Author
Nigel SB Rawson, Ph.D.
Background
Timely and unhindered access to recommended drugs for the treatment of cancer is expected by Canadians. However, Canada has been described as one of the countries with the most restricted access to publically-funded cancer drugs, with inter-provincial differences in oncology drug reimbursement being of serious concern to patients and oncologists.
Objective
The aim of this analysis is to estimate the number of potential patients impacted by provincial drug insurance coverage delays for a number of selected oncology drugs approved between 2010 and 2013 and the associated economic cost of these delays.
Methods
Fourteen oncology drugs indicated for the treatment of metastatic solid tumours approved by Health Canada between 2010 and 2013 were used in the evaluation. Notice of Compliance (NOC) dates were obtained from Health Canada’s website. Dates of submission to the pan-Canadian Oncology Drug Review (pCODR), its recommendations and provincial listing information were obtained from the pCODR website. Information on each drug’s benefit was obtained from the pivotal randomized clinical trial performed for marketing approval. The evaluation focused on delays in listing for reimbursement introduced by pharmaceutical companies failing to submit their application to pCODR during the 180-day allowable period before the anticipated NOC date (company delay), the HTA performed by pCODR (pCODR delay) and delays between pCODR recommendation and provincial listings (provincial delay). The number of patients potentially impacted by each type of delay for each drug was calculated by multiplying the estimated daily number of newly-diagnosed metastatic patients by the number of days in the relevant reimbursement delay period. The number of patient-years lost was estimated by multiplying the number of patients by the median difference from the relevant clinical trial and annualizing the health impact. Estimated costs of each delay were calculated using three conservative estimates of the value of a life-year.
Results
The total estimated number of patients potentially negatively impacted by delayed access to the 14 oncology drugs indicated for metastasized solid tumours in the nine pCODR provinces at the end of March 2016 was over 25,000. Based on the efficacy demonstrated in randomized clinical trials, the middle estimated cost of the delays was $238 million, with lower and upper estimates of over $176 million and more than $793 million.
Conclusion
Most of the survival gains in the treatment of cancer are attributable to improved drug treatments. However, new drugs are only of value to patients if they can access them in a timely manner. This analysis has demonstrated the need for more timely access to effective oncology treatments in Canada.
