Profiles England. 2020. https://www.commonwealthfund.org/international-health-policy-center/countries/england. Accessed November 3, 2021.
  69. Tarricone R, Listorti E, Tozzi V, et al. Transformation of Cancer Care during and after the COVID Pandemic, a point of no return. The Experience of Italy. J Cancer Policy. 2021;29:100297. doi:1016/j.jcpo.2021.100297
  70. Tikkanen R, Osborn R, Mossialos E, Djordjevic A, Wharton GA. International Health Care System Profiles Italy. 2020. https://www.commonwealthfund.org/international-health-policy-center/countries/italy. Accessed November 2, 2021.
  71. Hospital Authority. Financial Assessment. https://www.ha.org.hk/visitor/ha_visitor_index.asp?content_id=254525. Accessed November 15, 2021.
  72. Community Care Fund. Community Care Fund Latest Financial Position (as at 31 August 2021). https://www.communitycarefund.hk/en/finance.html. Accessed November 18, 2021.
  73. Legislative Council of Hong Kong. Legislative Council Panel on Health Services Subcommittee on Issues Relating to the Support for Cancer Patients - Support for Cancer Drug Treatment. 2019. https://www.ha.org.hk/haho/ho/ccf/hs_scp20191216cb2_356_1_e.pd.
  74. Legislative Council of Hong Kong. Panel on Health Services Meeting on 14 May 2021 - Updated Background Brief on Drug Formulary of the Hospital Authority and Drug Subsidies. 2021. https://www.legco.gov.hk/yr20-21/english/panels/hs/papers/hs20210514cb4-973-6-e.pdf.
  75. Hospital Authority. Report on the Samaritan Fund. https://www.legco.gov.hk/yr20-21/english/counmtg/papers/cm20201216-sp058-e.pdf. Accessed November 18, 2021.
  76. NHS England Cancer Drugs Fund Team. Appraisal and Funding of Cancer Drugs from July 2016 (Including the New Cancer Drugs Fund) A New Deal for Patients, Taxpayers and Industry. 2016. https://www.england.nhs.uk/cancer/cdf/. Accessed March 12, 2021.
  77. Chamberlain C, Owen-Smith A, MacKichan F, Donovan JL, Hollingworth W. "What's fair to an individual is not always fair to a population": a qualitative study of patients and their health professionals using the Cancer Drugs Fund. Health Policy. 2019;123(8):706-712. doi:1016/j.healthpol.2019.05.022
  78. Vola F, Vinci B, Golinelli D, Fantini MP, Vainieri M. Harnessing pharmaceutical innovation for anti-cancer drugs: some findings from the Italian regions. Health Policy. 2020;124(12):1317-1324. doi:1016/j.healthpol.2020.07.016
  79. Prada M, Rossi L, Mantovani M. Time to reimbursement and negotiation condition in Italy for drugs approved by the European Medicines Agency during the period 2014-2019. AboutOpen. 2020;7(1):89-94. doi:33393/abtpn.2020.2184
  80. Public Expenditure on Innovative Drugs in Italy from 2017 to 2020. https://www.statista.com/statistics/916357/public-expenditure-on-innovative-drugs-in-italy/. Accessed December 1, 2021.
  81. The National Drug System Development Committee. The National List of Essential Medicines in Thailand. 2021. http://ndi.fda.moph.go.th/uploads/file_news/20210723999860392.pdf. Accessed March 10, 2022.
  82. National Drug Information. Drugs and Herbal Information. http://ndi.fda.moph.go.th/drug_info. Accessed March 12, 2022.
  83. Central office of Healthcare Information (CHI). Drug List Under Criteria for Reimbursement. 2022. https://www.chi.or.th/Catalog/Drug_list.html. Accessed April 12, 2022.
  84. Hospital Authority. Hospital Authority Drug Formulary. https://www.ha.org.hk/hadf/en-us/Updated-HA-Drug-Formulary/Drug-Formulary.html. Accessed April 19, 2022.
  85. Nottinghamshire Area Prescribing Committee. Formulary Chapters. https://www.nottinghamshireformulary.nhs.uk/chapters.asp. Accessed March 12, 2022.
  86. NHS England. National Cancer Drugs Fund List. 2021. https://www.england.nhs.uk/publication/national-cancer-drugs-fund-list/. Accessed November 15, 2021.
  87. NHS England. NHS England Drugs List. 2022. https://www.england.nhs.uk/publication/nhs-england-drugs-list/. Accessed May 30, 2022.
  88. NHS England. Amendments to the Drug Tariff March 2022. 2022. https://www.nhsbsa.nhs.uk/sites/default/files/2022-02/Drug%20Tariff%20March%202022.pdf. Accessed May 10, 2022.
  89. Agenzia Italiana del Farmaco - Italian Medicines Agency. Innovative Medicinal Products. 2022. https://www.aifa.gov.it/en/farmaci-innovativi. Accessed May 10, 2022.
  90. Italian Medicines Agency (AIFA). Lists of Class A and Class H Medicinal Products. https://www.aifa.gov.it/en/liste-farmaci-a-h. Accessed May 10, 2022.
  91. Jommi C, Galeone C. The evaluation of drug innovativeness in Italy: key determinants and internal consistency. Pharmacoecon Open. 2023;7(3):373-381. doi:1007/s41669-023-00393-3
  92. Formoso G, Marino M, Guberti M, Grilli RG. End-of-life care in cancer patients: how much drug therapy and how much palliative care? Record linkage study in Northern Italy. BMJ Open. 2022;12(5):e057437. doi:1136/bmjopen-2021-057437
  93. The National Health Service (NHS). Cancer Drugs Fund Activity Update. 2023. https://www.england.nhs.uk/wp-content/uploads/2018/01/CDF-activity-update-Q3-2022-23.pdf. Accessed August 24, 2023.
  94. The Economist Group. Enhancing Patient-Centred Approaches to Optimise Early-Breast Cancer Care: A Review of Current Practice and Opportunities for Improvement in Thailand. 2023. https://impact.economist.com/perspectives/sites/default/files/msd_thailand_early_breast_cancer_report_final.pdf. Accessed August 25, 2023.
International Journal of Health Policy and Management
Volume 13, Issue 1
2024
Pages 1-15

XML
PDF 902.03 K
Supplementary File
(IJHPM does not take responsibility for any information provided in the supplementary files.)
Luksameesate-Supple-File-1-IJHPM.pdf
Luksameesate-Supple-File-2-IJHPM.pdf

  • Received Date 21 October 2022
  • Revised Date 25 November 2023
  • Accepted Date 31 December 2023
  • First Published Date 02 January 2024
  • Published Date 01 December 2024