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In the past three decades, the US Food and Drug Administration (FDA) has increasingly relied on surrogate endpoints (eg, disease-free and progression-free survival) to approve cancer drugs.1 2 In 2017, the percentage of approved cancer drugs demonstrating improvement in overall survival (OS) fell to 7% (n=2), compared with the 93% (n=25) demonstrating improvements in surrogate endpoints only.2 Health economists are thus faced with the challenge of approximating OS in model-based economic evaluations, as part of the health technology assessment process to help guide reimbursement decisions for both private and public insurers. Here are three characteristics of contemporary cancer survival that health economists and clinicians need to consider for more robust economic evaluations.