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Supervisors

LSHTM 

• Lead: John Cairns (John.Cairns@lshtm.ac.uk)

Nagasaki University

• (yamanashi@nagasaki-u.ac.jp)

Project

Background

The introduction of advanced cancer therapies, such as immune checkpoint inhibitors and molecularly targeted therapies, has substantially improved patient outcomes. However, these innovations have also significantly increased treatment costs, placing increasing financial pressure on healthcare systems worldwide [1,2]. Several countries use Health Technology Assessments (HTAs) to manage these financial pressures [3] but this can potentially limit patient access to treatment, which may negatively affect health outcomes[4]. 

Despite the importance of HTAs in balancing cost and access, there is limited comparative research on HTA implementation across different countries, particularly concerning drug reimbursement, pricing strategies, and their subsequent impact on patient health. England and Japan, both of which have achieved Universal Health Coverage and employ HTAs with defined cost-effectiveness thresholds as part of their social value framework, take distinct approaches in applying these frameworks[3]. A comparative analysis of these systems can offer insights into the balance between financial sustainability, patient access, and health outcomes, providing guidance for policymakers in other countries seeking to optimize their healthcare systems. 

Purpose

This research will provide key insights for national policy discussions by comparing HTA frameworks, focusing on balancing cost control with access to expensive cancer treatments. It will also guide the development of adaptable and equitable HTA models, particularly in low- and middle-income countries. 

Research Questions

1. Comparative Review of HTA Practices in England and Japan 
   How do HTA practices with respect to advanced cancer therapies differ between England and Japan, particularly in terms of decision-making criteria, reimbursement, and regulatory frameworks?
2. Differences in Cancer Treatment Costs and Health Outcomes in England and Japan 
   How do cancer treatment costs and health outcomes differ between England and Japan and to what extent might these be influenced by differences in HTA practices?  

Direct comparison of reimbursement decisions for cancer drugs will document which therapies were available and when. In particular, the impact of differences in the utilisation of immune checkpoint inhibitors and molecular targeted therapies between the two countries on cancer outcomes will be explored.

Data Sources

Detailed information on HTA practice in England and Japan is available from the National Institute for Health and Care Excellence and the Central Social Insurance Medical Council respectively. Comparative cancer outcomes will be based on the GLOBOCAN database, CONCORD-3 data and Global Cancer Observatory data. Information on treatment will primarily come from the Systemic Anti-Cancer Therapy (SACT) database (for England) and the Ministry of Health, Labour and Welfare National Data Base, National Cancer Registry and the Diagnosis Procedure Combination data (for Japan).

1. Burns R, Leal J, Sullivan R, Luengo-Fernandez R. Economic burden of malignant blood disorders across Europe: a population-based cost analysis. Lancet Haematol. 2016 Aug;3(8):e362-70 
2. Sullivan R, Peppercorn J, Sikora K, et al. Delivering affordable cancer care in high-income countries. Lancet Oncol. 2011 Sep;12(10):933-80.
3. Jenei K, Raymakers AJN, Bayle A, et al. Health technology assessment for cancer medicines across the G7 countries and Oceania: an international, cross-sectional study. Lancet Oncol. 2023 Jun;24(6):624-635. 
4. Claxton K, Sculpher M, Palmer S, Culyer AJ. Causes for concern: is NICE failing to uphold its responsibilities to all NHS patients? Health Econ Internet. 2015;24(1):1–7.

The role of LSHTM and NU in this collaborative project

This project provides an opportunity to broaden research collaboration between LSHTM and NU by focusing on decision making around the adoption of innovative technologies in one of the quantitatively most important areas of advanced healthcare.

Particular prior educational requirements for a student undertaking this project

• A master's degree in public health, health economics, health policy, epidemiology or a related field relevant to the project.
• An upper second-class degree from a UK university or an equivalent qualification from an overseas institution in a subject related to the project. 

Skills we expect a student to develop/acquire whilst pursuing this project

• Literature reviews.
• Analysis of behavioural and epidemiological data.
• Programming languages (R, Python).
• Cost-effectiveness analysis.
• Uncertainty modelling.