Search

Purpose In 2015, both ASCO and the European Society for Medical Oncology (ESMO) proposed frameworks to quantify the benefit of antineoplastic drugs in the face of rising costs. We applied these frameworks to drugs approved by the US Food and Drug Administration over the past 12 years and examined relationships between costs and benefits. Methods We searched FDA.gov for drugs that received initial approval for solid tumors from 2004 to 2015 and calculated the ASCO Net Health Benefit version 2016 (NHB16) and 2015 (NHB15) and the ESMO Magnitude of Clinical Benefit Scale scores for each drug. We calculated descriptive statistics and explored correlations and associations among benefit scores, cost, and independent variables. Results We identified 55 drug approvals supported by phase II (18.2%) and III (81.8%) trials, with primary outcomes of overall survival (36.4%), progression-free survival (43.6%), or response rate (20.0%). No significant association was found between NHB16 and year of approval (P = .81), organ system (P = .20), or trial comparator arm (P = .17), but trials with progression-free survival outcomes were associated with higher scores (P = .007). Both NHB15 and Magnitude of Clinical Benefit Scale scores were approximately normally distributed, but only a moderate correlation existed between them (r = 0.40, P = .006). No correlation between benefit score and cost (NHB16, r = 0.19; ESMO, r =20.07) was found. Before 2010, two (15.3%) of 13 approved drugs exceeded $500/NHB point 3 month compared with 10 (25.0%) of 40 drugs subsequently approved. Conclusion Our analysis of the ASCO and ESMO value frameworks illuminates the heterogeneous benefit of new medications and highlights challenges in constructing a unified concept of drug value. Drug benefit does not correlate with cost, and the number of high cost/benefit outliers has increased. [ABSTRACT FROM AUTHOR]

Ash dieback (ADB), caused by Hymenoscyphus fraxineus, has severely damaged a large proportion of ash trees (Fraxinus excelsior) in continental Europe. We have little damage data for the British Isles where the disease was found only five years ago in the Southeast, and is still spreading. A large-scale screening trial to evaluate ADB damage to provenances of F. excelsior sourced from throughout the British Isles was planted in 2013 in the southeast of England. In 2016, we scored trees by their level of ADB damage observed in field at the two worst affected (based on assessments in 2015) of the 14 sites. Significant differences were found in average ADB damage among planting sites and seed source provenances. Trees from certain provenances in Scotland were the least damaged by ADB, whereas trees from Wales and Southeast England were the most badly damaged in both trial sites. Thus the levels of ADB damage currently seen in ash populations in Southeast England may not be an accurate predictor of the damage expected in future throughout the British Isles. Given all provenances contained some healthy trees, a breeding programme to produce genetically variable native ash tree populations with lower ADB susceptibility may be feasible.