Background: Scientific and medical progress in oncology has led to the introduction of new medicines in rapid succession. In addition, the development of new therapy modalities, the so-called "targeted therapies” such as e.g. monoclonal antibodies or tyrosinekinase-inhibitors ("small molecules"), has resulted in swift increases in medicine costs in oncology in hospitals. The fast and, to some extent, uncontrolled implementation of these expensive cancer medicines has affected hospital drug budgets. The development of a Horizon Scanning System (HSS) which aims at identifying and evaluating new drug therapies in oncology early on, i.e. before their routine introduction for cancer treatment, could prepare Austrian hospitals (hospital administrators and drug commissions respectively) for new anticancer medicines, and could contribute to making rational decisions and planning prospective budgets. The main components of such a Horizon Scanning System are the determination of relevant information sources for the systematic identification of emerging anticancer drugs, the establishment of a useful filtering and prioritisation instrument, the set up of a network of Austrian oncologists involved in the Horizon Scanning process and the definition of the parameters and the format of early assessment.
Objectives: This project was performed in order to develop a concept for the preparation of a HSS for anticancer drugs in Austria and to test the two important steps of identification and priority setting within a first feasibility study.
Methods: A literature and internet search based on the EUnetHTA WP7 HSS-review (overview of Horizon Scanning activities) was performed to identify existing Horizon Scanning Systems and relevant information sources for new anticancer drugs. Experts from established HSSs, mainly members of EuroScan, were contacted for information about their identification and prioritisation processes. Existing methods were then adapted to the needs of Horizon Scanning in oncology. Clinical experts were involved in the priority-setting process and the selection of new anticancer drugs for performing an early assessment. In a pilot run, we tested the feasibility of the concept.
Results: In a time period of three months about sixty selected information sources for oncology were scanned weekly to identify emerging anticancer drugs or drugs with an extension of indication in phase II/ III of clinical testing. Our scanning revealed 116 different anticancer drugs for which we extracted relevant data. Three clinical experts in oncology then independently applied seven prioritisation criteria with an underlying score to the potentially important anticancer drugs. We analysed their preliminary estimations by calculating a mean score. The number of anticancer drugs relevant to the Austrian health care system could thereby be reduced to five, although this result has to be interpreted carefully. Prioritisations by the experts clearly differed. Therefore, a final decision about which anticancer drugs should undergo early assessment was not feasible after calculating a mean score. Instead, a multistage prioritisation process must be used to reach a consensus between oncologists. In addition, our experts have commented on the proposed procedures of drug identification and prioritisation. Their suggestions mainly dealt with how drugs are identified (i.e. more restricted inclusion criteria) and who makes up the expert panel (more experts with expertise in specific tumour entities). Their input could now be used to optimize the Horizon Scanning System and serve as a basis for further discussions.
Conclusions: The establishment of a Horizon Scanning System for anticancer drugs is an important tool to prepare Austrian hospitals for new/ emerging medicines. In principle our first experiences with the Horizon Scanning System from the feasibility study were acceptable but several changes, especially regarding the collection of data on anticancer drugs and the priority setting process, were proposed by our experts. The next steps will be to work out an optimized, final concept with various stakeholders (e.g. hospital administrators, clinical experts, drug commissions) in consideration of the results of the feasibility study. Secondly, the Horizon Scanning System should be made standard practice to regularly provide Austrian hospitals (hospital management and drug commissions) with information about new/ emerging anticancer drugs to support their financial drug budget planning and rational decision making. Third, as an input for the international HTA-community, the Ludwig Boltzmann Institute for HTA will join EuroScan in 2008/ 2009.