OnCo
ideasIdea

Payers fund cancer drugs conditionally on a registry with a pre-specified analysis

When a health system pays for a new, uncertain cancer drug, it would require that every patient's outcome is recorded and that a pre-agreed analysis decides whether payment continues.

Coverage with evidence development exists (the English Cancer Drugs Fund, Medicare CED, Italy's AIFA registries) but analyses are often weak, late or never published. The proposal standardises the model: a pre-registered statistical analysis plan agreed at listing, mandatory structured data capture, an independent analysis body, a fixed decision date, and publication of results whatever the outcome.

Hypothesis
Standardised CED with pre-specified analyses will produce a reimbursement decision for more than 90 percent of conditionally funded indications within three years, and will lead to withdrawal or price reduction in a meaningful share.
Rationale
The reformed Cancer Drugs Fund (2016) cleared its backlog by fixing decision dates and data collection; AIFA registries have supported outcome-based rebates. Standardising the analytic component is the missing piece.
What would test it
Audit all CED decisions in three systems over five years for timeliness and publication; introduce the standardised model in one and compare.
Maturity
being tested at scale
Who has to act
payer
Cost to try
Medium ($1M to $50M)
Years to first evidence
3
Bottlenecks it attacks
  • Weak real-world evidence and registries · We do not reliably know what happens to patients after approval, so we cannot tell which drugs deliver in practice.
  • Prices and value · New cancer drugs routinely cost over $150,000 a year, often for months of benefit. Systems cannot afford them and patients go bankrupt.

Connected

5top