Abstract
Background
Cost-effectiveness evidence is increasingly considered in the reimbursement decisions of pharmaceuticals. In some jurisdictions such as the UK and Canada, pharmaceutical manufacturers are required to submit economic evaluations when seeking reimbursement.
Objectives
Our objectives were to describe the role of economic evidence in the cancer drug review process in Canada, and to investigate the nature of problems encountered in the review and interpretation of economic evidence used in the process.
Design
We conducted a retrospective review of cancer drug review meeting minutes and reviewers’ comments on pharmacoeconomic studies submitted to the oncology drug review process in Canada.
Data Sources
We used pharmacoeconomic reviewers’ reports and relevant cancer drug review expert advisory committee meeting minutes during the first year of the review process (April 2007 to March 2008).
Results
Fifteen economic submissions were reviewed. One-third of the studies had flaws significant enough that the advisory committee could not determine the cost effectiveness of the drugs from the results. The common issues outlined by the reviewers and committee were related to the uncertainty of comparative clinical benefits, quality of life and costs. The reviewers felt that few analyses provided sufficient sensitivity analyses around key variables to assess the robustness of results. Most problems identified by reviewers are simple to fix and do not involve advanced methods.
Conclusions
Canada has a separate review process for making cancer drug funding recommendations, and this process uses both clinical and economic evidence. The committee could not determine the value for money of the drugs from several of the submitted pharmacoeconomic analyses. Transparent analyses and detailed critique of evidence are crucial to the use of economic evidence in reimbursement decisions. Rigorous evaluation is resource intensive and may benefit from a shared drug review process among several jurisdictions.
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Acknowledgments
The Pharmacoeconomics Research Unit receives funding from CCO, which receives funding from the Ontario Ministry of Health and Long-Term Care. The views expressed and any omissions in this paper are those of the authors alone.
Author contributions
As the first author, Jean H.E. Yong designed the study, examined and abstracted data from the pharmacoeconomic reviewers’ reports and CED/CCO subcommittee meeting minutes, and analysed them. Jean H.E. Yong also wrote the draft, revised the manuscript and prepared the manuscript for publication. Jaclyn Beca contributed to subsequent revisions of this manuscript. As the senior author, Jeffrey S. Hoch conceived of the research idea, oversaw the design and data collection, reviewed the abstracted data and analysis, and contributed to subsequent revisions of this manuscript. Jean H.E. Yong is the guarantor for the content of this paper.
Conflicts of interest
No funding was received for the study and/or preparation of the paper and the authors declare no conflicts of interest.
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Yong, J.H.E., Beca, J. & Hoch, J.S. The Evaluation and Use of Economic Evidence to Inform Cancer Drug Reimbursement Decisions in Canada. PharmacoEconomics 31, 229–236 (2013). https://doi.org/10.1007/s40273-012-0022-5
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DOI: https://doi.org/10.1007/s40273-012-0022-5