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As policy-makers examine a range of options to address concerns
about high drug prices in the United States, many are giving
renewed attention to the differences in prices between the US and
ex-US countries, and are considering deploying coverage and payment
tools used in ex-US countries (e.g., cost-effectiveness analysis)
to control costs. In this context, it is increasingly important to
understand whether ex-US models of drug access hold implications
for patient outcomes if they were applied in the US.
Our analysis indicates that, if the access models representing
five ex-US comparator countries (Australia, Canada, France, South
Korea, and the United Kingdom) were to replace the actual US access
conditions between 2006 and 2017, aggregate survival gains (i.e.,
gains in life years) due to innovative medicines would have been
cut in half for US patients diagnosed with locally advanced and
metastatic NSCLC. This reduction in health gains is due to the
access delays experienced by patients in other countries compared
to patients in the US.
This study quantifies the population health impact in the US of
introducing non-US models of drug access to an American patient
population with locally advanced or metastatic non-small cell lung
cancer (NSCLC) between 2006 and 2017. The model simulates the
lifetime health outcomes of the target patient population under the
actual US access landscape vs. five additional scenarios where US
access conditions are replaced by those in the five comparator
countries (i.e. characterized by the respective reimbursement
approval delays and coverage gaps).
Under each alternative access scenario, the model controls for
differences in regulatory approval timelines between the US and
other countries. The population health impact of transposing
alternative access models to the US is therefore driven by
differential rates of coverage and delays in effective first date
of reimbursement of the therapies in question.
Model outcomes indicate that American patients diagnosed with
locally advanced and metastatic NSCLC between 2006 and 2017 have
gained 201,700 life years in total due to access to innovative
medicines. They would lose half of this survival benefits if they
were living in the other countries.
Moreover, significant discrepancies remain between the access
conditions of different countries, with the Australian system
leading to the biggest drop in life years at -74% compared to the
default US system.
Lastly, a large majority of the life years gained can be
attributed to the non-squamous patient population. On a per capita
basis the non-squamous population improved their overall survival
by 73% due to innovative medicines, compared to 10% improvement in
the squamous population. This speaks to the importance of continued
investment in the research and development of precision medicines
targeting underserved patient subgroups.
