Patient access to innovative cancer drugs in Asia-Pacific

This is the third sub-report of the main report “Cancer care and access to cancer drugs in Asia-Pacific”. It describes patient access to innovative cancer drugs and its consequences for patients in 14 countries and locations (called “markets” in the report) in Asia-Pacific. They are grouped into 7 high-income markets (Australia, Hong Kong, Japan, New Zealand, Singapore, South Korea, Taiwan) and 7 middle-income markets (China, India, Indonesia, Malaysia, the Philippines, Thailand, Vietnam).

The sub-report provides a comparative analysis of the 14 markets. The main findings are:

1. Access to innovative cancer drugs (with ESMO-MCBS score of 4/B+) through reimbursement is quite limited. Of 38 innovative drug-indications approved by the US FDA in treatment of five major cancer types, 80% had received regulatory approval across Asia-Pacific in 2020. Yet only 35% of those indications were also reimbursed in 2020.

2. High-income markets achieve much higher proportions of both regulatory approval and reimbursement approval rates (91% and 59%, respectively) than middle-income markets (68% and 17%, respectively).

3. China, Indonesia, and Vietnam approve relatively fewer indications but at the same time reimburse a higher proportion of them. Japan sticks out due to its policy to reimburse all approved drugs essentially by default, which stands in stark contrast to the restrictive reimbursement policy observed in New Zealand.

4. Timely reimbursement of innovative cancer drugs is a major challenge in all markets except in Japan. In high-income markets along with China, the median delay between regulatory approval and reimbursement approval was around 1.5 to 3 years. In all middle-income markets except China, delays could not be assessed, because there are essentially no recent innovative indications that have ever achieved reimbursement listing.

5. The lack of timely reimbursement of innovative cancer drugs results in a great loss of patient life years. For every year of delay in reimbursement, almost 1 million patient life years are lost across Asia-Pacific, drawing on a limited sample of only 10 innovative drug-indications.

6. Reasons for delayed reimbursement of innovative cancer drugs vary. In middle-income markets, they relate more to limited public health budgets as well as the organization of the reimbursement process with listings being infrequently reviewed and updated. In high-income markets, they relate more to the criteria applied in the reimbursement process and the lack of fast-track systems for innovative drugs.

The report was funded by Merck Sharp & Dohme (MSD). Responsibility for the analysis, interpretations, and conclusions, as well as errors or omissions lies solely with the authors.

Previously published IHE Reports on cancer care and access to cancer drugs in Asia-Pacific:

Cancer care and access to cancer drugs in Asia-Pacific – Introduction
IHE Report 2021:3a, IHE: Lund, Sweden

Cancer care and access to cancer drugs in Asia-Pacific – Executive summary
IHE Report 2021:3b, IHE: Lund, Sweden

The burden of cancer in Asia-Pacific
IHE Report 2021:3c, IHE: Lund, Sweden

Health spending on cancer in Asia-Pacific
IHE Report 2021:3d, IHE: Lund, Sweden

For more information, please contact Thomas Hofmarcher

IHE Report 2021:3e, IHE: Lund, Sweden