PCN143 - Pcodr – the pointless canadian oncology drug review?

Abstract

The pan-Canadian Oncology Drug Review (pCODR) was established in 2010 to appraise oncology drugs in order to help guide provincial reimbursement decision-making. pCODR is currently being transferred to Canadian Agency for Drugs and Technologies in Health (CADTH) offering the opportunity for reform. This research aims to measure the impact of this process on access to oncology drugs in Canada and compare this with Quebec, which does not refer to pCODR. All published pCODR and Institut national d’excellence en santé et en services sociaux (INESSS, the Quebec Health Technology Assessment body) reports were identified alongside pCODR provincial funding summaries up to 30 September 2014 and the dates, decision, and key rationale were extracted. All statistical comparisons were made using ANOVA and t-tests. Most (62% [21/34]) pCODR recommendations were conditional on cost-effectiveness being demonstrated (20% recommended, 18% not recommended). Following pCODR recommendations, an average of 6.7 months from submission, there is an additional average 8.9 month delay for provincial funding decision-making. The time required for provincial decision making was no faster for drugs recommended by pCODR versus those conditional on acceptable cost-effectiveness (9.3 vs. 9.3 months, p=0.49). INESSS issued recommendations for these corresponding oncology drugs an average of only 2.1 months after pCODR, 6.8 months before the other provinces, a difference which is statistically significant (p=0.0013). Given that the key issue for most candidate oncologics facing reimbursement is cost-effectiveness, pCODR issuing large numbers of recommendations conditional on cost-effectiveness being demonstrated adds a time-consuming step that does not speed provincial decision making. INESSS, operating independently to pCODR, issue recommendations significantly sooner than other provinces. Based on this, we recommend that acceptable pCODR cost-effectiveness be a mandatory requirement prior to provincial consideration or that the pCODR process be curtailed into just providing a clinical benefit assessment.