Where are we in demonstrating economic value in prostate cancer trials

An update on the ICECaP Project by Associate Professor Richard De Abreu Lourenço, Research Fellow with CHERE and the Project Manager for the Cancer Research Economics Support Team (CREST).

Previously, we reported on research being undertaken at the Centre for Health Economics Research and Evaluation (CHERE) in collaboration with ANZUP to address one of the central questions of the Intermediate Clinical Endpoints in Cancer of the Prostate (ICECaP) project; can intermediate outcome measures be used to assess value for treatments in prostate cancer?

This research is focusing on how we can use intermediate measures of outcomes, like five-year metastasis free survival, to demonstrate to governments that new treatments represent value for money – that they are cost-effective.

What has happened since our last update on this project? Perhaps the most significant update is that Rafael de Feria Cardet joined the PhD program at CHERE UTS where he is working on RAFAEL the ICECaP project. Rafael has a degree in DE FERLA pharmacy, industry experience working in how medicines are regulated and public sector experience in applying health economics to medicine funding. He started his career as a health economist at the Health Technology Assessment department in the Ministry of Health, Chile.

Since joining CHERE at the beginning of 2019 he has made important inroads into the ICECaP health economics project. With input from local clinical, industry and patient advisors he has looked into how the relationships between intermediate outcomes-like metastases free survival – and overall survival can be used to develop economic analyses that can be used by governments when making decisions about drug funding. That analysis is currently in the testing phase and the next few months will see it tested and honed further to address whether decision makers can have confidence in the use of those intermediate data to inform funding decisions.

He has also led important research to understand how we, as members of society – and therefore as taxpayers – would advise governments thinking about funding medicines for prostate cancer. This considered how individuals value differences in how those medicines might affect disease, quality of life, whether they represent value for money and how much evidence we have about the way they work. The findings from that research are currently being finalised and will be an important input into understanding the potential trade-offs that we as a society might consider when deciding between making a treatment available on the basis of intermediate outcomes.

In all, the research that Rafael is undertaking acknowledges that often, rather than waiting for long-term evidence of survival or quality of life, governments and their advisory bodies make decisions about value for money on the basis of intermediate measures. One of the key considerations for these decision-making bodies is how much confidence they can have that those intermediate measures reflect what can be expected in terms of longer-term outcomes (e.g. survival). The work is well on the way to being able to demonstrate the accuracy of the links between intermediate and long-term outcomes, giving governments and decision makers greater confidence in their use for making decisions about which medicines to fund. This is critical as we see new medicines emerging, often on the basis of early trial evidence, with a desire to have those made available through our publicly funded health care system. Ultimately, providing decision makers with greater confidence that we can use that early trial evidence to make important funding decisions has the potential to make new treatments available sooner.

This work is supported by untied funding received from Astellas Pharma Singapore Pty Ltd and Janssen Global, and is coordinated by the ANZUP Cancer Trials Group.