Elsevier

Value in Health

Volume 22, Issue 5, May 2019, Pages 593-600
Value in Health

HEOR in the Broader Context of HTA/CER
Health Technology Assessment Challenges in Oncology: 20 Years of Value in Health

https://doi.org/10.1016/j.jval.2019.01.001Get rights and content
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Highlights

  • There have been significant advances in cancer therapeutics in the last 2 decades, from chemotherapy to targeted therapy and more recently immuno-oncology drugs.

  • As a result, there have been major developments in the field of health technology assessment associated with cancer therapeutics, such as quality of life, interpreting clinical evidence, health economic modeling, and financial impact.

  • This review highlights the health technology assessment challenges of oncology in the past 20 years seen through the lens of Value in Health, where major contributions have been published.

Abstract

Background

Oncology treatments have changed from chemotherapies to targeted therapies and more recently immuno-oncology. This has posed special challenges in the field of health technology assessment (HTA): capturing quality of life (QOL) associated with toxicity due to chemotherapy, crossover upon progression in targeted therapy trials, and survival extrapolation for immuno-oncology drugs.

Objectives

To showcase 20 years of Value in Health (ViH) publications in oncology.

Methods

A review was undertaken of oncology articles published in ViH from May 1998 to August 2018. Full-length articles published in ViH with the keywords “oncology,” “cancer,” “h(a)ematology,” and “malignancy” were included for review. Conference abstracts were excluded.

Results

Four major themes were identified: (1) QOL and the development of multiple functional assessment of cancer therapy tools and mapping instruments; (2) analysis of clinical evidence using indirect comparisons, network analyses, and adjustment for crossovers; (3) modeling, Markov models, partitioned survival models, and extrapolation methods; and (4) financial implications and how to deal with uncertainty, introduction of conditional reimbursement, managed entry, and risk share agreements.

Discussion

This review article highlights the important role ViH has played in disseminating HTA research in oncology. A few key issues loom on the horizon: precision medicine, further development and practical application of new QOL measures, methods for translating clinical evidence, and exploration of modeling techniques. For a better understanding of the complex interplay between access and financial risk management, ViH will no doubt continue to promote pioneering research in HTA and oncology.

Keywords

cost-effectiveness
cost-utility
health technology assessment
oncology
quality of life

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