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Zhang W, Sun H, Guh DP, Grootendorst P, Hollis A, Anis AH. The impact of proposed price regulations on new patented medicine launches in Canada: a retrospective cohort study. CMAJ 2024; 196:E691-E701. [PMID: 38802136 PMCID: PMC11142024 DOI: 10.1503/cmaj.231485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The Patented Medicine Prices Review Board (PMPRB), the agency that regulates the prices of patented medicines in Canada, published proposed amendments to the regulatory framework in December 2017. Because of a series of changes and delays, the revised policy has not yet been finalized. We sought to evaluate the potential early impact of the uncertainty about the PMPRB policy on patented-medicine launches. METHODS We developed a retrospective cohort of patented medicines (molecules) sold in Canada and the 13 countries that the PMPRB currently uses or has proposed to use as price comparators, from sales data from the IQVIA MIDAS database for 2012-2021. The outcome was whether a molecule was launched (i.e., sold) in a specific country within 2 years of its global first launch (2-yr launch). We compared the change of 2-year launch before (2012-2017) and after the proposed amendments were published ("uncertain period," 2018-2021) in Canada with the change in the United States and the other 12 countries as a group ("other-countries group"), using interrupted time series and logistic regressions, respectively. We further conducted analyses for each individual country and subgroups by molecule characteristics, such as therapeutic benefit, separately. RESULTS We included 242 and 107 new molecules launched before publication of the proposed amendments and during the uncertain period, respectively. The corresponding 2-year launch proportions were 45.0% and 30.8% in Canada, 81.4% and 82.2% in the US, and 83.9% and 70.1% in the other-countries group. All analyses showed changes in 2-year launch during the uncertain period in the US and in the other-countries group that were similar to the changes in Canada. Greater decreases were observed in Norway and Sweden than in Canada. The 2-year launch proportion for molecules with major therapeutic benefit decreased from 45.8% to 31.3% in Canada during the uncertain period and from 87.5% to 62.5% in the other-countries group, but increased from 91.7% to 100% in the US. INTERPRETATION No negative impact of the PMPRB-policy uncertainty on molecule launches was observed when comparing Canada with price-comparator countries, except for molecules with major therapeutic benefit. The reduction in launches of medicines with major therapeutic benefit in Canada requires continuing investigation.
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Affiliation(s)
- Wei Zhang
- Faculty of Pharmaceutical Sciences (Zhang) and School of Population and Public Health (Anis), University of British Columbia; Centre for Advancing Health Outcomes (Zhang, Sun, Guh, Anis), Providence Research, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Department of Economics (Hollis), University of Calgary, Calgary, Alta.
| | - Huiying Sun
- Faculty of Pharmaceutical Sciences (Zhang) and School of Population and Public Health (Anis), University of British Columbia; Centre for Advancing Health Outcomes (Zhang, Sun, Guh, Anis), Providence Research, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Department of Economics (Hollis), University of Calgary, Calgary, Alta
| | - Daphne P Guh
- Faculty of Pharmaceutical Sciences (Zhang) and School of Population and Public Health (Anis), University of British Columbia; Centre for Advancing Health Outcomes (Zhang, Sun, Guh, Anis), Providence Research, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Department of Economics (Hollis), University of Calgary, Calgary, Alta
| | - Paul Grootendorst
- Faculty of Pharmaceutical Sciences (Zhang) and School of Population and Public Health (Anis), University of British Columbia; Centre for Advancing Health Outcomes (Zhang, Sun, Guh, Anis), Providence Research, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Department of Economics (Hollis), University of Calgary, Calgary, Alta
| | - Aidan Hollis
- Faculty of Pharmaceutical Sciences (Zhang) and School of Population and Public Health (Anis), University of British Columbia; Centre for Advancing Health Outcomes (Zhang, Sun, Guh, Anis), Providence Research, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Department of Economics (Hollis), University of Calgary, Calgary, Alta
| | - Aslam H Anis
- Faculty of Pharmaceutical Sciences (Zhang) and School of Population and Public Health (Anis), University of British Columbia; Centre for Advancing Health Outcomes (Zhang, Sun, Guh, Anis), Providence Research, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Grootendorst), University of Toronto, Toronto, Ont.; Department of Economics (Hollis), University of Calgary, Calgary, Alta
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2
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Rawson NSB, Stewart DJ. Timeliness of Health Technology Assessments and Price Negotiations for Oncology Drugs in Canada. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:437-445. [PMID: 38812711 PMCID: PMC11135564 DOI: 10.2147/ceor.s462872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 05/14/2024] [Indexed: 05/31/2024] Open
Abstract
Purpose To evaluate whether time targets for Canadian Agency for Drugs and Technologies in Health (CADTH) reimbursement reviews and pan-Canadian Pharmaceutical Alliance (pCPA) price negotiations are being achieved for oncology drugs. Materials and Methods Recommendations, dates of submission and publication, and indications for oncology medicines issued between January 2014 and December 2023 were recorded from CADTH's reimbursement reports webpage. The date any negotiation began and the date it was completed (successfully or not), or when a decision was made not to pursue negotiation was extracted from the pCPA's webpage. The duration of each CADTH review and pCPA negotiation was calculated, together with time between CADTH's recommendation and start of the pCPA negotiation or a decision not to negotiate. Percentages of reviews completed within CADTH's target and of times taken by the pCPA to decide whether to negotiate and by its price negotiations completed within the relevant targets were calculated. Results CADTH achieved its 270-days target in 88.2% to 100% of reviews issued between 2015 and 2019 but only in 65.9% to 73.1% of reviews issued in the last three years of the decade. CADTH's "typical timeline" of 180 days was achieved in under 40% of reviews issued in 2015 and not attained in any review in 2021, 2022 or 2023. The pCPA's target of 60 days for deciding whether to negotiate was achieved for all recommendations issued in 2014 but dropped below 40% for the last seven years of the decade; its target of 130 days for negotiations was achieved for over 85% of the recommendations in 2014 but decreased to only 14.3% in 2016 and then gradually increased to 61.5% in 2023. Conclusion CADTH's "typical timeline" and the pCPA's targets were not met sufficiently to be meaningful. Their processes take too long for cancer drugs.
