IMPACT OF COMPARATOR SELECTION BASED ON SEQUENTIAL ANALYSIS ON COST-EFFECTIVENESS CONCLUSIONS IN CDA-AMC REIMBURSEMENT RECOMMENDATIONS
Author(s)
Catherine Beauchemin, PhD1, Jean Lachaine, PhD1, Jean-Eric Tarride, PhD2, Ana Rusu, Master in Public Policy3, Stephane Barakat, PhD4.
1PeriPharm, Montreal, QC, Canada, 2McMaster University, Hamilton, ON, Canada, 3AbbVie, Markham, ON, Canada, 4AbbVie, Saint-Laurent, QC, Canada.
1PeriPharm, Montreal, QC, Canada, 2McMaster University, Hamilton, ON, Canada, 3AbbVie, Markham, ON, Canada, 4AbbVie, Saint-Laurent, QC, Canada.
OBJECTIVES: For new drugs undergoing reimbursement review, comparator selection is a vital aspect of the health technology assessment, playing a major role in the economic assessment and reimbursement recommendation. At CDA-AMC, when multiple comparators are included in the pharmacoeconomic analysis, the results are reported based on a sequential analysis. This study aimed to understand how comparator selection via sequential analysis impacts the reimbursement review of new drugs in Canada.
METHODS: A review of CDA-AMC reimbursement reports from January 2022 to December 2023 was conducted to determine if the comparators used by CDA-AMC as the reference product for new drugs (selected via the sequential analysis) were also the comparators most commonly used in clinical practice. This assessment also included an analysis examining the impact on the cost-effectiveness conclusions had the most commonly used comparator been selected as the reference product instead of the comparator chosen by CDA-AMC.
RESULTS: 60 reimbursement recommendations were reviewed. In 25 (42%) of these recommendations, CDA-AMC used a reference product that was not the most commonly used comparator in clinical practice. In 21 of these 25 recommendations (84%), it was found that comparing new drugs to the most commonly used comparators, rather than the CDA-AMC selected comparators, resulted in more favourable reimbursement assessments for new drugs, with lower or no required price reductions to meet the $50,000/QALY threshold commonly applied during the respective review period.
CONCLUSIONS: The results of this review highlight concerns with the sequential analysis approach, as it may remove relevant comparators and ultimately result in a recommendation that is not based on actual clinical practice. This reinforces the importance of transparent and clinically informed comparator selection and points to a need for CDA-AMC to provide economic assessments of all clinically relevant comparators, ensuring that payers have a complete and balanced picture of the evidence.
METHODS: A review of CDA-AMC reimbursement reports from January 2022 to December 2023 was conducted to determine if the comparators used by CDA-AMC as the reference product for new drugs (selected via the sequential analysis) were also the comparators most commonly used in clinical practice. This assessment also included an analysis examining the impact on the cost-effectiveness conclusions had the most commonly used comparator been selected as the reference product instead of the comparator chosen by CDA-AMC.
RESULTS: 60 reimbursement recommendations were reviewed. In 25 (42%) of these recommendations, CDA-AMC used a reference product that was not the most commonly used comparator in clinical practice. In 21 of these 25 recommendations (84%), it was found that comparing new drugs to the most commonly used comparators, rather than the CDA-AMC selected comparators, resulted in more favourable reimbursement assessments for new drugs, with lower or no required price reductions to meet the $50,000/QALY threshold commonly applied during the respective review period.
CONCLUSIONS: The results of this review highlight concerns with the sequential analysis approach, as it may remove relevant comparators and ultimately result in a recommendation that is not based on actual clinical practice. This reinforces the importance of transparent and clinically informed comparator selection and points to a need for CDA-AMC to provide economic assessments of all clinically relevant comparators, ensuring that payers have a complete and balanced picture of the evidence.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA211
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes, Value Frameworks & Dossier Format
Disease
No Additional Disease & Conditions/Specialized Treatment Areas