Canadian Centre for Applied Research in Cancer Control.
British Columbia Cancer Agency.
Int J Technol Assess Health Care. 2017 Jan;33(4):481-486. doi: 10.1017/S0266462317000642. Epub 2017 Sep 5.
The Priorities and Evaluation Committee (PEC) funding recommendations for new cancer drugs in British Columbia, Canada have been based on both clinical and economic evidence. The British Columbia Ministry of Health makes funding decisions. We assessed the association between cost-effectiveness of cancer drugs considered from 1998 to 2008 and the subsequent funding decisions.
All proposals submitted to the PEC between 1998 and 2008 were reviewed, and the association between cost-effectiveness and funding decisions was examined by (i) using logistic regression to test the hypothesis that interventions with higher incremental cost-effectiveness ratios (ICERs) have a lower probability of receiving a positive funding decision and (ii) using parametric and nonparametric tests to determine if a statistically significant difference exists between the mean cost-effectiveness of funded versus not funded proposals. A sub-analysis was conducted to determine if the findings varied across different outcome measures.
Of the 149 proposals reviewed, 78 reported cost-effectiveness using various outcome measures. In the proposals that used life-years gained as the outcome (n = 22), a statistically significant difference of nearly $115,000 was observed between the mean ICERs for funded proposals ($42,006) and for unfunded proposals ($156,967). An odds ratio indicating higher ICERs have a lower probability of being funded was also found to be statistically significant (p < .05).
Economic evidence appears to play a role in British Columbia cancer funding decisions from 1998 to 2008; other decision-making criteria may also have an important role in recommendations and subsequent funding decisions.
加拿大不列颠哥伦比亚省的优先事项和评估委员会（PEC）对新癌症药物的资金建议是基于临床和经济证据。不列颠哥伦比亚省卫生部做出资金决策。我们评估了 1998 年至 2008 年期间考虑的癌症药物的成本效益与其后续资金决策之间的关联。
对 1998 年至 2008 年期间提交给 PEC 的所有提案进行了审查，并通过以下方法检查了成本效益与资金决策之间的关联：（i）使用逻辑回归检验假设，即具有较高增量成本效益比（ICER）的干预措施获得积极资金决策的可能性较低；（ii）使用参数和非参数检验确定资金和未资金提案的平均成本效益之间是否存在统计学上显著差异。进行了一项亚分析，以确定研究结果是否因不同的结果衡量标准而有所不同。
在审查的 149 项提案中，有 78 项使用各种结果衡量标准报告了成本效益。在使用所获得的生命年来衡量结果的提案中（n=22），对于已获资金提案（$42,006）和未获资金提案（$156,967），平均 ICER 之间观察到近 115,000 美元的统计学显著差异。还发现，指示较高 ICER 的可能性较低的优势比在统计学上也具有显著性（p<.05）。
1998 年至 2008 年，经济证据似乎在不列颠哥伦比亚省癌症资金决策中发挥了作用；其他决策标准在建议和随后的资金决策中也可能具有重要作用。
