Factors Influencing Coverage Decisions for New Cancer Drugs in Canada

Presenter: Roger Chafe, Cancer Care Ontario (Canada)

Abstract

Background: This presentation presents some of the initial findings of a three-year research project looking at variations in cancer drug coverage in Canada. In Canada, funding decisions around pharmaceutics, including for new cancer drugs, are made individually by the ten provinces. While there recently have been efforts to harmonize the review of cancer drugs, particularly through the establishment of the national Joint Oncology Drug Review, variations in coverage still exist across the provinces. Yet presumably, decision makers in different provinces have access to the same evidence and cost-effectiveness reviews.

Research Question: What are the factors which lead decision makers in different jurisdictions to different coverage conclusions based on similar clinical and economic evidence?

Methods: Using key informant interviews with providers and decision makers in three provinces - British Columbia, Ontario, and Newfoundland - and document analysis, the project team has determined some of the factors which led to positive and/or negative coverage decisions for three cancer drugs: trastuzumab (Herceptin); docetaxel (Taxotere); bevicizumab (Avastin).

Results: The presentation will 1) review the factors associated with positive and negative coverage decisions for selected cancer drugs, 2) discuss the impact of cost-effectiveness evidence on these coverage decisions and 3) present a decision making framework to assist decision makers making coverage decisions for cancer drugs.