1383P - When does personalized cancer therapy research provide positive return on investment in Europe?

Date 30 September 2012
Event ESMO Congress 2012
Session Poster presentation II
Topics Bioethics, Legal, and Economic Issues
Personalised Medicine
Presenter Henry Conter
Authors H.J. Conter1, D. Conter2, R.A. Wolff3
  • 1Division Of Cancer Medicine, UT M.D. Anderson Cancer Center, Houston/US
  • 2Philisophy, Huron College, London/CA
  • 3Gastrointestinal Medical Oncology, UT M.D. Anderson Cancer Center, Houston/US

Abstract

Background

Personalized cancer therapies targeting pre-specified genetic mutations currently benefits only subsets of patients. Developing the technologies and supporting the research to identify new targets and treatments requires a significant monetary outlay. How much money should the European public invest in such research?

Methods

Since current investment should be less than or equal to the net-present-value (NPV) of the future health gains achieved, the marginal benefit gained from a new drug can be estimated by calculating the difference between the incremental cost-effectiveness ratio (ICER) and the willingness-to-pay (WTP) for the increase in health by society.

We calculated the NPV of the future development for new drugs with similar characteristics to crizotinib, a prototypic personalized cancer therapy. Sensitivity analyses were performed to assess the influence of WTP thresholds, time horizon of return, and size of treatable population. Systematic reviews of PubMed and EMBASE were employed to determine the current range of ICERs for approved small-molecule inhibitors and monoclonal antibodies, and WTP thresholds. European cancer statistics were used to estimate the size of population who may benefit.

Results

Of 1576 titles, 104 abstracts and manuscripts were included in the final analysis. The median ICER for targeted therapies was €45,000 (range, €10,000-€163,000), and median WTP was €50,000 (range, €12,000-€152,000). With a development time horizon of 8 years, €840 million in research funding provides positive societal returns for new pharmaceuticals bought at a marginal value of greater than €5,000. Doubling the time horizon reduces the NPV of current research by €230 million. If current-generation personalized therapies are dominated by newer technologies earlier than predicted, halving their market-life as an example, only €500 million in public investment would be worthwhile. The NPV of research was highly sensitive to changes in the estimated size of the treatable population. Focusing on drug development for breast, lung, and colon cancer only, may yield a NPV for research of €1.34 billion.

Conclusion

Regional differences in cancer incidence and WTP for new therapeutics should be formally incorporated into research funding decisions to ensure optimal resource allocation.

Disclosure

All authors have declared no conflicts of interest.