80IN - Budget impact vs cost effectiveness: Implications for personalised cancer therapies

Date 29 September 2014
Event ESMO 2014
Session The impact on health services from personalised targeted therapies
Topics Bioethics, Legal, and Economic Issues
Personalised/Precision Medicine
Basic Principles in the Management and Treatment (of cancer)
Presenter Yolande Lievens
Citation Annals of Oncology (2014) 25 (suppl_4): iv29-iv30. 10.1093/annonc/mdu308
Authors Y. Lievens
  • Radiation Oncology Dept., University Hospital Ghent, 0000 - Ghent/BE




For decades, continuous rises in health care spending have been considered standard, but the most recent data from the OECD (Organisation for Economic Co-operation and Development) demonstrate that the cost curve starts to bend in many countries. In this era of budgetary restrictions imposed by the governments, reflection on the economical consequences of our actions becomes unavoidable. One of the consequences of this scarcity in health care resources is that evidence on the value for money of new interventions has become an integral part of reimbursement setting in many countries. Whereas economic evaluations are typically required for the introduction of new drugs, in recent years this evolution has also been observed for the adoption of other health care interventions such as new surgical procedures and radiotherapy techniques. A full economic evaluation calculates the extra cost ensuing from a new treatment strategy compared to a standard alternative and divides this by the gain in outcome obtained with the new treatment. This results in a so-called incremental cost-effectiveness ratio (ICER), which allows to a rank the new treatments by value for money, thus supporting the decision on which interventions to introduce in the context of a given – extra – budget. This also entails, unfortunately, that a novel treatment judged acceptable by society on the basis of its cost-effectiveness may turn out unaffordable within the constraints of a restricted budget. Hence the importance to formally analyze the potential budgetary impact of introducing new treatments into the health care basket in parallel with the evaluation of their cost-effectiveness. In a so-called budget impact analysis, the planned resource use and related expenditures of a treatment are estimated over a certain period of time, with the aim to predict the impact of a policy decision on the healthcare budget. In the presentation this intricate balance between cost-effectiveness and budget will be explored through examples on new systemic agents as well as looking at the specificities of non-drug interventions such as radiotherapy.


The author has declared no conflicts of interest.