Organizations that perform health technology assessment—policy analysis that seeks to bridge medical research with clinical decision-making on a broad scale—are struggling to deal with cancer’s “exceptionalism” around the world. That’s according to a paper published April 9 in Health Affairs, “Therapies For Advanced Cancers Pose A Special Challenge For Health Technology Assessment Organizations In Many Countries.”

“Research suggests that cancer is the most dreaded condition, ranking ahead of Alzheimer’s, heart disease and stroke. For health technology assessment (HTA) organizations that evaluate medical therapies and technologies to help inform coverage and reimbursement decisions, cancer poses a special challenge,” wrote lead author Peter J. Neumann, ScD, director of the Center for the Evaluation of Value and Risk in Health (CEVR), in a blog post summarizing the study. “The issue is particularly important given the abundance of new high-priced therapies in oncology, the growing health and economic burden of cancer, and the proliferation of HTA organizations worldwide.”

The paper pointed out that, while some countries have created separate health technology assessment pathways for cancer treatment, others have either eased access or created exceptions to ease access to cancer treatment.

In the U.K., Canada and Australia, “authorities have sometimes bent their own rules to cover cancer drugs despite poor cost-effectiveness,” wrote Neumann, adding that, in the U.S., unique Medicare rules favor off-label coverage of cancer drugs.

Neumann noted that an enduring challenge for health technology assessment organizations is whether and how to grant special status to cancer.

“We argue that, in the U.S., HTA bodies are unlikely to employ explicit cost-effectiveness considerations to determine the value of cancer therapies, despite the appeal of such a strategy,” he wrote. “Instead, they are likely to pay more attention to personalized medicine so as to limit access to those patients most likely to benefit and tie payment more directly to patient outcomes.”

CEVR is part of the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center in Boston.