[Reporter’s View] CDDC continues to raise controversy

The Cancer Disease Deliberation Committee acts as a barrier to cancer drug reimbursement in Korea

The Cancer Disease Deliberation Committee has settled as the highest threshold in reimbursement for anticancer drugs in Korea.

 

This expert committee, which is a mandatory step for reimbursement in Korea, has put many anticancer drugs through an ordeal, to the extent that it was coined the ‘wailing wall’ to reimbursement in Korea.

 

The committee, which had originally been launched for the purpose of evaluating the clinical usefulness of anticancer drugs that applied for reimbursement listing, had become ridden with issues after additionally starting a review on each drug’s fiscal impact.

 

Questions were raised on what grounds the CDDC had to analyze the drug’s fiscal impact, and the fairness and objectivity of the review results were also criticized.

 

However, the Health Insurance Review and Assessment Service only disclosed the meeting results and made no other significant change in the operation of the committee.

 

As a result, the CDDC’s power grew stronger, empowering the government with the justification that ‘the doctors that use the drugs said no,’ and the doctors that were selected as members have become priority targets for management by pharmaceutical companies.

 

Recently, controversy arose over the composition of the committee itself.

 

The criticism was that the blood cancer drugs were not properly evaluated due to the high proportion of solid cancer experts in the committee.

 

In other words, it was pointed out that the large proportion of solid cancer specialists with low expertise in hematologic malignancies in the committee made the committee unfit for proper evaluation of blood cancer drugs.

 

In fact, the Korean Society of Hematology and The Korean Society of Blood and Marrow Transplantation had asked HIRA to organize a separate deliberation committee to review blood cancer drugs, but HIRA has been conservative in their response.

 

This is not the first time an issue was raised on the expertise of the committee’s review.

 

The CDDC had excluded direct stakeholders from deliberations in last year’s committee.

 

In other words, doctors who participated in the clinical study of the subject drug were not allowed to attend the committee on the day of the drug’s deliberation.

 

In terms of the purpose itself, the measure was made to secure transparency.

 

However, as the scope of “direct stakeholders” included doctors who participated in PMS – or Phase IV studies – the composition of the committee itself was at a point where the expertise on the drug could not be ensured.

 

Doctors are not financial experts.

 

They are word by word, a medical expert.

 

This is why the government had to explain that financial experts and healthcare experts were added to the CDDC to support the legitimacy of CDDC in evaluating the financial impact made by anticancer drugs.

 

If so, the key role of the doctor in CDDC is to inform the committee of the medical necessity of the drug and the significance of its clinical trial results.

 

An expert committee can no longer function as an expert committee without expertise.

 

CDDC deliberates not any drug, it evaluates long-awaited new drugs for cancer patients.

 

Neither exclusion for transparency nor the proportion of hematological and solid cancer experts should lead to a lack of expertise.

 

With so many voicing the need for change, when will the government continue to argue that there is “no problem?”