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Affiliation(s)
- Nigel S B Rawson
- Macdonald-Laurier Institute, Ottawa, Ontario, Canada
- Canadian Health Policy Institute, Toronto, Ontario, Canada
- Centre for Health Policy Studies, Fraser Institute, Vancouver, British Columbia, Canada
| | - David J Stewart
- Department of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
- Division of Medical Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
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Balijepalli C, Gullapalli L, Joshy J, Rawson NSB. The impact of willingness-to-pay threshold on price reduction recommendations for oncology drugs: a review of assessments conducted by the Canadian Agency for Drugs and Technologies in Health. J Comp Eff Res 2024; 13:e230178. [PMID: 38567953 PMCID: PMC11037021 DOI: 10.57264/cer-2023-0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/15/2024] [Indexed: 04/23/2024] Open
Abstract
Since late 2020, the Canadian Agency of Drugs and Technologies in Health (CADTH) has been using a threshold of $50,000 (CAD) per quality-adjusted life-year (QALY) for both oncology and non-oncology drugs. When used for oncology products, this threshold is hypothesized to have a higher impact on the time to access these drugs in Canada. We studied the impact of price reductions on time to engagement and negotiation with the pan-Canadian Pharmaceutical Alliance for oncology drugs reviewed by CADTH between January 2020 and December 2022. Overall, 103 assessments reported data on price reductions recommended by CADTH to meet the cost-effectiveness threshold for reimbursement. Of these assessments, 57% (59/103) recommendations included a price reduction of greater than 70% off the list price. Eight percent (8/103) were not cost-effective even at a 100% price reduction. Of the 47 assessments that had a clear benefit, in 21 (45%) CADTH recommended a price reduction of at least 70%. The median time to price negotiation (not including time to engagement) for assessments that received at least 70% vs >70% price reduction was 2.6 vs 4.8 months. This study showed that there is a divergence between drug sponsor's incremental cost-effectiveness ratio (ICER) and CADTH revised ICER leading to a price reduction to meet the $50,000/QALY threshold. For the submissions with clear clinical benefit the median length of engagement (2.5 vs 3.3 months) and median length of negotiation (3.1 vs 3.6 months) were slightly shorter compared with the submissions where uncertainties were noted in the clinical benefit according to CADTH. This study shows that using a $50,000 per QALY threshold for oncology products potentially impacts timely access to life saving medications.
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Affiliation(s)
| | | | - Juhi Joshy
- Pharmalytics Group, Vancouver, BC V6B 2Z4, Canada
| | - Nigel SB Rawson
- Canadian Health Policy Institute, Toronto, ON, Canada
- Macdonald-Laurier Institute, Ottawa, ON, Canada
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4
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Stewart DJ, Bradford JP, Sehdev S, Ramsay T, Navani V, Rawson NSB, Jiang DM, Gotfrit J, Wheatley-Price P, Liu G, Kaplan A, Spadafora S, Goodman SG, Auer RAC, Batist G. New Anticancer Drugs: Reliably Assessing "Value" While Addressing High Prices. Curr Oncol 2024; 31:2453-2480. [PMID: 38785465 PMCID: PMC11119944 DOI: 10.3390/curroncol31050184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
Countries face challenges in paying for new drugs. High prices are driven in part by exploding drug development costs, which, in turn, are driven by essential but excessive regulation. Burdensome regulation also delays drug development, and this can translate into thousands of life-years lost. We need system-wide reform that will enable less expensive, faster drug development. The speed with which COVID-19 vaccines and AIDS therapies were developed indicates this is possible if governments prioritize it. Countries also differ in how they value drugs, and generally, those willing to pay more have better, faster access. Canada is used as an example to illustrate how "incremental cost-effectiveness ratios" (ICERs) based on measures such as gains in "quality-adjusted life-years" (QALYs) may be used to determine a drug's value but are often problematic, imprecise assessments. Generally, ICER/QALY estimates inadequately consider the impact of patient crossover or long post-progression survival, therapy benefits in distinct subpopulations, positive impacts of the therapy on other healthcare or societal costs, how much governments willingly might pay for other things, etc. Furthermore, a QALY value should be higher for a lethal or uncommon disease than for a common, nonlethal disease. Compared to international comparators, Canada is particularly ineffective in initiating public funding for essential new medications. Addressing these disparities demands urgent reform.
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Affiliation(s)
- David J. Stewart
- Division of Medical Oncology, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada (J.G.); (P.W.-P.)
- Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada; (T.R.); (R.A.C.A.)
- Life Saving Therapies Network, Ottawa, ON K1H 5E6, Canada; (J.-P.B.); (G.B.)
| | - John-Peter Bradford
- Life Saving Therapies Network, Ottawa, ON K1H 5E6, Canada; (J.-P.B.); (G.B.)
| | - Sandeep Sehdev
- Division of Medical Oncology, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada (J.G.); (P.W.-P.)
- Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada; (T.R.); (R.A.C.A.)
- Life Saving Therapies Network, Ottawa, ON K1H 5E6, Canada; (J.-P.B.); (G.B.)
| | - Tim Ramsay
- Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada; (T.R.); (R.A.C.A.)
| | - Vishal Navani
- Division of Medical Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Nigel S. B. Rawson
- Canadian Health Policy Institute, Toronto, ON M5V 0A4, Canada;
- Macdonald-Laurier Institute, Ottawa, ON K1N 7Z2, Canada
| | - Di Maria Jiang
- University of Toronto, Toronto, ON M5S 3H2, Canada; (D.M.J.); (G.L.); (A.K.); (S.G.G.)
- Princess Margaret Cancer Center, Toronto, ON M5G 2M9, Canada
| | - Joanna Gotfrit
- Division of Medical Oncology, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada (J.G.); (P.W.-P.)
- Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada; (T.R.); (R.A.C.A.)
| | - Paul Wheatley-Price
- Division of Medical Oncology, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada (J.G.); (P.W.-P.)
- Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada; (T.R.); (R.A.C.A.)
