OnCo
ideasIdea

A reliance pathway for companion diagnostics so the test arrives with the drug

Targeted cancer drugs often reach a country years before the test needed to select patients is approved there. Recognising other regulators' test approvals would close the gap.

In vitro diagnostic regulation has fragmented further since the EU IVDR: a companion diagnostic cleared by FDA as a PMA needs a separate notified-body assessment in Europe and different routes in Japan, China and Brazil. Because the drug is unusable without the test, this delay is a drug access delay. The proposal is a reliance route under which a companion diagnostic approved alongside a drug by a WHO-listed authority is accepted for that indication, with local requirements limited to laboratory accreditation and proficiency testing.

Hypothesis
Countries adopting diagnostic reliance reduce the gap between drug approval and reimbursed availability of its companion test from a median of over a year to under six months.
Rationale
Analytical and clinical validation of a companion test does not vary by geography, and the test's clinical utility was already established in the pivotal drug trial that every regulator reviews.
What would test it
Survey the drug-to-test availability gap for ten recent targeted oncology approvals across 20 countries to size the problem; then pilot reliance in three countries and remeasure.
Maturity
speculative
Who has to act
regulator
Cost to try
Small (under $1M)
Years to first evidence
3
Bottlenecks it attacks

Connected

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