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Takhar P, Geirnaert M, Gavura S, Beca J, Mercer RE, Denburg A, Muñoz C, Tadrous M, Parmar A, Dionne F, Boehm D, Chambers C, Craig E, Trudeau M, Cheung MC, Houlihan J, McDonald V, Pechlivanoglou P, Taylor M, Wasylenko E, Wranik WD, Chan KKW. Application of Multi-Criteria Decision Analysis (MCDA) to Prioritize Real-World Evidence Studies for Health Technology Management: Outcomes and Lessons Learned by the Canadian Real-World Evidence for Value of Cancer Drugs (CanREValue) Collaboration. Curr Oncol 2024; 31:1876-1898. [PMID: 38668044 PMCID: PMC11049582 DOI: 10.3390/curroncol31040141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/09/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
Multi-criteria decision analysis (MCDA) is a value assessment tool designed to help support complex decision-making by incorporating multiple factors and perspectives in a transparent, structured approach. We developed an MCDA rating tool, consisting of seven criteria evaluating the importance and feasibility of conducting potential real-world evidence (RWE) studies aimed at addressing uncertainties stemming from initial cancer drug funding recommendations. In collaboration with the Canadian Agency for Drugs and Technologies in Health's Provincial Advisory Group, a validation exercise was conducted to further evaluate the application of the rating tool using RWE proposals varying in complexity. Through this exercise, we aimed to gain insight into consensus building and deliberation processes and to identify efficiencies in the application of the rating tool. An experienced facilitator led a multidisciplinary committee, consisting of 11 Canadian experts, through consensus building, deliberation, and prioritization. A total of nine RWE proposals were evaluated and prioritized as low (n = 4), medium (n = 3), or high (n = 2) priority. Through an iterative process, efficiencies and recommendations to improve the rating tool and associated procedures were identified. The refined MCDA rating tool can help decision-makers prioritize important and feasible RWE studies for research and can enable the use of RWE for the life-cycle evaluation of cancer drugs.
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Affiliation(s)
- Pam Takhar
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada; (P.T.); (S.G.); (J.B.); (R.E.M.); (C.M.)
| | | | - Scott Gavura
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada; (P.T.); (S.G.); (J.B.); (R.E.M.); (C.M.)
| | - Jaclyn Beca
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada; (P.T.); (S.G.); (J.B.); (R.E.M.); (C.M.)
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada
| | - Rebecca E. Mercer
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada; (P.T.); (S.G.); (J.B.); (R.E.M.); (C.M.)
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada
- Evaluative Clinical Services, Sunnybrook Research Institute, Toronto, ON M4N 3M3, Canada;
| | - Avram Denburg
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Caroline Muñoz
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada; (P.T.); (S.G.); (J.B.); (R.E.M.); (C.M.)
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada;
- Women’s College Hospital, Toronto, ON M5S 1B2, Canada
| | - Ambica Parmar
- Division of Medical Oncology & Hematology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M3, Canada; (A.P.); (M.T.)
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | | | - Darryl Boehm
- Saskatchewan Cancer Agency, Regina, SK S4W 0G3, Canada;
| | | | - Erica Craig
- New Brunswick Cancer Network, Fredericton, NB E3B 5G8, Canada;
| | - Maureen Trudeau
- Division of Medical Oncology & Hematology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M3, Canada; (A.P.); (M.T.)
| | - Matthew C. Cheung
- Evaluative Clinical Services, Sunnybrook Research Institute, Toronto, ON M4N 3M3, Canada;
- Division of Medical Oncology & Hematology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M3, Canada; (A.P.); (M.T.)
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | | | - Valerie McDonald
- Independent Patient Representative, Toronto, ON M6G 2V3, Canada;
| | - Petros Pechlivanoglou
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | | | - Eric Wasylenko
- Department of Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada;
- John Dossetor Health Ethics Centre, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - Wiesława Dominika Wranik
- Department of Public and International Affairs, Faculty of Management, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Kelvin K. W. Chan
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada; (P.T.); (S.G.); (J.B.); (R.E.M.); (C.M.)
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada
- Evaluative Clinical Services, Sunnybrook Research Institute, Toronto, ON M4N 3M3, Canada;
- Division of Medical Oncology & Hematology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M3, Canada; (A.P.); (M.T.)
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
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Access to Cancer Drugs in Canada. Curr Oncol 2022; 29:7583-7586. [PMID: 36290875 PMCID: PMC9600617 DOI: 10.3390/curroncol29100598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/10/2022] [Indexed: 01/13/2023] Open
Abstract
Lung cancer, because of the multiple subtypes now identifiable and because of the myriad of new and effective therapies, provides fertile ground to highlight issues related to oncology drug access in Canada [...].