- Life Saving Therapies Network, Ottawa, ON K1H 5E6, Canada; (J.-P.B.); (G.B.)
| | - Geoffrey Liu
- University of Toronto, Toronto, ON M5S 3H2, Canada; (D.M.J.); (G.L.); (A.K.); (S.G.G.)
- Princess Margaret Cancer Center, Toronto, ON M5G 2M9, Canada
| | - Alan Kaplan
- University of Toronto, Toronto, ON M5S 3H2, Canada; (D.M.J.); (G.L.); (A.K.); (S.G.G.)
- Family Physicians Airway Group of Canada, Markham, ON L3R 9X9, Canada
| | - Silvana Spadafora
- Algoma District Cancer Program, Sault Ste Marie, ON P6B 0A8, Canada;
| | - Shaun G. Goodman
- University of Toronto, Toronto, ON M5S 3H2, Canada; (D.M.J.); (G.L.); (A.K.); (S.G.G.)
- St. Michael’s Hospital, Unity Health Toronto, and Peter Munk Cardiac Centre, University Health Network, Toronto, ON M5B 1W8, Canada
| | - Rebecca A. C. Auer
- Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada; (T.R.); (R.A.C.A.)
- Department of Surgery, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Gerald Batist
- Life Saving Therapies Network, Ottawa, ON K1H 5E6, Canada; (J.-P.B.); (G.B.)
- Centre for Translational Research, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
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5
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Sehdev SR, Rawson NSB, Aseyev OI, Buick CJ, Butler MO, Edwards S, Gill S, Gotfrit JM, Hsia CC, Juergens RA, Manna M, McCarthy JS, Mukherjee SD, Snow SL, Spadafora S, Stewart DJ, Wentzell JR, Wong RPW, Zalewski PG. Access to Oncology Medicines in Canada: Consensus Forum for Recommendations for Improvement. Curr Oncol 2024; 31:1803-1816. [PMID: 38668039 PMCID: PMC11048816 DOI: 10.3390/curroncol31040136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Patient access to new oncology drugs in Canada is only possible after navigating multiple sequential systemic checkpoints for national regulatory approval, health technology assessment (HTA) and collective government price negotiation. These steps delay access and prevent health care providers from being able to prescribe optimal therapy. Eighteen Canadian oncology clinicians from the medicine, nursing and pharmacy professions met to develop consensus recommendations for defining reasonable government performance standards around process and timeliness to improve Canadian cancer patients' access to best care. A modified Delphi methodology was used to identify consensus on 30 questions involving five themes: accountability, disparities, endpoints, timeliness, and cost-effectiveness. It was agreed that greater transparency is required across regulatory and HTA processes. Health professionals in oncology are frustrated for their patients because they are unable to deliver the modern guideline-supported therapies they want to provide due to delays in approval or funding. Canadian health care providers request improvements in timely access to life-saving therapeutics in line with other comparator countries. Clinicians expect urgent improvements in Canadian health systems to give our patients their best chance of survival.
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Affiliation(s)
- Sandeep R. Sehdev
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada
| | | | - Olexiy I. Aseyev
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON P7B 6V4, Canada
| | - Catriona J. Buick
- Faculty of Health, York University, Toronto, ON M3J 1P3, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Canadian Association of Nurses in Oncology/Association Canadienne des Infirmières en Oncologie, Vancouver, BC V6A 1B6, Canada
| | - Marcus O. Butler
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Scott Edwards
- Dr H Bliss Murphy Cancer Centre, Eastern Health, St. John’s, NL A1B 3V6, Canada
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
| | - Sharlene Gill
- Department of Medicine, Division of Medical Oncology, University of British Columbia and BC Cancer, Vancouver, BC V5Z 1M9, Canada
| | - Joanna M. Gotfrit
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada
| | - Cyrus C. Hsia
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON N6A 5W9, Canada
| | | | - Mita Manna
- Saskatoon Cancer Centre, Saskatoon, SK S7N 4H4, Canada
| | - Joy S. McCarthy
- Cancer Care Program, Newfoundland and Labrador Health Services, St. John’s, NL A1B 3V6, Canada
| | - Som D. Mukherjee
- Juravinski Cancer Centre, McMaster University, Hamilton, ON L8V 5C2, Canada
| | | | - Silvana Spadafora
- Algoma District Cancer Program, Sault Area Hospital, Sault Ste Marie, ON P6B 0A8, Canada
- Northern Ontario School of Medicine University, Sudbury, ON P3E 2C6, Canada
| | - David J. Stewart
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada
| | - Jason R. Wentzell
- Department of Pharmacy, the Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada
| | - Ralph P. W. Wong
- CancerCare Manitoba, University of Manitoba, Winnipeg, MB R3E 0V9, Canada
| | - Pawel G. Zalewski
- Lakeridge Health, Durham Regional Cancer Centre, Oshawa, ON L1G 8A2, Canada
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Sehdev S, Gotfrit J, Elias M, Stein BD. Impact of Systemic Delays for Patient Access to Oncology Drugs on Clinical, Economic, and Quality of Life Outcomes in Canada: A Call to Action. Curr Oncol 2024; 31:1460-1469. [PMID: 38534943 PMCID: PMC10969399 DOI: 10.3390/curroncol31030110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/18/2024] [Accepted: 03/01/2024] [Indexed: 05/26/2024] Open
Abstract
Canada has one of the most complex and rigorous drug approval and public reimbursement processes and is, unfortunately, one of the countries with the longest delays in drug access. To assess the overall impact of systemic delays in access to cancer therapy, a targeted literature review (TLR) was performed to identify studies associated with the clinical, economic, and quality of life impacts of delayed access to oncology drugs. Using MEDLINE/PubMed databases and snowballing, four unique records met the eligibility criteria. Results revealed that clinical outcomes were the most impacted by systemic delays in access to oncology drugs (e.g., life years lost, overall survival, and progression-free survival). The four articles retrieved by the TLR specifically illustrated that a substantial number of life years could potentially be saved by increasing systemic efficiency regarding the development, approval, and reimbursement processes of new drugs for advanced malignancies. It is imperative that initiatives are put in place to improve the performance and speed of Canadian drug regulatory and health technology assessment (HTA) processes, especially for new cancer therapeutics. The proposed solutions in this paper include better coordination between HTA and Canadian payers to harmonize coverage decisions, international collaborations, information sharing, and national standards for timeliness in oncology drug access.
