engleski

Assessment of Reimbursement Processes and Outcomes for Cancer Drugs in Croatia – Comparison to NICE and NCCN Guidelines.

Objectives: Objective of this study was to assess reimbursement outcomes and patient access to oncology drugs in Croatia. National Institute of Clinical Excellence (NICE) cancer guidelines and National Comprehensive Cancer Network (NCCN) guidelines were used as benchmark. NICE is known for being committed to complying with legal obligations on equity and human rights, conducting their work based on identified cost effectiveness thresholds and known to be restrictive in their recommendations. On the other hand, NCCN professional guidelines are key international guidelines for oncology professionals which have been accepted and followed worldwide. Methods: Reimbursement processes, specific indications and restrictions for 23 studied cancer drugs, ATC L01 class (antineoplastic agents) have been analyzed and compared to UK NHS funding and reimbursement recommendations given through NICE cancer guidelines as well as recommendations given through NCCN guidelines. Results: Studied cancer drugs were used for the treatment of 14 different tumor locations: breast, colon, lung, leukemia, renal, GIST, ovary, lymphoma, glioblastoma, prostate, liver, gastric, myeloma. Among 57 registered indications, Croatian Health Insurance Fund has in total reimbursed 43 (75%) while NICE has issued positive recommendations for only 35 (60%). On the other hand, all investigated drugs and relevant indications except of one partially have been recommended by NCCN guidelines. At the same time, we identified many instances where the recommendations given by the NCCN guidelines have not been endorsed by HZZO. Conclusions: Considering process related inconsistencies and consequential differences in reimbursement outcomes and patient access to cancer drugs in Croatia compared, there is a strong need for the expedited implementation of transparent HTA processes for cancer drugs. Multiple technology assessments of the main indication groups and the highest cost drivers are highly needed to ensure the full transparency of the reimbursement system and the equity of patients' access to the treatment options irrespectively of the disease.

pharmacoeconomics; outcomes; cancer drugs; guidelines

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