The Hong Kong Hospital Authority reviewed 12 drugs in the fourth quarter, rejecting Pfizer (US)'s Xalkori (crizotinib), Novo Nordisk (Denmark)'s Victoza (liraglutide), and Roche (Switzerland)'s Perjeta (pertuzumab) on cost grounds.
IHS Life Sciences perspective | |
Significance | The Drug Advisory Committee of the Hong Kong Hospital Authority (HA) has issued 12 decisions on drug approvals for the fourth quarter, rejecting Xalkori (crizotinib), Victoza (liraglutide), and Perjeta (pertuzumab) on cost grounds. |
Implications | The decisions also included approvals of Afinitor (everolimus) and Treanda (bendamustine) following previous rejections. |
Outlook | The HA's decisions do not come with details on targeted indications for the treatments. However, the decisions underline Hong Kong's increasing scrutiny of the cost-value considerations for drugs. |
The Hong Kong Hospital Authority (HA) reviewed 12 drugs in the fourth quarter. The full guidelines are available here.
Hong Kong Hospital Authority decisions (Q4) | |||
Drug | Company | Primary reason for rejection | Submission status |
Approved | |||
Oseni (alogliptin + pioglitazone) | Takeda (Japan) | N/A | New drug / indication |
Eliquis (apixaban) | Bristol-Myers Squibb/Pfizer (US) | N/A | Re-submission |
Treanda (bendamustine) | Lundbeck (Denmark) | N/A | Re-submission |
Afinitor (everolimus) | Novartis (Switzerland) | N/A | Re-submission |
Relvar Ellipta (fluticasone + vilanterol) | GlaxoSmithKline (UK) | N/A | New drug / indication |
Emend IV (fosaprepitant) | Merck & Co (US) | N/A | New drug / indication |
Seebri Breezhaler (glycopyrronium bromide) | Novartis (Switzerland) | N/A | New drug / indication |
Rejected | |||
Alutard SQ | ALK Abelló (Denmark) | Insufficient evidence to demonstrate its clinical benefits | New drug / indication |
Loceryl (amorolfine) | Galderma (France) | Alternative(s) available | New drug / indication |
Xalkori (crizotinib) | Pfizer (US) | The justification of the treatment's cost in relation to its benefits is insufficient | Re-submission |
Victoza (liraglutide) | Novo Nordisk (Denmark) | Significant cost difference versus existing treatment | Re-submission |
Perjeta (pertuzumab) | Roche (Switzerland) | The justification of the treatment's cost in relation to its benefits is insufficient | New drug / indication |
Source: HA | |||
Outlook and implications
Hong Kong's Hospital Authority, the city's biggest purchaser of pharmaceuticals, released approval decisions on 12 drugs for the fourth quarter, including approvals which come after several rejections.
The HA manages 41 public hospitals, 48 specialist outpatient clinics, and 75 general outpatient clinics, with increasing regulation on the pricing of pharmaceuticals. This is reflected in the HA's rejection of Xalkori and Victoza. Xalkori was originally rejected in the third quarter of last year, with the HA concluding at the time, "The justification of the treatment's cost in relation to its benefits is insufficient." Victoza was also rejected in the fourth quarter of 2012, on the grounds that there were alternative treatments available.
The sparse detail that comes with the decisions does not disclose the targeted indications with the applications. Although the HA issues and reviews guidelines on clinical practices to ensure that drug utilisation in the organisation is rational and evidence-based, its approval outcomes touch mainly on cost considerations.
The addition of Afinitor (everolimus) also comes after local breast cancer groups lobbied the HA to list the drug on its formulary, after it was approved by Hong Kong's Department of Health in March 2013. The treatment was rejected in the third quarter of 2013 due to "insufficient well-controlled/randomised studies to demonstrate its advantage over existing treatment".
The inclusion of Treanda (bendamustine) also comes after a series of rejections in the fourth quarter of 2013, the second quarter of 2012, and the fourth quarter of 2011, all on the basis of "insufficient comparative study(ies) versus existing treatment".