Time to review authorisation and funding for new cancer medicines in Europe? Inferences from the case of Olaratumab

Pontes, Caridad and Zara, Corinne and Torrent-Farnell, Josep and Obach, Merce and Nadal, Cristina and Vella-Bonanno, Patricia and Ermisch, Michael and Simoens, Steven and Curi Hauegen, Renata and Gulbinovic, Jolanta and Timoney, Angela and Martin, Antony P. and Mueller, Tanja and Nachtnebel, Anna and Campbell, Stephen and Selke, Gisbert and Bochenek, Tomasz and Rothe, Celia C. and Mardare, Ileana and Bennie, Marion and Fürst, Jurij and Malmstrom, Rickard E. and Godman, Brian (2020) Time to review authorisation and funding for new cancer medicines in Europe? Inferences from the case of Olaratumab. Applied Health Economics and Health Policy, 18. pp. 5-16. ISSN 1179-1896 (https://doi.org/10.1007/s40258-019-00527-x)

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The potential benefits of early patient access to new medicines in areas of high unmet medical need are recognised, but uncertainties concerning effectiveness, safety and added value when new medicines are authorised, and subsequently funded based on initial preliminary data only, have important implications. In 2016 olaratumab received accelerated conditional approval from both the European Medicines Agency and the US Food and Drug Administration for the treatment of soft-tissue sarcoma, based on the claims of a substantial reduction in the risk of death with an 11.8-month improvement in median overall survival in a phase II trial in combination with doxorubicin vs. doxorubicin alone. The failure to confirm these benefits in the post-authorisation pivotal trial has highlighted key concerns regarding early access and conditional approvals for new medicines. Concerns include potentially considerable clinical and economic costs, so that patients may have received suboptimal treatment and any money spent has foregone the opportunity to improve access to effective treatments. As a result, it seems reasonable to reconsider current marketing authorisation models and approaches. Potential pathways forward include closer collaboration between regulators, pharmaceutical companies and payers to enhance the generation of rapid and comparative confirmatory trials in a safe and fair manner, with minimal patient exposure as required to achieve robust evidence. Additionally, it may be time to review early access systems, and to explore new avenues regarding who should pay or part pay for new treatments whilst information is being collected as part of any obligations for conditional marketing authorisation. Greater co-operation between countries regarding the collection of data in routine clinical care, and further research on post-marketing data analysis and interpretation, may also contribute to improved appraisal and continued access to new innovative cancer treatments.