Impact of Systemic Delays for Patient Access to Oncology Drugs on Clinical, Economic, and Quality of Life Outcomes in Canada: A Call to Action

Abstract

Canada has one of the most complex and rigorous drug approval and public reimbursement processes and is, unfortunately, one of the countries with the longest delays in drug access. To assess the overall impact of systemic delays in access to cancer therapy, a targeted literature review (TLR) was performed to identify studies associated with the clinical, economic, and quality of life impacts of delayed access to oncology drugs. Using MEDLINE/PubMed databases and snowballing, four unique records met the eligibility criteria. Results revealed that clinical outcomes were the most impacted by systemic delays in access to oncology drugs (e.g., life years lost, overall survival, and progression-free survival). The four articles retrieved by the TLR specifically illustrated that a substantial number of life years could potentially be saved by increasing systemic efficiency regarding the development, approval, and reimbursement processes of new drugs for advanced malignancies. It is imperative that initiatives are put in place to improve the performance and speed of Canadian drug regulatory and health technology assessment (HTA) processes, especially for new cancer therapeutics. The proposed solutions in this paper include better coordination between HTA and Canadian payers to harmonize coverage decisions, international collaborations, information sharing, and national standards for timeliness in oncology drug access.

Timeliness of Health Technology Assessments and Price Negotiations for Oncology Drugs in Canada

“…Patients and providers are often frustrated and concerned about the lack of transparency in CADTH's and the pCPA's processes. [29][30][31]40,41 CADTH and the pCPA are both non-profit corporations, not government departments. As such, they do the work for governments, but the traditional accountability tools and requirements of freedom of information requests, independent ombudsperson appeals, and parliamentary auditor-general performance reviews do not apply to them.…”

“…Many calls have been made for Canada to reduce delays in patient access to new oncology medicines via government drug plans. [3][4][5]11,12,15,[29][30][31]47 Canada's governments have established HTA and price negotiation organizations and allowed them to develop procedures without accountable performance targets. Even when a drug has passed through these processes, government drug plans do not automatically list the medicine, leading to further delays.…”

“…28 Health professionals want to be able to prescribe what they consider to be optimal therapy for their patients as soon as the drugs are available and patients are concerned that their access is not delayed. 15,[29][30][31] Delays due to processes like HTAs and price negotiations exacerbate these concerns. The objective of this work was to evaluate whether the CADTH and pCPA time standards are achieved for oncology therapies with a reimbursement recommendation issued during the 10-year period, January 2014 to December 2023.…”