List prices and clinical value of anticancer drugs in China, Japan, and South Korea: a retrospective comparative study

Jay Pan; Xiaolin Wei; Hao Lu; Xueer Wu; Chunyuan Li; Xuelian Hai; Tianjiao Lan; Quanfang Dong; Yili Yang; Mihajlo Jakovljevic; Jing Zhou

doi:10.1016/j.lanwpc.2024.101088

List prices and clinical value of anticancer drugs in China, Japan, and South Korea: a retrospective comparative study

Lancet Reg Health West Pac. 2024 May 16:47:101088. doi: 10.1016/j.lanwpc.2024.101088. eCollection 2024 Jun.

Authors

Jay Pan^{1

2}, Xiaolin Wei³, Hao Lu⁴, Xueer Wu⁵, Chunyuan Li⁶, Xuelian Hai^{1

2}, Tianjiao Lan^{1

2}, Quanfang Dong³, Yili Yang², Mihajlo Jakovljevic^{7

8

9}, Jing Zhou^{1

2}

Affiliations

¹ HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
² Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China.
³ Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
⁴ School of Public Health, Imperial College London, London, UK.
⁵ Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
⁶ Department of Hematology, Peking University Third Hospital, Beijing, China.
⁷ UNESCO - The World Academy of Sciences (TWAS), Trieste, Italy.
⁸ Shaanxi University of Technology, Hanzhong, China.
⁹ Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia.

Abstract

Background: High prices of anticancer drugs have raised concerns due to their financial impact on patients and healthcare systems. This study aimed to assess the initial and latest list prices and clinical value of reimbursed anticancer drugs in China, Japan, and South Korea.

Methods: We identified anticancer drugs newly approved by the National Medical Products Administration of China from January 2012 to June 2022, and by the Pharmaceuticals and Medical Devices Agency of Japan and the Ministry of Food and Drug Safety of South Korea up until June 2022. We compared initial and latest treatment prices between countries and assessed clinical value using patients' survival, quality of life (QoL), and European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS). We calculated Spearman rank correlation coefficients of treatment prices with clinical value for individual countries and employed regression analyses to investigate whether the relationship between prices and clinical value was modified by the country setting.

Findings: Our cohort included 91 anticancer drug indications, with 60 listed for reimbursement in China, 91 in Japan, and 87 in South Korea. Median treatment prices were highest in Japan, followed by South Korea, and lowest in China, both for initial prices (US$64082 vs. US$45529 vs. US$19144, p < 0.0001) and latest prices (US$50859 vs. US$31611 vs. US$18666, p < 0.0001). Over time, China (β = -0.047, p < 0.0001) and South Korea (β = -0.049, p < 0.0001) witnessed more significant price reductions compared to Japan (β = -0.013, p = 0.011). The correlations between both initial and latest treatment prices and clinical value (QoL and ESMO-MCBS) were more significant and stronger in China and South Korea than in Japan, although Japan exhibited slightly stronger correlations in terms of survival compared to China and South Korea. The relationship between clinical value and treatment prices may not be modified by the country setting.

Interpretation: In comparison, South Korea's list prices and their correlations with clinical value appear reasonable. Policymakers in Japan could enhance efficiency by controlling prices and aligning them with clinical value, while China would need to take substantial steps to expand anticancer drug coverage.

Funding: National Natural Science Foundation of China (72374149 and 72074163), and China Center for South Asian Studies, Sichuan University.

Keywords: Anticancer drugs; China; Clinical value; Japan; Prices; South Korea.