Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada.
Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada.
Curr Oncol. 2022 Mar 15;29(3):1997-2007. doi: 10.3390/curroncol29030162.
Background: Canada has a publicly funded healthcare system with a complex drug funding process. After Health Canada approval to market a drug, the pan-Canadian Oncology Drug Review (pCODR) (now renamed the CADTH reimbursement review) makes a non-binding funding recommendation to the Canadian provinces (except Quebec), which each then decide whether the drug will be publicly funded. We identified the determinants of funding in this process. Methods: We analyzed drugs for advanced lung (n = 15), breast (n = 8), colorectal (CRC) (n = 7), melanoma (n = 10), and neuroendocrine (NET) (n = 3) cancers undergoing the funding decision process from 2011 to 2019. Determinants of funding assessed in the model included list price, cancer type, drug class, and pCODR recommendation. The primary outcome was the correlation between list price and time to funding (TTF: Health Canada approval to first provincial funding). Secondary outcomes included an exploratory analysis of predictors of drug funding. Results: We analyzed 43 drugs: targeted agents 72%, immunotherapy 20%, chemotherapy 7%. A total of 72% were funded in at least one province. Median TTF was 379 days (IQR 203−601). Median list price (28-day course) was CAD 8213 (IQR CAD 5391−9445). Higher list price was not correlated with TTF (correlation coefficient −0.20, p = 0.28). There was no association between list price and pCODR recommendation or the decision to fund in at least one province. A positive pCODR recommendation correlated with the provinces’ funding decisions (p < 0.001), where 89% of drugs with a positive recommendation were funded and 100% of drugs with a negative recommendation were not funded. Tumor type was predictive of TTF (p < 0.001): CRC drugs were the slowest at a median of 2541 days (IQR 702−4379), and NETs were the quickest at a median of 0 days (IQR 0−502). Cancer type predicted decision to fund in at least one province (p = 0.005), with funding for 100% of NET drugs at the high end and 29% of CRC drugs at the low end. Drug class was predictive of TTF (p = 0.01): 465 days (IQR 245−702) for targeted agents, 443 days (IQR 298−587) for chemotherapy, and 339 days (IQR 164−446) for immunotherapy. Conclusions: Determinants of drug funding included cancer type, drug class, and pCODR recommendation but not list price. Factors other than cost were more heavily weighted in the funding decisions of cancer drugs in Canadian provinces.
加拿大拥有公共资助的医疗体系，其药品资助流程较为复杂。在药品获得加拿大卫生部批准上市后，加拿大全加肿瘤药物评审（pCODR）（现更名为 CADTH 报销评审）会向加拿大除魁北克省外的其他省份提出非约束性的资助建议，随后由各省份自行决定是否对该药品进行公共资助。我们确定了这一过程中的资助决定因素。方法：我们分析了在 2011 年至 2019 年间接受资助决策流程的 15 种晚期肺癌、8 种晚期乳腺癌、7 种晚期结直肠癌、10 种晚期黑色素瘤和 3 种晚期神经内分泌瘤药物。模型中评估的资助决定因素包括标价、癌症类型、药物类别和 pCODR 建议。主要结局是标价与资助时间（从加拿大卫生部批准到首次省级资助的时间，TTF）之间的相关性。次要结局包括对药物资助预测因素的探索性分析。结果：我们共分析了 43 种药物：靶向药物占 72%，免疫疗法占 20%，化疗药物占 7%。共有 72%的药物在至少一个省份获得了资助。中位 TTF 为 379 天（IQR 203-601）。中位标价（28 天疗程）为 CAD8213（IQR CAD5391-9445）。标价与 TTF 无相关性（相关系数-0.20，p=0.28）。标价与 pCODR 建议或至少在一个省份资助的决定之间没有关联。pCODR 建议呈阳性与各省份的资助决定相关（p<0.001），其中 89%的阳性建议药物获得了资助，100%的阴性建议药物未获得资助。肿瘤类型是 TTF 的预测因素（p<0.001）：结直肠癌药物中位 TTF 最长，为 2541 天（IQR 702-4379），神经内分泌瘤药物中位 TTF 最短，为 0 天（IQR 0-502）。癌症类型是决定至少在一个省份资助的预测因素（p=0.005），神经内分泌瘤药物的资助率为 100%，结直肠癌药物的资助率为 29%。药物类别是 TTF 的预测因素（p=0.01）：靶向药物的 TTF 中位值为 465 天（IQR 245-702），化疗药物的 TTF 中位值为 443 天（IQR 298-587），免疫治疗药物的 TTF 中位值为 339 天（IQR 164-446）。结论：药物资助的决定因素包括癌症类型、药物类别和 pCODR 建议，但不包括标价。在加拿大各省的癌症药物资助决策中，成本以外的因素的权重更大。
