Pan-Canadian Oncology Drug Review reports in 2019: Has there been a reduction in positive recommendations?
To provide collateral documentation to Ryan Clarke’s recent CCSN webinar entitled When the pan-Canadian Oncology Drug Review says “no,” then what?, CCSN commissioned a report on whether pCODR approved fewer treatments in 2019. This report was researched and written by Nigel S B Rawson, PhD, President, Eastlake Research Group, Affiliated Scholar, Canadian Health Policy Institute, and Senior Fellow of the Fraser Institute. Link to the full report is below.
Several barriers exist in Canada between a drug being given marketing approval by Health Canada and being available to patients. One of these hurdles is health technology assessment in which the benefits, risks and costs of the drug are evaluated to provide an assessment of its “value.” This is not an easy task, since it is trying to predict the future cost-effectiveness of the drug in the real world of clinical medicine based on balancing experimental data testing the medicine in a highly monitored environment in relatively few patients against a price that is unrepresentative of the cost to public and private insurers. 
When it comes to drugs intended for life-threatening diseases or those that cause significant disability, patients want timely access to such products. This is especially the case for cancer therapies. Health technology assessment of oncology drugs is performed for all cancer agencies in Canada, except Quebec’s, by the pan-Canadian Oncology Drug Review (pCODR), which is part of the Canadian Agency for Drugs and Technologies in Health (CADTH). pCODR evaluates oncology drugs based on four criteria: clinical evidence of efficacy, cost-effectiveness, alignment with patient values, and feasibility of adoption into the health system. The effectiveness of pCODR has been evaluated in 2014 and found to provide positive reimbursement recommendations to cancer agencies in around 80% of its reviews.
All positive recommendations were qualified by one or more conditions, the most frequent being the need for the drug’s cost-effectiveness to be improved to an acceptable level and the second most common being that the impact on drug plan budgets must be addressed. The principal reason for a negative recommendation was uncertainty or concern about the information in the submission regarding the drug’s clinical benefit.
The most striking result in this analysis was the difference in the rate of positive recommendations between the first and second halves of 2019. This difference could be due to the type of clinical data included in the submissions or the result of the closer alignment of pCODR with the Common Drug Review. Further analysis of pCODR’s positive recommendation rate in 2020 is warranted.
To read the report,visit pCODR 2019 Report – Nigel SB Rawson
To view Ryan’s webinar, When the pan-Canadian Oncology Drug Review says “no,” then what?, please CLICK HERE