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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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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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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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Hollis A. An Optional Delinked Reward System: Making Pharmaceutical Innovation Work for Everyone. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:155-164. [PMID: 38133844 DOI: 10.1007/s40258-023-00860-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
Conflicts over pharmaceutical pricing are driven by the patients' need for affordable medicines and the producer's reward for the investments in developing innovative medicines. A single price cannot achieve both goals, as it will either obstruct access by patients or provide too low a return to investors. This has led to calls to "delink" the payment for innovation from the price paid for drugs, so that both goals can be met efficiently and without conflict. However, the details of how best to do that are unclear. This paper proposes a specific implementation for delinking the Optional Delinked Reward System (ODRS), which integrates ideas from numerous pharmaceutical reimbursement systems. The ODRS would allow firms to choose either to negotiate a sales price for a drug (as is the current practice in most countries) or to sell their drug at a low "generic" price with a supplementary "delinked" reward based on assessed health benefit. This model builds on recent innovations in drug reimbursement including the UK's Antibiotic Subscription Pilot and the Pneumococcal Vaccine Advanced Market Commitment. The ODRS would ensure affordable and immediate access for patients and a fair reward for innovators.
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Affiliation(s)
- Aidan Hollis
- Department of Economics, University of Calgary, Calgary, Canada.
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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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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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