Abstract
This study employs a two-way fixed effects research design to measure the mortality impact and cost-effectiveness of cancer drugs: It analyzes the correlation across 36 countries between the relative mortality from 19 types of cancer in 2015 and the relative number of drugs previously launched in that country to treat that type of cancer, controlling for relative incidence. The sample size (both in terms of number of observations and population covered) of this study is considerably larger than the sample sizes of previous studies; a new and improved method of analyzing the lag structure of the relationship between drug launches and life-years lost is used; and a larger set of measures of the burden of cancer is analyzed. The number of DALYs and life-years lost are unrelated to drug launches 0–4 years earlier. This is not surprising, since utilization of a drug tends to be quite low during the first few post-launch years. Moreover, there is likely to be a lag of several years between utilization of a drug and its impact on mortality. However, mortality is significantly inversely related to the number of drug launches at least 5 years earlier, especially to drug launches 5–9 years earlier. One additional drug for a cancer site launched during 2006–2010 is estimated to have reduced the number of 2015 DALYs due to cancer at that site by 5.8%;; one additional drug launched during 1982–2005 is estimated to have reduced the number of 2015 DALYs by about 2.6%. Lower quality (or effectiveness) of earlier vintage drugs may account for their smaller estimated effect. We estimate that drugs launched during the entire 1982–2010 period reduced the number of cancer DALYs in 2015 by about 23.0%, and that, in the absence of new drug launches during 1982–2010, there would have been 26.3 million additional DALYs in 2015. Also, the nine countries with the largest number of drug launches during 1982–2010 are estimated to have had 14% fewer cancer DALYs (controlling for incidence) in 2015 than the nine countries with the smallest number of drug launches during 1982–2010. Estimates of the cost per life-year gained in 2015 from drugs launched during 2006–2010 range between $1,635 (life-years gained at all ages) and $2,820 (life-years gained before age 65). These estimates are similar to those obtained in previous country-specific studies of Belgium, Canada, and Mexico, and are well below the estimate obtained in one study of Switzerland. Mortality in 2015 is strongly inversely related to the number of drug launches in 2006–2010. If the relationship between mortality in 2020 and the number of drug launches in 2011–2015 is similar, drug launches 5–9 years earlier will reduce mortality even more (by 9.9%) between 2015 and 2020 than they did (by 8.4%) between 2010 and 2015.