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Dai WF, Beca JM, Nagamuthu C, Liu N, de Oliveira C, Earle CC, Trudeau M, Chan KKW. Cost-effectiveness Analysis of Pertuzumab With Trastuzumab in Patients With Metastatic Breast Cancer. JAMA Oncol 2022; 8:597-606. [PMID: 35201264 PMCID: PMC8874900 DOI: 10.1001/jamaoncol.2021.8049] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE The initial assessment of pertuzumab use for treatment of metastatic breast cancer by health technology assessment agencies suggested that pertuzumab was not cost-effective. In Ontario, Canada, pertuzumab became funded in November 2013 based on the substantial clinical benefit. To date, there is a paucity of analysis of pertuzumab using real-world data for cost-effectiveness. OBJECTIVE To assess the cost-effectiveness of pertuzumab, trastuzumab, and chemotherapy vs trastuzumab and chemotherapy for patients with metastatic breast cancer. DESIGN, SETTING, AND PARTICIPANTS A population-based retrospective economic evaluation was conducted in Ontario, Canada. Patients who received first-line treatments for metastatic breast cancer from January 1, 2008, to March 31, 2018, were identified. Patients were followed up from the start of treatment up to 5 years, with maximum follow-up to March 31, 2019. Patients were identified from the Ontario Cancer Registry and linked to the New Drug Funding Program database to identify receipt of first-line treatment (N = 1158). INTERVENTIONS Treatment with pertuzumab, trastuzumab, and chemotherapy after public funding (November 25, 2013) compared with treatment with trastuzumab and chemotherapy before funding. MAIN OUTCOMES AND MEASURES Cost-effectiveness, from a public payer perspective, was estimated from administrative data with a 5-year time horizon, adjusted for censoring, and discounted (1.5%). Incremental cost-effectiveness ratios for life-years gained and quality-adjusted life year (QALY) with bootstrapped 95% CIs were calculated. Sensitivity analysis with price reduction of pertuzumab alone or in combination with trastuzumab was conducted. RESULTS A total of 579 pairs of matched patients receiving pertuzumab and controls were included. The mean (SD) age of the matched study cohort was 58 (12.97) years; 1151 were women (99.4%). Pertuzumab resulted in 0.61 life-years gained and 0.44 QALYs gained at an incremental cost of $192 139 (all costs measured in Canadian dollar values, CAD) with an incremental cost-effectiveness ratio of $316 203 per life-year gained and $436 679 per QALY. The main factors associated with cost included the cost of pertuzumab (60%), outpatient cancer treatment delivery (24%), and trastuzumab (15%). With 100% price reduction of pertuzumab, the incremental cost-effectiveness ratio was $174 027 per QALY. When the price of pertuzumab and trastuzumab were both reduced by more than 71%, the incremental cost-effectiveness ratio decreased below $100 000 per QALY. CONCLUSIONS AND RELEVANCE The findings of this population-based study suggest that pertuzumab may increase survival for patients with metastatic breast cancer but would not be considered cost-effective, even after 100% price reduction, under conventional thresholds.
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Affiliation(s)
- Wei Fang Dai
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
| | - Jaclyn M. Beca
- Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada,Ontario Health, Ontario, Canada
| | | | | | - Claire de Oliveira
- ICES, Ontario, Canada,Centre for Health Economics and Hull York Medical School, University of York, York, United Kingdom
| | | | | | - Kelvin K. W. Chan
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada,Ontario Health, Ontario, Canada,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Mapping Canadian Data Assets to Generate Real-World Evidence: Lessons Learned from Canadian Real-World Evidence for Value of Cancer Drugs (CanREValue) Collaboration’s RWE Data Working Group. Curr Oncol 2022; 29:2046-2063. [PMID: 35323365 PMCID: PMC8947246 DOI: 10.3390/curroncol29030165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/02/2022] [Accepted: 03/11/2022] [Indexed: 11/16/2022] Open
Abstract
Canadian provinces routinely collect patient-level data for administrative purposes. These real-world data (RWD) can be used to generate real-world evidence (RWE) to inform clinical care and healthcare policy. The CanREValue Collaboration is developing a framework for the use of RWE in cancer drug funding decisions. A Data Working Group (WG) was established to identify data assets across Canada for generating RWE of oncology drugs. The mapping exercise was conducted using an iterative scan with informant surveys and teleconference. Data experts from ten provinces convened for a total of three teleconferences and two in-person meetings from March 2018 to September 2019. Following each meeting, surveys were developed and shared with the data experts which focused on identifying databases and data elements, as well as a feasibility assessment of conducting RWE studies using existing data elements and resources. Survey responses were compiled into an interim data report, which was used for public stakeholder consultation. The feedback from the public consultation was used to update the interim data report. We found that databases required to conduct real-world studies are often held by multiple different data custodians. Ninety-seven databases were identified across Canada. Provinces held on average 9 distinct databases (range: 8–11). An Essential RWD Table was compiled that contains data elements that are necessary, at a minimal, to conduct an RWE study. An Expanded RWD Table that contains a more comprehensive list of potentially relevant data elements was also compiled and the availabilities of these data elements were mapped. While most provinces have data on patient demographics (e.g., age, sex) and cancer-related variables (e.g., morphology, topography), the availability and linkability of data on cancer treatment, clinical characteristics (e.g., morphology and topography), and drug costs vary among provinces. Based on current resources, data availability, and access processes, data experts in most provinces noted that more than 12 months would be required to complete an RWE study. The CanREValue Collaboration’s Data WG identified key data holdings, access considerations, as well as gaps in oncology treatment-specific data. This data catalogue can be used to facilitate future oncology-specific RWE analyses across Canada.
