Wisely Frugal: Ensuring sustainable funding for novel cancer therapeutics using cost-effectiveness thresholds in resource limited settings

Introduction Cancer care in Sri Lanka is predominantly provided through its public funded state health system which is free at the point of delivery. The health system faced unprecedented funding restrictions brought about by the post-pandemic recession. We performed a cost-effectiveness analysis of novel cancer drugs with a view to prioritising novel cancer therapeutics to its sustainability during these challenging times. Methods The direct cost of drug procurement was obtained, and the cost per life year gained was computed for each indication. Two thresholds - per capita GDP per life year gained (GDPx1) and three times per capita GDP per life year gained (GDPx3) were considered to determine cost effectiveness. The cumulative annual cost of these treatments were then determined by multiplying the cost per treatment course per patient by the estimated number of treated patients per year for each indication. Results Data obtained on 42 novel cancer drugs spanning across 90 indications were included in the analysis. The cumulative annual treatment cost when the threshold was set at GDPx1 was US$ 6 million and it increased to US$ 16.3 million if the threshold was expanded GDPx3. Only 28 indications met the GDPx3 threshold while there were 18 drugs that did not meet the thresholds for any indication. Without a threshold, if every eligible patient were to receive the indicated currently used novel drugs, the total cost of treatment would reach almost US$ 300 million per year. Conclusion Cost-effectiveness thresholds will lead to considerable savings and help prioritise procurement and supply of cost-effective novel agents in the state health system in Sri Lanka. Advances in Knowledge In this work, we show that significant savings can be achieved by performing simple cost-effectiveness analyses and defining thresholds. The absence of robust quality of life and costing data should not deter policy makers from such conducting analyses from available information. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors