Health systems are struggling to work out when the price is right for personalised cancer treatments, hampering patient access, Australian researchers have found.

University of Queensland health economists including Dr Yufan Wang and Professor Haitham Tuffaha reviewed the cost-effectiveness of radiotheranostic therapies, combining radiopharmaceutical imaging and radiopharmaceutical therapy, and the methodologies used to make economic evaluations for these treatments [link here].

Their analysis of 16 articles and nine HTA (health technology assessment) reports found:

• The modelling approach used in cost evaluations varied – the reported incremental cost effectiveness ratio ranged from $21,350 to $146,526 per quality-adjusted life-year for radiopharmaceutical imaging and from $66,761 to $397,342 for radiopharmaceutical therapy,
• The HTA reviews indicated uncertainties in both the clinical and economic evidence relating to the therapies.

Only one of the evaluations, made by Australia’s MSAC, considered the value across the full theranostic pathway, by looking at PSMA PET/CT and subsequent treatment with [177Lu]Lu-PSMA within one economic valuation, rather than as separate treatments.

“We found conventional healthcare funding models were clearly not well suited to these advanced treatments,” Dr Wang said in a statement.

Writing in Journal of Nuclear Medicine, the authors said substantial differences in the methods used to evaluate these treatments contributed to “uncertainty around their value for money”.

“These findings underscore the need for fit-for-purpose HTA frameworks that integrate the full theranostic pathway and address system level constraints and equity considerations,” they said.

Radiotheranostics is playing a growing role in oncology, particularly in areas like prostate cancer.

But securing subsidies for these therapies is often complex. For example, patient access to treatments like Novartis-made radioligand therapy Pluvicto have strict access criteria and patients can face significant up-front and out-of-pocket costs.

Novartis recently made a new MSAC application to expand subsidised access for patients before they proceed to chemotherapy [link here].

In their analysis, Dr Wang and colleagues noted current approaches failed to evaluate the costs of both the diagnostic and therapeutic parts of theranostics as one item, making it difficult to evaluate the true value.

“Failure to integrate imaging and therapeutic pathways in economic evaluations can bias cost effectiveness estimates, particularly in universal health care systems that fund both imaging and treatment interventions,” they said.

Dr Yufan Wang.

Dr Wang told the limbic that for a theranostics treatment framework, it would need to be developed in collaboration with those who shape funding, reimbursement and health service delivery decisions.

“This includes government, health technology assessment bodies such as MSAC, clinicians, nuclear medicine specialists, hospitals, patient advocates, industry, and state and territory health services,” she said.

“This is currently the next phase of our research, where we are seeking to understand the barriers and facilitators to accessing this specialised class of medicine in Australia from the perspectives of these key stakeholders.”

The value framework should include both conventional HTA assessment criteria and broader system issues, taking into account factors like clinical effectiveness, patient outcomes and manufacturing and implementation feasability, Dr Wang said.

This was important because theranostic medicine is not simply a drug or a single diagnostic scan.

“It is an integrated diagnostic and therapeutic pathway, where imaging is used to identify patients whose tumours express the relevant target before they proceed to treatment. A framework should therefore assess the diagnostic and therapeutic components together as a genuine theranostic pair, rather than evaluating them separately.”