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Affiliation(s)
- Sandeep Sehdev
- The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada; (S.S.); (J.G.)
| | - Joanna Gotfrit
- The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada; (S.S.); (J.G.)
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7
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Farah E, Kenney M, Kica A, Haddad P, Stewart DJ, Bradford JP. Beyond Participation: Evaluating the Role of Patients in Designing Oncology Clinical Trials. Curr Oncol 2023; 30:8310-8327. [PMID: 37754518 PMCID: PMC10527717 DOI: 10.3390/curroncol30090603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/28/2023] Open
Abstract
Historically, subject matter experts and healthcare professionals have played a pivotal role in driving oncology clinical trials. Although patients have been key participants, their deliberate and active contribution to the design and decision-making process has been limited. This scoping review aimed to examine the existing literature to scope the extent of active patient engagement in the design of oncology clinical trials and its corresponding influence on trial outcomes. We conducted a systematic search using two databases, namely MEDLINE (Ovid) and EMBASE, to identify relevant studies exploring patient engagement in cancer-related clinical research design. We identified seven studies that met the eligibility criteria. The studies highlighted the benefits of active patient involvement, such as improved recruitment strategies, and the attainment of more patient-centered trial outcomes. The influence of patient involvement varied from tangible developments like patient-friendly resources to indirect impacts like improved patient experiences and potentially higher adherence to trial intervention. The future of clinical trials should prioritize patients' values and perspectives, with regulatory bodies fostering these practices through clear guidelines. As the concept of patient centricity takes root in oncology research, the involvement of patients should evolve beyond mere participation.
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Affiliation(s)
- Eliya Farah
- Life-Saving Therapies Network, 173 Heath Street, Ottawa, ON K1H 8L6, Canada
| | - Matthew Kenney
- Life-Saving Therapies Network, 173 Heath Street, Ottawa, ON K1H 8L6, Canada
| | - Anris Kica
- Life-Saving Therapies Network, 173 Heath Street, Ottawa, ON K1H 8L6, Canada
| | - Paul Haddad
- Life-Saving Therapies Network, 173 Heath Street, Ottawa, ON K1H 8L6, Canada
| | - David J. Stewart
- Department of Medicine, Faculty of Medicine, The Ottawa Hospital, University of Ottawa, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada;
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8
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Hussain M, Wong C, Taguedong E, Verma S, Mahsin M, Karim S, Lee-Ying R, Ezeife DA. Impact of Oncology Drug Review Times on Public Funding Recommendations. Curr Oncol 2023; 30:7706-7712. [PMID: 37623039 PMCID: PMC10453657 DOI: 10.3390/curroncol30080558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/26/2023] [Accepted: 08/06/2023] [Indexed: 08/26/2023] Open
Abstract
New oncology drugs undergo detailed review prior to public funding in a single-payer healthcare system. The aim of this study was to assess how cancer drug review times impact funding recommendations. Drugs reviewed by the pan-Canadian Oncology Drug Review (pCODR) between the years 2012 and 2020 were included. Data were collected including Health Canada approval dates, initial and final funding recommendations, treatment intent, drug class, clinical indications, and incremental cost-effectiveness ratios (ICER). Univariable and multivariable analyses were used to determine the association between funding recommendations and review times. Of the 164 applications submitted, 130 received a positive final recommendation. Median time from Health Canada (HC) approval to final recommendation was longer for drugs indicated for the treatment of gastrointestinal (GI) and lung cancer compared to breast, genitourinary (GU), and other tumours (205 vs. 198 vs. 111 vs. 129 vs. 181 days, respectively; Kruskal-Wallis p = 0.0312). Drugs with longer review times were more likely to receive a negative pCODR recommendation, even when adjusting for tumour type, drug class, and intent of therapy (157 vs. 298 days; Wilcoxon p = 0.0003, OR 1.002 95% CI [1.000-1.004].). There was no association between funding recommendation and tumour type or class of drug. The exploration of factors associated with variance in review times will be important in ensuring timely patient access to cancer drugs.
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Affiliation(s)
- Marya Hussain
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada; (S.K.); (R.L.-Y.); (D.A.E.)
| | - Chelsea Wong
- Faculty of Arts, Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Eddy Taguedong
- Department of Medicine, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Saurav Verma
- London Regional Cancer Program, Department of Medical Oncology, London Health Sciences Centre, London, ON N6A 5W9, Canada;
| | - Md Mahsin
- Precision Oncology Hub, Alberta Health Services, Calgary, AB T2N 4Z6, Canada;
| | - Safiya Karim
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada; (S.K.); (R.L.-Y.); (D.A.E.)
| | - Richard Lee-Ying
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada; (S.K.); (R.L.-Y.); (D.A.E.)
| | - Doreen A. Ezeife
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada; (S.K.); (R.L.-Y.); (D.A.E.)
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Jackson EB, Simmons CE, Chia SK. Current Challenges and Disparities in the Delivery of Equitable Breast Cancer Care in Canada. Curr Oncol 2023; 30:7263-7274. [PMID: 37623008 PMCID: PMC10453522 DOI: 10.3390/curroncol30080527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
Recent exciting advances in the diagnosis and management of breast cancer have improved outcomes for Canadians diagnosed and living with breast cancer. However, the reach of this progress has been uneven; disparities in accessing care across Canada are increasingly being recognized and are at risk of broadening. Members of racial minority groups, economically disadvantaged individuals, or those who live in rural or remote communities have consistently been shown to experience greater challenges in accessing 'state of the art' cancer care. The Canadian context also presents unique challenges-vast geography and provincial jurisdiction of the delivery of cancer care and drug funding create significant interprovincial differences in the patient experience. In this commentary, we review the core concepts of health equity, barriers to equitable delivery of breast cancer care, populations at risk, and recommendations for the advancement of health equity in the Canadian cancer system.
