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Improving the Efficiency of Cost-effectiveness Analysis to Inform Policy Decisions in the Real World: Lessons from the Pharmacoeconomics Research Unit at Cancer Care Ontario

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Operations Research and Health Care Policy

Part of the book series: International Series in Operations Research & Management Science ((ISOR,volume 190))

Abstract

There are important challenges in the application of using operations research (OR) and cost-effectiveness analysis (CEA) in the real world that highlight the great divide between academic research and practical application. The difficulty is magnified in cancer. Nevertheless, the potential for CEA to inform policy decisions is also great. The best estimate of a new drug’s cost-effectiveness is not knowledge for knowledge’s sake; this type of information is the foundation of accountability for the hundreds of millions of dollars being spent. In 2007, Cancer Care Ontario (CCO) established Canada’s first in-house Pharmacoeconomics Research Unit comprised of independent researchers. This chapter reviews the initial years of the Unit at CCO after briefly describing Canada’s cancer drug funding landscape. The chapter concludes by sharing lessons from the Pharmacoeconomics Research Unit’s experience and pointing out directions for future research aimed at reaching decision makers in the real world.

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Notes

  1. 1.

    It is interesting to note that the deal struck between the payer and the drug manufacturer in the UK was based on the assumption that the drug would be cost-effective in 10 years.

  2. 2.

    For example, at http://www.pcodr.ca/portal/server.pt/community/find_a_review/547/pcodr_-_find_a_review_detail_-_votrient one can see that pCODR’s first submission was deemed complete on July 21, 2011 and pCODR’s final recommendation was issued about 6 months later on January 5, 2012.

References

  1. Aaron HJ, Ginsburg PB (2009) Is health spending excessive? If so, what can we do about it? Health Aff 28:1260–1275

    Article  Google Scholar 

  2. Smith TJ, Hillner BE (2011) Bending the cost curve in cancer care. N Engl J Med 364(21):2060–2065

    Article  Google Scholar 

  3. Elkin EB, Bach PB (2010) Cancer’s next frontier: addressing high and increasing costs. JAMA 303(11):1086–1087

    Article  Google Scholar 

  4. Fojo T, Grady C (2009) How much is life worth: cetuximab, non-small cell lung cancer, and the $440 billion question. J Natl Cancer Inst 101(15):1044–1048

    Article  Google Scholar 

  5. Brown ML, Lipscomb J, Snyder C (2001) The burden of illness of cancer: economic cost and quality of life. Annu Rev Public Health 22:91–113

    Article  Google Scholar 

  6. National Heart, Lung, and Blood Institute. NHLBI Fact Book, Fiscal Year 2008 Bethesda, MD National Institutes of Health. http://www.nhlbi.nih.gov/about/factbook/FactBookFinal.pdf. Accessed 8 June 2010

  7. National Cancer Institute. Cancer trends progress report—2009/2010 update. http://progressreport.cancer.gov/doc_detail.asp?pid=1&did=2009&chid=95&coid=926&mid=

  8. Mariotto AB, Yabroff KR, Shao Y et al. (2011) Projections of the cost of cancer care in the United States: 2010–2020. J Natl Cancer Inst 103:117–128

    Article  Google Scholar 

  9. Bach PB (2009) Limits on Medicare’s ability to control rising spending on cancer drugs. N Engl J Med 360(6):626–633

    Article  Google Scholar 

  10. Neumann PJ, Weinstein MC et al. (2010) Legislating against use of cost-effectiveness information. N Engl J Med 363(16):1495–7

    Article  Google Scholar 

  11. O’Donnell JC, Pham SV, Pashos CL et al. (2009) Health technology assessment: lessons learned from around the world—an overview. Value Health Suppl 2:S1–S5

    Article  Google Scholar 

  12. Weinstein M, Zeckhauser R (1973) Critical ratios and efficient allocation. J Public Econ 2:147–158

    Article  Google Scholar 

  13. Zaric GS (2012) Cost effectiveness analysis, healthcare policy, and operations research models. In: Cochran JJ (ed) Wiley encyclopedia of operations research and management science

    Google Scholar 

  14. Laupacis A, Feeny D, Detsky AS et al. (1992) How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ 146(4):473–481

    Google Scholar 

  15. Naylor CD, Williams JI, Basinski A et al. (1993) Technology assessment and cost-effectiveness analysis: misguided guidelines? CMAJ 148(6):921–924

    Google Scholar 

  16. Khor S, Djalalova D, Hoch J (2010) The Paradox of the Laupacis Parallax. Oral presentation at the CADTH symposium. http://healtheconomics.utoronto.ca/publications-presentations Accessed 8 June 2012

  17. Hoch JS, Hodgson DC, Earle CC. Role of comparative effectiveness research in cancer funding decisions in Ontario, Canada. J Clin Oncol. 2012 Dec 1;30(34):4262–6.

