Impact of Oncology Drug Review Times on Public Funding Recommendations

Abstract

New oncology drugs undergo detailed review prior to public funding in a single-payer healthcare system. The aim of this study was to assess how cancer drug review times impact funding recommendations. Drugs reviewed by the pan-Canadian Oncology Drug Review (pCODR) between the years 2012 and 2020 were included. Data were collected including Health Canada approval dates, initial and final funding recommendations, treatment intent, drug class, clinical indications, and incremental cost-effectiveness ratios (ICER). Univariable and multivariable analyses were used to determine the association between funding recommendations and review times. Of the 164 applications submitted, 130 received a positive final recommendation. Median time from Health Canada (HC) approval to final recommendation was longer for drugs indicated for the treatment of gastrointestinal (GI) and lung cancer compared to breast, genitourinary (GU), and other tumours (205 vs. 198 vs. 111 vs. 129 vs. 181 days, respectively; Kruskal–Wallis p = 0.0312). Drugs with longer review times were more likely to receive a negative pCODR recommendation, even when adjusting for tumour type, drug class, and intent of therapy (157 vs. 298 days; Wilcoxon p = 0.0003, OR 1.002 95% CI [1.000–1.004].). There was no association between funding recommendation and tumour type or class of drug. The exploration of factors associated with variance in review times will be important in ensuring timely patient access to cancer drugs.

Access to Oncology Medicines in Canada: Consensus Forum for Recommendations for Improvement

“…Many new oncology therapies now in use or on the pharmaceutical horizon are targeted treatments for cancers caused by genetic mutations that can advance treatment beyond traditional options of surgery, radiation and chemotherapy [13]. These new drugs are often expensive and the obstacles created by Canadian governments frequently delay or deny patient access to them [11,[14][15][16], prevent health care providers from prescribing optimal therapy, cause concern among patients and their families, and lead to lives being lost [17]. If Canadians with cancers are to fully benefit from new advanced treatments, current processes need to change [13].…”