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Affiliation(s)
- Emily B. Jackson
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Christine E. Simmons
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Stephen K. Chia
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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10
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Martins D, O’Sullivan DE, Boyne DJ, Cheung WY, Allonby O, Habash M, Brenner DR, Riemer J, McGee J. Understanding Characteristics, Treatment Patterns, and Clinical Outcomes for Individuals with Advanced or Recurrent Endometrial Cancer in Alberta, Canada: A Retrospective, Population-Based Cohort Study. Curr Oncol 2023; 30:2277-2289. [PMID: 36826137 PMCID: PMC9955469 DOI: 10.3390/curroncol30020176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Endometrial cancer (EC) incidence has increased in recent decades. However, population-based outcomes data are limited. In this retrospective cohort study, we examined characteristics, treatment patterns, and clinical outcomes, including time to next treatment (TNNT) and overall survival (OS), among advanced/recurrent (A/R) EC patients between 2010 and 2018 in Alberta, Canada. Kaplan-Meier statistics evaluated TTNT and OS, stratified by patient (A/R) and treatment. A total of 1053 patients were included: 620 (58.9%) advanced and 433 (41.1%) recurrent. A total of 713 (67.7%) patients received first-line therapy: 466 (75.2%) advanced and 247 (57.0%) recurrent. Platinum-based chemotherapy (PBCT) was the most common first-line regimen (overall: 78.6%; advanced: 96.1%; recurrent: 45.3%). The median TTNT and OS from first-line therapy were 19.9 months (95% confidence interval [CI]: 17.5-23.5) and 35.9 months (95% CI: 31.5-53.5), respectively. Following first-line PBCT, the median OS from second-line chemotherapy (N = 187) was 10.4 months (95% CI: 8.9-13.3) and higher for those rechallenged with PBCT (N = 72; 38.5%) versus no rechallenge (N = 115; 61.5%) (13.3 months [95% CI: 11.2-20.9] vs. 6.4 months [95% CI: 4.6-10.4; p < 0.001]). The findings highlight poor outcomes in A/R EC, particularly following first-line therapy, and that additional tolerable therapeutic options are needed to improve patient outcomes.
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Affiliation(s)
| | - Dylan E. O’Sullivan
- Oncology Outcomes Initiative, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Devon J. Boyne
- Oncology Outcomes Initiative, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Winson Y. Cheung
- Oncology Outcomes Initiative, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | | | | | - Darren R. Brenner
- Oncology Outcomes Initiative, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | | | - Jacob McGee
- Department of Obstetrics and Gynecology, Schulich Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
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11
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Bright K, Mills A, Bradford JP, Stewart DJ. RAPID framework for improved access to precision oncology for lethal disease: Results from a modified multi-round delphi study. FRONTIERS IN HEALTH SERVICES 2023; 3:1015621. [PMID: 36926496 PMCID: PMC10012713 DOI: 10.3389/frhs.2023.1015621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/10/2023] [Indexed: 03/03/2023]
Abstract
Introduction Predictive oncology, germline technologies, and adaptive seamless trials are promising advances in the treatment of lethal cancers. Yet, access to these therapies is stymied by costly research, regulatory barriers, and structural inequalities worsened by the COVID-19 pandemic. Methods To address the need for a comprehensive strategy for rapid and more equitable access to breakthrough therapies for lethal cancers, we conducted a modified multi-round Delphi study with 70 experts in oncology, clinical trials, legal and regulatory processes, patient advocacy, ethics, drug development, and health policy in Canada, Europe, and the US. Semi-structured ethnographic interviews (n = 33) were used to identify issues and solutions that participants subsequently evaluated in a survey (n = 47). Survey and interview data were co-analyzed to refine topics for an in-person roundtable where recommendations for system change were deliberated and drafted by 26 participants. Results Participants emphasized major issues in patient access to novel therapeutics including burdens of time, cost, and transportation required to complete eligibility requirements or to participate in trials. Only 12% of respondents reported satisfaction with current research systems, with "patient access to trials" and "delays in study approval" the topmost concerns. Conclusion Experts agree that an equity-centered precision oncology communication model should be developed to improve access to adaptive seamless trials, eligibility reforms, and just-in-time trial activation. International advocacy groups are a key mobilizer of patient trust and should be involved at every stage of research and therapy approval. Our results also show that governments can promote better and faster access to life-saving therapeutics by engaging researchers and payors in an ecosystem approach that responds to the unique clinical, structural, temporal, and risk-benefit situations that patients with life-threatening cancers confront.
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Affiliation(s)
- Kristin Bright
- Department of Anthropology, Middlebury College, Middlebury, VT, United States.,Department of Anthropology, University of Toronto, Toronto, ON, Canada
| | - Anneliese Mills
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - David J Stewart
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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12
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Cowling T, Nayakarathna R, Wills AL, Tankala D, Paul Roc N, Barakat S. Early access for innovative oncology medicines: a different story in each nation. J Med Econ 2023; 26:944-953. [PMID: 37466223 DOI: 10.1080/13696998.2023.2237336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/04/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND As innovative oncology medicines are rapidly developed, there is increasing pressure on payers to offer patients timely access to life-saving therapies. The uncertainty surrounding these therapies when phase III clinical trials are pending has necessitated new, adapted pathways to market access, with timelines that greatly vary by country. Understanding differences between pathways may identify opportunities to expedite patient access universally. OBJECTIVES To describe early access pathways for new oncology medicines among selected countries with established health technology assessment (HTA) frameworks and publicly funded health systems, with a special focus on real-world evidence (RWE). METHODS We reviewed the HTA agency websites of the selected OECD countries: National Institute for Health and Care Excellence (NICE) for England and Wales; Haute Autorité de Santé (HAS) for France; IQWiG and G-BA for Germany; Agenzia Italiana del Farmaco (AIFA) for Italy; Pharmaceutical Benefits Advisory Committee (PBAC) for Australia; and CADTH and Institut National d'Excellence en Santé et Services Sociaux (INESSS) for Canada as the primary source of evidence. RESULTS Processes for early patient access to innovative oncology therapies varied across selected countries; however, most countries have an established pathway for publicly funded early access (England and Wales, France, Germany, Italy, and Australia). The utilization of RWE to support earlier access (coverage with evidence) also varied by country, with some HTA organizations being actively engaged in these agreements (NICE, AIFA, and HAS) and others having no established processes in place (G-BA and CADTH/INESSS). CONCLUSIONS This review of early access pathways for novel oncology medicines found substantial variability between countries of interest. Coverage with evidence frameworks may provide a unique opportunity for industry and payers to collaborate on earlier access to innovative cancer therapies with life-saving potential.
