title: Linking the Price of Cancer Drug Treatments to Their Clinical Value.
abstract: OBJECTIVE
  Appropriate pricing of medications is one of the ultimate goals for decision makers, but reliable data on the risk/benefit ratio are often lacking when a Marketing Authorization Application is submitted. Here we propose a method to consistently evaluate price adequacy, which we applied to six anticancer medications approved in Italy in recent years.
  
  
  METHODS
  We obtained ratios of cost per survival per day (cost/survival/day) by dividing the total costs of evaluated medications for the median survival gain in days. Each cost/survival/day corresponds to a crude score, with 0 assigned to a cost/survival/day ≥€586. The maximum price considered as adequate was €91 cost/survival/day (score 75) while a score of 100 corresponded to a cost/survival/day ≤€11, based on the thresholds set by the British National Health System (NHS) and the "willingness-to-pay" of the Italian NHS. Crude scores were then adjusted using correction factors for efficacy, safety, quality of life, and prevalence of disease.
  
  
  RESULTS
  None of the analyzed medications (abiraterone, afatinib, aflibercept, bevacizumab, dabrafenib, and ipilimumab) achieved a final score of 75, corresponding to adequate pricing. The final score for afatinib was the highest with 55 points. Prices of all the other drugs resulted in being inadequate, with negative final scores for bevacizumab, dabrafenib, and ipilimumab.
  
  
  CONCLUSIONS
  This method may be considered a tool for the evaluation of appropriateness of price proposed at negotiation and could represent a reliable resource for decision-making. Furthermore, this analysis suggests that most recently approved cancer drugs in Italy do not fulfill price adequacy.
authors.affiliation: Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, Via S. Sofia 64, Catania, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Gozzo
authors.affiliation: Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, Via S. Sofia 64, Catania, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Navarria
authors.affiliation: Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Drago
authors.affiliation: Regional Pharmacovigilance Centre of Catania, A.O.U. Policlinico, Vittorio Emanuele, Catania, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Longo
authors.affiliation: Regional Pharmacovigilance Centre of Catania, A.O.U. Policlinico, Vittorio Emanuele, Catania, Italy.
authors.forename: Silvana
authors.initials: S
authors.lastname: Mansueto
authors.affiliation: Department of Economics and Quantitative Methods, University of Catania, Catania, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Pignataro
authors.affiliation: Department of Economics and Management and ALTEMS (Graduate School of Health Economics and Management), Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Americo
authors.initials: A
authors.lastname: Cicchetti
authors.affiliation: Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, Via S. Sofia 64, Catania, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Salomone
authors.affiliation: Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, Via S. Sofia 64, Catania, Italy. f.drago@unict.it.
authors.forename: Filippo
authors.initials: F
authors.lastname: Drago
mesh_terms: D000077716:Afatinib; D000465:Algorithms; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006801:Humans; D007558:Italy / Q000453:epidemiology; D009369:Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D015995:Prevalence; D011788:Quality of Life; D011799:Quinazolines / Q000191:economics / Q000627:therapeutic use; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; D000068258:Bevacizumab; D000077716:Afatinib