PHP108 - Consistency In Reimbursement Decisions At Canadian Hta Agencies: Inesss Versus Cdr

Abstract

To compare the positive recommendation rate and agreement between CDR and INESSS. In Canada, eligible non-cancer prescription drugs approved by Health Canada are reviewed by 2 health technology assessment (HTA) agencies: the Common Drug Review (CDR) and the Institute national d’excellence en santé et en services sociaux (INESSS). CDR is part of the Canadian Agency for Drugs and Technologies in Health (CADTH), which makes reimbursement recommendations that are considered by provincial and federal plans, with the exception of Quebec, in making their formulary coverage decisions. In Quebec INESSS performs HTA and issues recommendations to the Regie d’assurance maladie Quebec (RAMQ). Prior to INESSS, HTA in Quebec was performed by the Conseil du Médicaments (CdM). Using our proprietary CDR Tracker®database we examined the recommendations by both agencies and compared recommendation positivity and congruence for all drugs which have been reviewed by CDR, up to December 31, 2013. We separately considered positive and negative recommendations by both agencies. The overall positivity rate for CDR recommendations in this period was 52%, compared to 66.9% for INESSS. Of the 275 recommendations issued by CDR, 143 were negative and INESSS agreed with CDR in 90% of these recommendations. 132 of CDR’s recommendations were negative, of which INESSS agreed in 48% of cases. INESSS has a higher positive recommendation rate and, possibly due to the broader scope for funding recommendations, frequently disagrees with CDR’s analysis, particularly when CDR’s recommendation is negative.