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Affiliation(s)
- Tara Cowling
- Medlior Health Outcomes Research Ltd., Calgary, Canada
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13
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Kaplan A, Stewart DJ, Batist G, Spadafora S, Sehdev S, Goodman SG. Access Denied? The Unintended Consequences of Pending Drug Pricing Rules. Curr Oncol 2022; 29:2504-2508. [PMID: 35448178 PMCID: PMC9025245 DOI: 10.3390/curroncol29040204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
The government of Canada now plans to bring into force new federal drug pricing regulations on 1 July 2022. We do not take issue with the goal of medication affordability, which is vital in healthcare the world over. Our concern is that the new guidelines are being implemented without due consideration for three major unintended consequences: regulatory changes will lower the number of clinical trials for new medications in Canada, fewer clinical trials will mean lower research and development investments, and changes will reduce patients’ access to new medications. Access to effective medications is a cornerstone of healthcare for Canadian patients. As physicians, our duty to patient care demands that we tell the government to protect the right of Canadians to timely access to life-changing medicines.
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Affiliation(s)
- Alan Kaplan
- Enhanced Care Clinic, Aurora, ON L4G 1N2, Canada
- Correspondence: ; Tel.: +1-905-883-1100
| | - David J. Stewart
- Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (D.J.S.); (S.S.)
| | - Gerald Batist
- Segal Cancer Centre, Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
| | - Silvana Spadafora
- Algoma District Cancer Program, Sault Ste. Marie, ON P6B 0A8, Canada;
| | - Sandeep Sehdev
- Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (D.J.S.); (S.S.)
| | - Shaun G. Goodman
- St. Michael’s Hospital, Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada;
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14
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MacPhail C, Snow S. Not All Canadian Cancer Patients Are Equal—Disparities in Public Cancer Drug Funding across Canada. Curr Oncol 2022; 29:2064-2072. [PMID: 35323366 PMCID: PMC8947051 DOI: 10.3390/curroncol29030166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Canada lacks a national drug insurance plan. The home province or territory of a patient determines which cancer drugs are available on the public formulary, who is eligible for public coverage and what portion of the financial burden of cancer care falls to the individual. This narrative review describes the current interprovincial disparities in access to cancer drugs across Canada. Health technology assessment (HTA) of drugs at a provincial and territory level is a closed process, does not necessarily follow the recommendations of national HTA and leads to further delays in drug access. The public coverage of take-home cancer drugs (THCDs) in Ontario and the Atlantic provinces is often fragmented, unnecessarily complex and a barrier to cancer drug access. Policy solutions to address inter-provincial formulary variation and poor access to THCDs are discussed.
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Determinants of the Cancer Drug Funding Process in Canada. Curr Oncol 2022; 29:1997-2007. [PMID: 35323362 PMCID: PMC8946987 DOI: 10.3390/curroncol29030162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Canada has a publicly funded healthcare system with a complex drug funding process. After Health Canada approval to market a drug, the pan-Canadian Oncology Drug Review (pCODR) (now renamed the CADTH reimbursement review) makes a non-binding funding recommendation to the Canadian provinces (except Quebec), which each then decide whether the drug will be publicly funded. We identified the determinants of funding in this process. Methods: We analyzed drugs for advanced lung (n = 15), breast (n = 8), colorectal (CRC) (n = 7), melanoma (n = 10), and neuroendocrine (NET) (n = 3) cancers undergoing the funding decision process from 2011 to 2019. Determinants of funding assessed in the model included list price, cancer type, drug class, and pCODR recommendation. The primary outcome was the correlation between list price and time to funding (TTF: Health Canada approval to first provincial funding). Secondary outcomes included an exploratory analysis of predictors of drug funding. Results: We analyzed 43 drugs: targeted agents 72%, immunotherapy 20%, chemotherapy 7%. A total of 72% were funded in at least one province. Median TTF was 379 days (IQR 203−601). Median list price (28-day course) was CAD 8213 (IQR CAD 5391−9445). Higher list price was not correlated with TTF (correlation coefficient −0.20, p = 0.28). There was no association between list price and pCODR recommendation or the decision to fund in at least one province. A positive pCODR recommendation correlated with the provinces’ funding decisions (p < 0.001), where 89% of drugs with a positive recommendation were funded and 100% of drugs with a negative recommendation were not funded. Tumor type was predictive of TTF (p < 0.001): CRC drugs were the slowest at a median of 2541 days (IQR 702−4379), and NETs were the quickest at a median of 0 days (IQR 0−502). Cancer type predicted decision to fund in at least one province (p = 0.005), with funding for 100% of NET drugs at the high end and 29% of CRC drugs at the low end. Drug class was predictive of TTF (p = 0.01): 465 days (IQR 245−702) for targeted agents, 443 days (IQR 298−587) for chemotherapy, and 339 days (IQR 164−446) for immunotherapy. Conclusions: Determinants of drug funding included cancer type, drug class, and pCODR recommendation but not list price. Factors other than cost were more heavily weighted in the funding decisions of cancer drugs in Canadian provinces.
