Association between added therapeutic value and incremental cost-effectiveness ratios for oncology medicines in Europe

Aim This study assessed the association between the magnitude of added therapeutic value (ATV) and corresponding incremental cost-effectiveness ratios (ICERs) for oncology medicines approved for public reimbursement. Methods Five European countries (Portugal, France, Italy, Germany and Netherlands) with established frameworks for the assessment and classification of ATV were included. HTA reports of oncology medicines published between 2018 and 2025 were reviewed to extract ATV classifications and corresponding ICERs (€ per Quality-Adjusted Life Year [QALY]), complemented by an Embase® search for additional data. Associations between ICERs and ATV classifications were assessed using Spearman’s rho and Kendall’s tau, with cluster bootstrap resampling used to estimate confidence intervals in R. Results A total of 133 reimbursement reports for 88 oncology medicines with ICER data were included in the analysis. Median ICER values ranged from €34,906/QALY in Italy to €109,627/QALY in France. The association between ATV magnitude and ICER values differed across countries. In Italy, greater ATV was associated with higher ICER values (ρ = 0.58, 95% CI: 0.05 to 0.81; τ = 0.42, 95% CI: 0.00–0.68). No clear association was observed in France (ρ = 0.04, 95% CI: −0.27 to 0.29; τ = 0.03, 95% CI: −0.22–0.24), Portugal (ρ = −0.03, 95% CI: −0.63 to 0.51; τ = −0.06, 95% CI: −0.55 to 0.41), or Germany (ρ = 0.09, 95% CI: −0.94 to 0.88; τ = 0.04, 95% CI: −0.89 to 0.79). In the Netherlands, greater ATV tended to be associated with lower ICER values (ρ = −0.28, 95% CI: −0.59 to 0.08; τ = −0.21, 95% CI: −0.47 to 0.07). Confidence intervals were generally wide, reflecting the limited sample sizes available for analysis. Discussion These findings do not support a consistent association between the magnitude of ATV and ICERs across European HTA systems. The observed variability suggests that clinical and economic assessments may capture distinct dimensions of value, reflecting differences in how national HTA frameworks inform reimbursement decision-making.