title: Do new cancer drugs offer good value for money? The perspectives of oncologists, health care policy makers, patients, and the general population.
abstract: BACKGROUND
  In oncology, establishing the value of new cancer treatments is challenging. A clear definition of the different perspectives regarding the drivers of innovation in oncology is required to enable new cancer treatments to be properly rewarded for the value they create. The aim of this study was to analyze the views of oncologists, health care policy makers, patients, and the general population regarding the value of new cancer treatments.
  
  
  METHODS
  An exploratory and qualitative study was conducted through structured interviews to assess participants' attitudes toward cost and outcomes of cancer drugs. First, the participants were asked to indicate the minimum survival benefit that a new treatment should have to be funded by the Spanish National Health System (NHS). Second, the participants were requested to state the highest cost that the NHS could afford for a medication that increases a patient's quality of life (QoL) by twofold with no changes in survival. The responses were used to calculate incremental cost-effectiveness ratios (ICERs).
  
  
  RESULTS
  The minimum improvement in patient survival means that justified inclusions into the NHS were 5.7, 8.2, 9.1, and 10.4 months, which implied different ICERs for oncologists (€106,000/quality-adjusted life year [QALY]), patients (€73,520/QALY), the general population (€66,074/QALY), and health care policy makers (€57,471/QALY), respectively. The costs stated in the QoL-enhancing scenario were €33,167, €30,200, €26,000, and €17,040, which resulted in ICERs of €82,917/QALY for patients, €75,500/QALY for the general population, €65,000/QALY for oncologists, and €42,600/QALY for health care policy makers, respectively.
  
  
  CONCLUSIONS
  All estimated ICER values were higher than the thresholds previously described in the literature. Oncologists most valued gains in survival, whereas patients assigned a higher monetary value to treatments that enhanced QoL. Health care policy makers were less likely to pay more for therapeutic improvements compared to the remaining participants.
authors.affiliation: Medical Department, Lilly, Madrid, Spain.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Dilla
authors.affiliation: Outcomes'10, Jaime I University, Castellón, Spain.
authors.forename: Luís
authors.initials: L
authors.lastname: Lizan
authors.affiliation: Outcomes'10, Jaime I University, Castellón, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Paz
authors.affiliation: Medical Oncology Department, University Hospital Ramon y Cajal, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Garrido
authors.affiliation: Clinical Pharmacology Department, Puerta de Hierro-Majadahonda Hospital, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Avendaño
authors.affiliation: Salamanca Institute for Biomedical Research, University Hospital of Salamanca, Salamanca, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Cruz-Hernández
authors.affiliation: Medical Oncology Department, General Hospital Ciudad Real, Ciudad Real, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Espinosa
authors.affiliation: Medical Department, Lilly, Madrid, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Sacristán
keywords: ICER; Spain; clinically meaningful outcomes; cost; cost-effectiveness; cost-effectiveness threshold; oncology