title: How do the EMA and FDA decide which anticancer drugs make it to the market? A comparative qualitative study on decision makers' views.
abstract: BACKGROUND
  The process leading to a regulatory outcome is guided by factors both related and unrelated to the data package, defined in this analysis as 'formal and informal factors', respectively. The aim of this qualitative study was to analyse which formal and informal factors drive the decision-making process of the European Medicines Agency (EMA) and Food and Drug Administration (FDA) regulators with regard to anticancer drugs, using in-depth semi-structured interviews with regulators of the two agencies.
  
  
  METHODS
  In line with the theory and practice of qualitative research, no set sample size was defined a priori. Respondent enrolment continued until saturation and redundancy were reached. Data were collected through means of in-depth semi-structured interviews conducted either in a face-to-face setting or via Skype(®) with each regulator. The interviews were audio-recorded and verbatim transcribed. The analysis was manually carried out on the transcribed text. Data were independently coded and categorized by two researchers. Interpretation of the findings emerged through a process of triangulation between the two.
  
  
  RESULTS
  Seven EMA and six FDA regulators, who had extensive experience with making decisions about anticancer medicines, were interviewed between April and June 2012. There is an open dialogue between the FDA and EMA, with the two moving closer and exchanging information, not opinions. Differences in decision-making between the agencies may be due to a different evaluation of end points. Different interaction modalities with industry and patients represent an additional source of divergence with a potential impact on decision-making. The key message of our respondents was that the agencies manage uncertainty in a different way: unlike the EMA, the FDA has a prevailing attitude to take risks in order to guarantee quicker access to new treatments.
  
  
  CONCLUSIONS
  Although formal factors are the main drivers for regulatory decisions, the influence of informal factors plays an important role in the drug evaluation process.
authors.affiliation: Italian Medicines Agency (AIFA), Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Tafuri
authors.forename: P
authors.initials: P
authors.lastname: Stolk
authors.forename: F
authors.initials: F
authors.lastname: Trotta
authors.forename: M
authors.initials: M
authors.lastname: Putzeist
authors.forename: H G
authors.initials: HG
authors.lastname: Leufkens
authors.forename: R O
authors.initials: RO
authors.lastname: Laing
authors.forename: M
authors.initials: M
authors.lastname: De Allegri
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003657:Decision Making; D017277:Drug Approval; D005060:Europe; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D000970:Antineoplastic Agents
keywords: EMA; FDA; anticancer medicines; interview study; qualitative research; regulatory