Despite tremendous advances in new drug development over recent decades, the medical needs of an ever increasing and ageing global population are still significantly unmet. Drug repurposing (DR)—finding new therapeutic uses for existing medicinal substances and products—offers a promising strategy by potentially reducing development time, costs and risk. However, currently, significant hurdles restrict broader application of DR. This study was conducted within the European Commission funded REMEDi4ALL consortium to systematically identify and analyse the key policy obstacles perceived to be hindering the success of DR. A systematic literature review was conducted using PubMed and Embase, supplemented by grey literature searches and expert interviews within the consortium. The extracted data underwent thematic analysis. A barrier tree was developed and validated through five workshops with 80 experts from seven stakeholder groups. From 4059 hits, 192 were included for data extraction, resulting in the identification of 33 key barriers grouped into nine main themes: perception of off‐patent medicines, business case for on‐patent DR, business case for off‐patent DR, non‐industry‐funded DR, ecosystem for non‐profit or small and medium‐sized enterprise‐driven repurposing, market authorisation, exclusivity rights, health technology assessment and pricing. This comprehensive analysis provides a foundation for prioritizing the main areas for future interventions. Surprisingly, there were considerable differences in how different stakeholders perceived the importance of a number of key barriers. Such multidimensional aspects of DR barriers will need to inform future development of actionable policy recommendations to enhance the DR ecosystem and facilitate broader access to repurposed medicines.

At diagnosis, metastatic prostate cancer (PC) is sensitive to androgen deprivation therapy (ADT), and patients are usually referred to as having castration-sensitive prostate cancer (mCSPC). The combination of ADT and androgen receptor pathway inhibitors (ARPI) is the current standard of care for mCSPC. This study aimed to review the literature on economic evaluations and health economic models related to mCSPC. A literature search was performed covering Medline, Embase, and Scopus with additional grey literature sources. Studies with data on health economic evaluations focusing on Europe or North America were relevant. 18 peer-reviewed articles and 10 grey literature documents were included. The majority (n = 23) had a deterministic Markov structure and applied either Markov cohort or partitioned survival models. Evaluations investigated various types of ADT-based combinations, comparing the addition of ARPI, chemotherapy agents, or radiation therapy to ADT alone. We concluded that economic evaluations in the field of PC are widely published, and there are a large number of publications even in the specific subgroup of mCSPC. Regardless of the investigated interventions, most studies applied similar methodologies and simulated patients from the mCSPC state until the development of mCRPC or death.