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Simpson A, Ramagopalan SV. R WE ready for reimbursement? A round up of developments in real-world evidence relating to health technology assessment: part 6. J Comp Eff Res 2022; 11:473-475. [PMID: 35261285 DOI: 10.2217/cer-2022-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In this latest update we highlight recent publications from the US FDA and a Canadian Health Technology Assessment collaboration which provide insights into the future role of real-world evidence in market access in terms of health technology management.
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Affiliation(s)
- Alex Simpson
- Global Access, F Hoffmann-La Roche, Basel, Switzerland
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Dai WF, Craig E, Fraser B, Chambers A, Mai H, Brown MB, Earle CC, Evans WK, Geirnaert M, Taylor M, Trudeau M, Sperber D, Beca JM, Denburg A, Mercer RE, Parmar A, Tadrous M, Takhar P, Chan KKW. Building a National Reassessment Process for Oncology Drugs: Lessons Learned by the Canadian Real-World Evidence for Value of Cancer Drugs (CanREValue) Collaboration through a Simulated Reassessment Exercise. Curr Oncol 2021; 28:4645-4654. [PMID: 34898572 PMCID: PMC8628679 DOI: 10.3390/curroncol28060392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
The CanREValue Collaboration established the Reassessment & Uptake Working Group to develop a preliminary process to reassess funded cancer drugs in Canada. A simulated exercise was conducted to evaluate the proposed reassessment process using a real-world case. We invited 32 attendees including representatives from Health Canada and Health Technology Assessment (HTA) agencies, along with payers, clinicians, academics, and patient representatives. A case was developed using a real-world study on a publicly funded cancer drug. In facilitated group sessions, participants were asked to deliberate upon the evidence presented in the case to issue reassessment recommendations. Several themes were identified through the deliberation discussions. While the generalizability of real-world evidence (RWE) is perceived as a strength, trust in the RWE depends largely on the source of the real-world data. The attendees suggested several improvements to the proposed reassessment process including evidence requirement for reassessment, recommendation categories, and a priori study protocols. This exercise generated important insights on the evidence required for conducting reassessment and considerations for improvements of the proposed reassessment process. Building upon lessons from this exercise, future work would continue to refine the reassessment process as part of the overall CanREValue framework.
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Affiliation(s)
- Wei Fang Dai
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada;
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
| | - Erica Craig
- New Brunswick Cancer Network, Fredericton, NB E3B 5G8, Canada;
| | - Brent Fraser
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON K1S 5S8, Canada; (B.F.); (A.C.); (H.M.)
| | - Alex Chambers
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON K1S 5S8, Canada; (B.F.); (A.C.); (H.M.)
| | - Helen Mai
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON K1S 5S8, Canada; (B.F.); (A.C.); (H.M.)
| | - M. Bryson Brown
- Philosophy Department, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada;
| | - Craig C. Earle
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (C.C.E.); (M.T.); (A.P.)
| | - William K. Evans
- Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada;
- Ontario Health (CCO), Toronto, ON M5G 2L3, Canada;
| | | | | | - Maureen Trudeau
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (C.C.E.); (M.T.); (A.P.)
| | - Daniel Sperber
- Pan-Canadian Pharmaceutical Alliance, Toronto, ON M5S 2B1, Canada;
| | - Jaclyn M. Beca
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
- Ontario Health (CCO), Toronto, ON M5G 2L3, Canada;
| | - Avram Denburg
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Rebecca E. Mercer
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
- Ontario Health (CCO), Toronto, ON M5G 2L3, Canada;
| | - Ambica Parmar
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (C.C.E.); (M.T.); (A.P.)
| | - Mina Tadrous
- Women’s College Hospital, Toronto, ON M53 1B2, Canada;
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M53 3M2, Canada
| | - Pam Takhar
- Ontario Health (CCO), Toronto, ON M5G 2L3, Canada;
| | - Kelvin K. W. Chan
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada;
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
- Ontario Health (CCO), Toronto, ON M5G 2L3, Canada;
- Correspondence: ; Tel.: +1-416-480-4928
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