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16
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Sehdev S, Chambers A. Is It Time to Commit to a Process to Re-Evaluate Oncology Drugs? A Descriptive Analysis of Systemic Therapies for Solid Tumour Indications Reviewed in Canada from 2017 to 2021. Curr Oncol 2022; 29:1919-1931. [PMID: 35323356 PMCID: PMC8947363 DOI: 10.3390/curroncol29030156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 11/20/2022] Open
Abstract
We undertook an analysis of the Canadian Agency for Drugs and Technologies in Health (CADTH)’s health technology assessments (HTAs) of systemic therapies for solid tumour indications to determine if a mechanism to re-evaluate HTA decisions is needed based on the level of certainty supporting the original recommendation. To measure the certainty in the evidence, we analysed if: (1) overall survival (OS) was the primary endpoint in the pivotal trial, (2) median OS was available at the time of the recommendation, and (3) the expert review committee explicitly identified gaps in the evidence. There were 96 drugs approved by Health Canada that met our eligibility criteria between 1 January 2017 and 31 October 2021. Median OS was not estimable at the time of the recommendation in 57% of the positive recommendations, and the uncertainty in the magnitude of clinical benefit was identified by the expert review committee in 21% of the positive recommendations. There is uncertainty at the time of the HTA recommendation for many drugs, and thus a need to implement a process to re-evaluate drugs in Canada to allow patients timely access to promising therapies while ensuring long-term value of therapies to patients and the healthcare system.
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Affiliation(s)
- Sandeep Sehdev
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre and The University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Alexandra Chambers
- Novartis Pharmaceuticals Inc. Canada, Dorval, ON H9S 1A9, Canada
- Correspondence:
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17
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Vanderpuye-Orgle J, Erim D, Qian Y, Boyne DJ, Cheung WY, Bebb G, Shah A, Pericleous L, Maruszczak M, Brenner DR. Estimating the Impact of Delayed Access to Oncology Drugs on Patient Outcomes in Canada. Oncol Ther 2022; 10:195-210. [PMID: 35230672 PMCID: PMC8886863 DOI: 10.1007/s40487-022-00187-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/21/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction New requirements in Canada’s pricing processes for patented drugs may exacerbate delays in regulatory and reimbursement reviews. This study seeks to better understand the impact of any additional delays on non-small cell lung cancer (NSCLC) patients by measuring the following: (a) durations and outcomes of regulatory and reimbursement reviews of NSCLC drugs in Canada and reference countries; (b) delays in Canada’s reviews of three NSCLC drugs (nivolumab, afatinib, and pemetrexed [NAP]); and (c) estimating clinical, patient, and economic impacts of delays in Canada’s reviews on access to NAP. Methods Information from the Context Matters database and the literature (2005–2020) was used to evaluate the durations and outcomes of reimbursement reviews of NSCLC drugs in Canada and comparator countries. Public information was used to assess delays in Canada’s reviews of NAP. Empirical modeling with data from the literature and the Southern Alberta Lung Cancer database was used to estimate the impact of delays in Canada’s NAP reviews on patients (i.e., as losses in person-years of life and quality-adjusted life-years [QALYs]). Results Regulatory and reimbursement reviews in countries of interest take 12–18 months. In Canada, reviews of NSCLC drugs took 216 days (median), with a 24% rejection rate (mean = 19%). Delays in NAP reviews ranged from 5 to 94 days at Health Canada, 0–80 days at CADTH/pCODR, and 12–797 days in Canadian provinces. These delays may have affected 6400 patients, who lost up to 1740 person-years of life and 1122 QALYs (valued at CA$112 million). Conclusion Changes to Canada’s prescription drug pricing processes may prolong reviews. Supplementary Information The online version contains supplementary material available at 10.1007/s40487-022-00187-3.
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Affiliation(s)
| | - Daniel Erim
- Advanced Analytics, HEOR and RWE, Parexel International, Billerica, MA, USA
| | - Yi Qian
- Amgen Inc, Thousand Oaks, CA, USA
| | - Devon J Boyne
- Department of Oncology, University of Calgary, Calgary, AB, Canada
- Oncology Outcomes (O2) Initiative, University of Calgary, Calgary, AB, Canada
| | - Winson Y Cheung
- Department of Oncology, University of Calgary, Calgary, AB, Canada
- Oncology Outcomes (O2) Initiative, University of Calgary, Calgary, AB, Canada
| | - Gwyn Bebb
- Amgen Inc, Thousand Oaks, CA, USA
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | | | | | | | - Darren R Brenner
- Department of Oncology, University of Calgary, Calgary, AB, Canada
- Oncology Outcomes (O2) Initiative, University of Calgary, Calgary, AB, Canada
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18
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Stewart DJ, Bradford JP, Batist G. Treatment Access, Health Economics, and the Wave of a Magic Wand. Curr Oncol 2022; 29:1176-1189. [PMID: 35200599 PMCID: PMC8870945 DOI: 10.3390/curroncol29020100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
New drugs are expensive, in part due to excessive drug development costs. Governments are trying to reduce drug prices. This can delay access to effective agents. A country’s access to new drugs correlates with prices they agree to pay. After Health Canada approves a drug, the Canadian Agency for Drug and Technologies in Health (CADTH) assesses it. CADTH’s approval is usually contingent on it costing ≤CAD 50,000 per quality adjusted life year (QALY) gained. This value (unchanged from the 1970s) is inappropriately low. An inflation-adjusted CAD 50,000 1975 QALY should translate into a CAD 250,000 2021 QALY. CADTH’s target also does not consider that drug development costs have risen much faster than inflation or that new precision therapies may only be used in small populations. In a separate process, proposals from the Patented Medicines Price Review Board (PMPRB) would decrease initial Canadian drug prices by 20%, but prices would fall further as sales increased, with ultimate price reductions of up to 80%. PMPRB claims its proposal would not reduce drug access, but multiple analyses strongly suggest otherwise. Government price controls target the symptom (high prices), not the disease. They translate into shortages without solving the problem. CADTH and PMPRB approaches both threaten access to effective drugs.
