A descriptive analysis of clinician input and feedback into the CADTH pan-Canadian Oncology Drug Review process.

Abstract

42 Background: In Canada, through the pan-Canadian Oncology Drug Review (pCODR) process, CADTH conducts evaluations of clinical, economic, and patient evidence on cancer drugs to provide public reimbursement recommendations. The pCODR Expert Review Committee (pERC) makes these recommendations based on a drug’s overall clinical benefit, alignment with patient values, cost-effectiveness, and feasibility of adoption into the health system. Methods: In February 2016, pCODR launched a pilot process that allowed eligible clinicians (individually or as groups) not directly involved in the reviews to participate in the pCODR process, to provide: (1) input at the outset of a review; and, (2) feedback on the Initial Recommendation made by the pERC. Eligible clinicians are those who: (1) are actively practising physicians; (2) are members of a provincial cancer agency or similar body or a national cancer organization; and, (3) submit a declaration of conflict of interest. Results: As of March 31, 2018, 177 oncologists have registered to participate in the pCODR process. Of 43 submissions, 38 (88%) included clinician input. Fifteen submissions received individual input, and 33 received group input, the latter involving three to 13 clinicians or groups. Between April 2016 and March 2018, clinician input by tumour type was as follows: lung (n = 8), leukemia (n = 5), lymphoma (n = 5), gastrointestinal (n = 5), myeloma (n = 4), breast (n = 3), melanoma (n = 2), gynecological (n = 2), endocrine (n = 2), sarcoma (n = 1), and genitourinary (n = 1). Clinician input has answered several key questions, including current treatments, eligible patient populations, relevance to clinical practice, sequencing and priority of treatments, and companion diagnostic testing. Conclusions: Clinician engagement has provided value-added information on local issues from a practice perspective and insights into areas of unmet need. Continuous process improvement is important, however, and the pCODR program completed consultations in April 2018 to enhance clinician participation, proposing to: (1) customize the template that clinicians complete; and, (2) broaden the eligibility of clinicians to oncology pharmacists and oncology nurses.