The Impact of CDA-AMC Sequential Analysis on Decision-Making in Oncology
Author(s)
Catherine Beauchemin, PhD1, Jean Lachaine, PhD2, Juliette Garneau, M.Sc.2, Jean-Eric Tarride, PhD3;
1PeriPharm, Partner, Montreal, QC, Canada, 2PeriPharm, Montreal, QC, Canada, 3McMaster University, Center for Health Economics and Policy Analysis (CHEPA), Hamilton, ON, Canada
1PeriPharm, Partner, Montreal, QC, Canada, 2PeriPharm, Montreal, QC, Canada, 3McMaster University, Center for Health Economics and Policy Analysis (CHEPA), Hamilton, ON, Canada
Presentation Documents
OBJECTIVES: The CDA-AMC Procedures for Reimbursement Reviews state that when multiple comparators are included in the pharmacoeconomic analysis, results should be reported using a sequential analysis to show where the drug stands on the cost-effectiveness efficiency frontier. There is concern that this approach may lead to price reductions recommended by CDA-AMC based on treatments not widely used in clinical practice. This study aims to assess the appropriateness of the sequential analysis and its impact on the comparator choice used for the price reduction recommendation.
METHODS: A review of CDA-AMC oncology reimbursement reports from January 2022 to December 2023 was conducted to identify comparators determined by the sequential analysis and their market shares. Extracted data included comparators used for economic evaluation, their prices, market shares, and recommended price reductions.
RESULTS: Of the 62 oncology reimbursement reviews, 13 recommendations were based on sequential analysis. In over half (7/13) of the recommendations, the cost-effectiveness efficiency frontier included one or more comparators not commonly used in clinical practice, with a median market share of 5% (ranging from 0% to 26%). Nearly half of these recommendations (3/7) used the least expensive comparator and referenced treatments not commonly used in clinical practice, leading to high price reduction recommendations of at least 70%. The other comparators with larger market shares were excluded by CDA-AMC in the sequential analysis due to dominance or extended dominance. No information on these comparators was reported in the reimbursement recommendation.
CONCLUSIONS: CDA-AMC should include key information, such as market share for all comparators used in the sequential analysis in their recommendations. This would create a more balanced reporting format reflecting relevant information to the reimbursement decision-making process. The analysis should be expanded to include all oncology reimbursement recommendations by CDA-AMC for the past five years to validate the preliminary results.
METHODS: A review of CDA-AMC oncology reimbursement reports from January 2022 to December 2023 was conducted to identify comparators determined by the sequential analysis and their market shares. Extracted data included comparators used for economic evaluation, their prices, market shares, and recommended price reductions.
RESULTS: Of the 62 oncology reimbursement reviews, 13 recommendations were based on sequential analysis. In over half (7/13) of the recommendations, the cost-effectiveness efficiency frontier included one or more comparators not commonly used in clinical practice, with a median market share of 5% (ranging from 0% to 26%). Nearly half of these recommendations (3/7) used the least expensive comparator and referenced treatments not commonly used in clinical practice, leading to high price reduction recommendations of at least 70%. The other comparators with larger market shares were excluded by CDA-AMC in the sequential analysis due to dominance or extended dominance. No information on these comparators was reported in the reimbursement recommendation.
CONCLUSIONS: CDA-AMC should include key information, such as market share for all comparators used in the sequential analysis in their recommendations. This would create a more balanced reporting format reflecting relevant information to the reimbursement decision-making process. The analysis should be expanded to include all oncology reimbursement recommendations by CDA-AMC for the past five years to validate the preliminary results.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HTA26
Topic
Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes
Disease
SDC: Oncology