Rocchi Angela, Mills Fergal
Athena Research.
J Popul Ther Clin Pharmacol. 2018 Aug 7;25(2):e12-e22. doi: 10.22374/1710-6222.25.2.2.
The pan-Canadian Pharmaceutical Alliance (pCPA) was established in 2010 to negotiate confidential prices for drugs coming forward from Canada's centralized health technology assessment (HTA) agency reviews, on behalf of the participating public drug plans.
To analyze the activities of the pCPA, to determine: alignment of HTA agency recommendations and pCPA negotiation decisions; the role of health economics in pCPA activities; and patterns of implicit prioritization.
The analysis was based on the archive of drugs handled through the pCPA, as posted on its website. The period of observation was from inception to August 31, 2017. HTA recommendations were sourced from the websites of the Common Drug Review (CDR) and the pan-Canadian Oncology Drug Review. Descriptive and statistical analyses were conducted.
The dataset contained 206 drug-indication pairings. There was close but imperfect alignment between HTA agency recommendations and the pCPA's decisions to negotiate; deviations occurred only with CDR-reviewed drugs. The median incremental cost-effectiveness ratio of negotiated drugs was $168K/QALY for oncology drugs, but $70K/QALY for non-oncology drugs. The time to initiate negotiations was dramatically shorter for oncology versus non-oncology drugs (mean 54 versus 263 days), and also differed between therapeutic areas at CDR. The time required for PCPA activity was surprisingly similar for drugs recommended without a price condition and for those conditional on a price reduction.
These findings revealed a strong alignment between HTA recommendations and pCPA negotiations, an implicit prioritization favouring oncology drug negotiations, and an evolving role for health economics in Canada's reimbursement process.
泛加拿大药品联盟（pCPA）成立于2010年，旨在代表参与的公共药品计划，就加拿大中央卫生技术评估（HTA）机构审查提出的药品谈判保密价格。
分析pCPA的活动，以确定：HTA机构建议与pCPA谈判决定的一致性；卫生经济学在pCPA活动中的作用；以及隐性优先排序模式。
分析基于pCPA网站上公布的通过该联盟处理的药品档案。观察期从成立至2017年8月31日。HTA建议来自通用药品审查（CDR）和泛加拿大肿瘤药品审查的网站。进行了描述性和统计分析。
数据集包含206种药物-适应症配对。HTA机构建议与pCPA的谈判决定之间存在密切但不完全的一致性；仅在CDR审查的药物中出现偏差。谈判药品的中位增量成本效益比，肿瘤药物为每质量调整生命年16.8万美元，而非肿瘤药物为每质量调整生命年7万美元。与非肿瘤药物相比，肿瘤药物启动谈判的时间显著更短（平均54天对263天），CDR各治疗领域之间也存在差异。对于无价格条件推荐的药物和有降价条件的药物，PCPA活动所需时间惊人地相似。
这些发现揭示了HTA建议与pCPA谈判之间的高度一致性、有利于肿瘤药物谈判的隐性优先排序，以及卫生经济学在加拿大报销过程中不断演变的作用。
