An Investigation of Value for Money of Oncology Drugs in Canada

OBJECTIVES: Cancer care cost is increasing to unsustainable levels due, largely in part, to rising drug prices. Therefore, it is key to better assess the value of oncology drugs to help guide future drug funding recommendations. We aim to examine the value-for-money of oncology drugs reviewed by the pan Canadian Oncology Drug Review (pCODR).

METHODS: We systematically reviewed the oncology drugs for which pCODR made reimbursement recommendations from 2011 to 2019. Data were extracted from pCODR’s funding recommendation reports by two independent reviewers, and discrepancies were resolved by a third reviewer. Data was collected on drug characteristics, cost, clinical benefit, and incremental cost utility ratio (ICUR).

RESULTS: Of the 142 submissions reviewed, 10 (7.0%) received a pCODR recommendation to fund the drug, 29 (20.4%) to not fund the drug, and the remaining 103 (72.5%) received a recommendation for funding on a conditional basis, most of which (96.1%) were due to poor cost-effectiveness. Most drugs (89.4%) were submitted for palliative intent, and the most common cancer type indicated was hematological malignancies (21.8%). Only 14 (9.8%) drugs demonstrated improved toxicity over a comparator while 77 (54.2%) exhibited worse toxicity. Regarding health-related quality of life, 46 (32.4%) drugs demonstrated an improvement over relevant comparators, while 57 (40.1%) were unchanged or worsened. The average ICUR of the submitted drugs was $233,273.90 (range -$16,690 to $2,120,433) and the average change in quality adjusted life-years (QALY) was 0.621 (range 0 to 4.74). The average ICUR increased over time from $194,014.50 in the first half of the study to $260,969.60 in the second half.

CONCLUSIONS: The results of this study indicate that the increase in cost of oncology drugs has outpaced the increase in clinical benefit. Provinces should make more judicious choices when making reimbursement decisions, considering not only the drug price, but also the value for money.