OBJECTIVE: The CADTH reimbursement review process determines cost-effectiveness using the incremental cost-effectiveness ratio (ICER). CADTH makes three possible recommendations: reimburse (recommended), reimburse with conditions (conditionally recommended), and do not reimburse (not recommended). ICER values are reported exactly, as a range, or as dominant/dominated. This study determines the ICER change between the manufacturer submitted and CADTH reanalyzed values for oncology reviews, stratified by decision type.

METHODS: CADTH economic reports for oncology products submitted between 2019 and 2021 were extracted from the Pricentric HTA database. The base case and final re-analysis ICERs were extracted for all economic comparators and patient populations. Each ICER value within a submission was considered as a separate datapoint. Only datapoints with exact ICERs for the base case and the re-analysis were included. The mean percent change in ICER values (% Δ ICER) were calculated and stratified by the recommendation type.

RESULTS: CADTH economic reports encompassing 80 oncology indications were extracted and 168 unique datapoints were generated based on the economic comparator and patient population. Exact ICER values for the base case and re-analysis were available for 57 datapoints (mean % Δ ICER = +207.91%). Conditional recommendations had a mean % Δ ICER of +255.65% (N=40) and non-recommendations had a mean % Δ ICER = +93.15% (N=15). Only 2/57 of decisions were recommended (mean % Δ ICER = +113.63%). Datapoints with a mean % Δ ICER < 50% accounted for 38.6% (N=22) of datapoints; those with a mean % Δ ICER between 50 and 100%, accounted for 21.05% (N=12) datapoints; and, 40.35% (N=23) had a mean% Δ ICER ≥ 100%

CONCLUSIONS: For oncology drugs, there is a large discordance between manufacturer submitted ICERs and re-analyses conducted by CADTH. Future research should aim to better understand these discrepancies in cost-effectiveness estimates, especially if ICERs are linked to drug pricing.