    Google Scholar 

  18. Chafe R, Culyer A, Dobrow M et al. (2011) Access to cancer drugs in Canada: looking beyond coverage decisions. Healthcare Policy 6(3):27–35

    Google Scholar 

  19. Berry SR, Hubay S, Soibelman H et al. (2007) The effect of priority setting decisions for new cancer drugs on medical oncologists’ practice in Ontario: a qualitative study. BMC Health Serv Res 7:193

    Article  Google Scholar 

  20. Evidence presented to the Standing Committee on Health on Monday (2007) April 30

    Google Scholar 

  21. Tappenden P, Chilcott J, Ward S et al. (2006) Methodological issues in the economic analysis of cancer treatments. Eur J Cancer 42(17):2867–2875

    Article  Google Scholar 

  22. Baker CB, Johnsrud MT, Crismon ML, Rosenheck RA, Woods SW (2003) Quantitative analysis of sponsorship bias in economic studies of antidepressants. Br J Psychiatry 183:498–506

    Article  Google Scholar 

  23. Martin DK, Pater JL, Singer PA (2001) Priority-setting decisions for new cancer drugs: a qualitative case study. Lancet 358:1676–1681

    Article  Google Scholar 

  24. Bell CM, Urbach DR, Ray JG, Bayoumi A et al. (2006) Bias in published cost effectiveness studies: systematic review. BMJ 332(7543):699–703

    Article  Google Scholar 

  25. Leslie K (2007) Ontario won’t cover all costs of new cancer drugs. Canadian Press. Accessed 8 June 2007 http://www.colorectal-cancer.ca/en/news-and-resources/ont-cancer-drugs/

  26. Statistics Canada. www.40.statcan.ca/l01/cst01/health36.htm Accessed 8 June 2008

  27. Public Health Agency of Canada (1998) The economic burden of illness. 102

    Google Scholar 

  28. Sullivan R, Peppercorn J, Sikora K et al. (2011) Delivering affordable cancer care in high-income countries. Lancet Oncol 12(10):933–980

    Article  Google Scholar 

  29. Barbieri M, Drummond MF (2001) Conflict of interest in industry-sponsored economic evaluations: real or imagined? Curr Oncol Rep 3(5):410–413

    Article  Google Scholar 

  30. Chilcott J, McCabe C, Tappenden P et al. (2003) Modelling the cost effectiveness of interferon beta and glatiramer acetate in the management of multiple sclerosis. Commentary: evaluating disease modifying treatments in multiple sclerosis. BMJ 326(7388):522

    Google Scholar 

  31. Miners AH, Garau M, Fidan D et al. (2005) Comparing estimates of cost effectiveness submitted to the National Institute for Clinical Excellence (NICE) by different organisations: retrospective study. BMJ 330(7482):65

    Article  Google Scholar 

  32. Chauhan D, Miners AH, Fischer AJ (2007) Exploration of the difference in results of economic submissions to the National Institute of Clinical Excellence by manufacturers and assessment groups. Int J Technol Assess Health Care 23(1):96–100

    Article  Google Scholar 

  33. Claxton K, Sculpher M, McCabe C et al. (2005) Probabilistic sensitivity analysis for NICE technology assessment: not an optional extra. Health Econ 14(4):339–347

    Article  Google Scholar 

  34. Hoch J (2009) Improving efficiency and value in palliative care with net benefit regression: an introduction to a simple method for cost-effectiveness analysis with person-level data. J Pain and Sympt Manage 38(1):54–61

    Article  Google Scholar 

  35. Yong JH, Beca J, Hoch JS.The Evaluation and Use of Economic Evidence to Inform Cancer Drug Reimbursement Decisions in Canada. Pharmacoeconomics. 2013 Jan 16.[Epub ahead of print]

    Google Scholar 

  36. Khor S, Beca J, Krahn M, Hodgson D et al. (2012) Real world costs and cost-effectiveness of rituximab for diffuse large b cell lymphoma patients using registry data. Pharmacoeconomics Working Paper

    Google Scholar 

  37. ARCC (2012) The Canadian Centre for Applied Research in Cancer Control. http://www.cc-arcc.ca Accessed 8 June 2012

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Acknowledgments

This chapter has benefited from comments from Greg Zaric and an anonymous reviewer. I am grateful to Cancer Care Ontario (CCO) for funding me to develop and direct an in-house Pharmacoeconomics Research Unit comprised of independent researchers. Funding in support of this publication was provided by Cancer Care Ontario. However, the analyses, conclusions, opinions and statements expressed herein are those of the author, and not necessarily those of Cancer Care Ontario.

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Authors and Affiliations

  1. Centre for Research on Inner City Health, The Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON, Canada, M5B 1W8

    Jeffrey S. Hoch

  2. Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, Canada

    Jeffrey S. Hoch

  3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Jeffrey S. Hoch

  4. Canadian Centre for Applied Research in Cancer Control (ARCC), Toronto, ON, Canada

    Jeffrey S. Hoch

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  1. Jeffrey S. Hoch
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Correspondence to Jeffrey S. Hoch .

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Editors and Affiliations

  1. , Ivey School of Business, University of Western Ontario, London, N6A 3K7, Ontario, Canada

    Gregory S. Zaric

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Hoch, J.S. (2013). Improving the Efficiency of Cost-effectiveness Analysis to Inform Policy Decisions in the Real World: Lessons from the Pharmacoeconomics Research Unit at Cancer Care Ontario. In: Zaric, G. (eds) Operations Research and Health Care Policy. International Series in Operations Research & Management Science, vol 190. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6507-2_18

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