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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Health Services Research 1/2014

International comparison of the factors influencing reimbursement of targeted anti-cancer drugs

BMC Health Services Research > Ausgabe 1/2014
Carol Sunghye Lim, Yun-Gyoo Lee, Youngil Koh, Dae Seog Heo
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Electronic supplementary material

The online version of this article (doi:10.​1186/​s12913-014-0595-0) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

CSL and YGL participated in study design, data collection, data analysis and interpretation, and led on writing this manuscript. YK participated in study design and data interpretation and assisted in writing this paper. DSH conceived of and led this study, participated in study design and data interpretation, and led on writing this manuscript. All authors read and approved the final manuscript.



Reimbursement policies for anti-cancer drugs vary among countries even though they rely on the same clinical evidence. We compared the pattern of publicly funded drug programs and analyzed major factors influencing the differences.


We investigated reimbursement policies for 19 indications with targeted anti-cancer drugs that are used variably across ten countries. The available incremental cost-effectiveness ratio (ICER) data were retrieved for each indication. Based on the comparison between actual reimbursement decisions and the ICERs, we formulated a reimbursement adequacy index (RAI): calculating the proportion of cost-effective decisions, either reimbursement of cost-effective indications or non-reimbursement of cost-ineffective indications, out of the total number of indications for each country. The relationship between RAI and other indices were analyzed, including governmental dependency on health technology assessment, as well as other parameters for health expenditure. All the data used in this study were gathered from sources publicly available online.


Japan and France were the most likely to reimburse indications (16/19), whereas Sweden and the United Kingdom were the least likely to reimburse them (5/19 and 6/19, respectively). Indications with high cost-effectiveness values were more likely to be reimbursed (ρ = −0.68, P = 0.001). The three countries with high RAI scores each had a healthcare system that was financed by general taxation.


Although reimbursement policies for anti-cancer drugs vary among countries, we found a strong correlation of reimbursements for those indications with lower ICERs. Countries with healthcare systems financed by general taxation demonstrated greater cost-effectiveness as evidenced by reimbursement decisions of anti-cancer drugs.
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