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Affiliation(s)
- David J. Stewart
- Department of Medicine, Faculty of Medicine, The Ottawa Hospital, University of Ottawa, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada
- Life Saving Therapies Network, 173 Heath St., Ottawa, ON K1H 5E6, Canada;
- Correspondence: ; Tel.: +613-737-7700
| | | | - Gerald Batist
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada;
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19
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Gotfrit J, Dempster W, Chambers J, Wheatley-Price P. The Pathway for New Cancer Drug Access in Canada. Curr Oncol 2022; 29:455-464. [PMID: 35200541 PMCID: PMC8870298 DOI: 10.3390/curroncol29020041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/14/2022] [Accepted: 01/16/2022] [Indexed: 11/16/2022] Open
Abstract
Cancer treatment has evolved significantly over the past decade with the emergence of a multitude of new treatments across cancer types. Alongside the pace of drug discovery, the cost of cancer drugs has also increased. In the face of this growth in development and spending, it is crucial to have an understanding of the processes and pressures new drugs navigate to get to the market in Canada. This paper is a review of the complex, multi-step regulatory and funding process undertaken by cancer drugs in Canada. It reviews the role of Health Canada, the Patented Medicine Prices Review Board, the Health Technology Assessment, the pan-Canadian Pharmaceutical Alliance, and finally, the provincial, territorial, and federal payers. Recent developments are highlighted. Strategies to minimize duplication of effort, improve timeliness, and increase efficiency are explored. The cancer drug regulatory and funding process in Canada is complex, and an understanding of the current system and ongoing evolution is essential.
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Affiliation(s)
- Joanna Gotfrit
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1H 8L6, Canada;
- Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
| | - William Dempster
- 3Sixty Public Affairs, Ottawa, ON K2P 1P1, Canada; (W.D.); (J.C.)
| | - Johanne Chambers
- 3Sixty Public Affairs, Ottawa, ON K2P 1P1, Canada; (W.D.); (J.C.)
| | - Paul Wheatley-Price
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1H 8L6, Canada;
- Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
- Correspondence: ; Tel.: +613-737-8899 (ext. 70175)
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20
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Ho C, Lim HJ, Regier DA. FDA Accelerated Approval for Malignant Hematology and Oncology Indications in the Canadian Environment. Curr Oncol 2022; 29:402-410. [PMID: 35200536 PMCID: PMC8870743 DOI: 10.3390/curroncol29020036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Accelerated approval (AA) by the FDA enables earlier access to promising new therapies. Health Canada has a similar process. Canada implemented a national health technology assessment (HTA) for reimbursement decisions in 2011. This study evaluated regulatory and funding timelines and decisions for FDA AA cancer therapies in Canada. The FDA’s AA of malignant hematology and oncology from January 2000–December 2019 was reviewed. Dates from Health Canada, HTA decisions and provincial listings were collected. There were 94 FDA AAs, two of which were subsequently withdrawn. Of the 92 AAs, 70 received full (46)/conditional (24) Health Canada approval, and 22 were not filed. Since the introduction of HTA, 31 out of 45 of Health Canada’s approved indications underwent HTA review: 18 received a positive recommendation conditional on cost-effectiveness, 8 were not recommended and 5 were withdrawn/suspended. The median time from the AA to any Health Canada approval is 9.4 months, from any Health Canada approval to HTA decision is 5.8 months and from HTA decision to the first formulary listing is 12.0 months. The access and timeline for the first formulary listing differences were observed between the USA and Canada due to the decision of pharmaceutical companies to submit (or not) to regulatory/HTA bodies, national procedural delays with different healthcare delivery models and submission timelines. This study demonstrates that there is delayed access to promising new therapies in Canada.
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Affiliation(s)
- Cheryl Ho
- Department of Medical Oncology, BC Cancer, Vancouver, BC V5Z 4E6, Canada;
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Correspondence: ; Tel.: +1-604-877-6000 (ext. 2445); Fax: +1-604-877-0585
| | - Howard J. Lim
- Department of Medical Oncology, BC Cancer, Vancouver, BC V5Z 4E6, Canada;
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Dean A. Regier
- Cancer Control Research, BC Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada;
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
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21
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Stewart DJ, Wheatley-Price P. Randomized Clinical Trials in the Era of Precision Oncology-The Role of End Points, Industry Funding, and Medical Writing Integrity. JAMA Oncol 2021; 7:1577-1578. [PMID: 34436567 DOI: 10.1001/jamaoncol.2021.3338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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22
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Ho C, Lim HJ, Regier DA. Canadian Regulatory and Health Technology Assessment for Malignant Hematology and Oncology Indications Compared With the US Food and Drug Administration Accelerated Approval Program. JAMA Netw Open 2021; 4:e2120301. [PMID: 34379128 PMCID: PMC8358729 DOI: 10.1001/jamanetworkopen.2021.20301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This quality improvement study compares US Food and Drug Administration accelerated approvals with Canadian health and technology assessment approvals and timelines for malignant hematology and oncology treatments.
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Affiliation(s)
- Cheryl Ho
- Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Howard J. Lim
- Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dean A. Regier
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Leighl NB, Nirmalakumar S, Ezeife DA, Gyawali B. An Arm and a Leg: The Rising Cost of Cancer Drugs and Impact on Access. Am Soc Clin Oncol Educ Book 2021; 41:1-12. [PMID: 33956494 DOI: 10.1200/edbk_100028] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Increasing cancer drug prices present global challenges to treatment access and cancer outcomes. Substantial variability exists in drug pricing across countries. In countries without universal health care, patients are responsible for treatment costs. Low- or middle-income countries are heavily impacted, with limited patient access to novel cancer treatments. Financial toxicity is seen across cancer types, countries, and health care systems. Those at highest risk include younger patients, new immigrants, visible minority groups, and those without private health coverage. Currently, cancer drug pricing does not correlate with value or clinical benefit. Value-based pricing of oncology drugs may incentivize development of higher-value medicines and eliminate excess spending on drugs that yield little benefit. Generics and biosimilars in oncology can also improve affordability and patient access, offering dramatic reductions in drug spending while maintaining patient benefit. Oncologists can promote value-based care by following evidence-based clinical guidelines that avoid low-value treatments. Researchers can also engage in value-based research that critically explores optimal cancer drug dosing, schedules, and treatment duration and defines patient populations most likely to benefit (e.g., through biomarker selection). Cancer Groundshot proposes that we improve outcomes for today's patients with cancer, including broader global access for high-value treatments, promotion of affordable cancer control strategies, and reduction of cancer morbidity and mortality through low-cost prevention and screening initiatives. Moving forward, major oncology societies recommend promoting uniform global access to essential cancer medicines and avoiding financial harm for patients as key principles in addressing the affordability of cancer drugs.
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Affiliation(s)
- Natasha B Leighl
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sharon Nirmalakumar
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Doreen A Ezeife
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Bishal Gyawali
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
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