OBJECTIVES:

Partitioned Survival Model (PSM) and State Transition Models are the most frequently used approaches to estimate the cost-effectiveness of treatments. However, each of these approaches have their own limitations in their application in oncology. Our objective was to review the reimbursement submissions of oncology treatments made to Canadian Agency for Drugs and Technologies in Health (CADTH) between 2018 and 2022 to examine the modeling approaches considered by manufacturers.

METHODS:

We reviewed the reimbursement reports of oncology pharmaceuticals and oncology cell gene therapies and extracted the economic evidence data from the reports identified between January 2018 and December 2022.

RESULTS: A total of 154 submissions were identified in the review, of which 31 submissions did not receive a reimbursement recommendation. Of the identified submissions, 75% used a PSM, 15% used a markov model, 5% used a semi-markov model. Of the submissions that used more than one modeling approach, differences in the ICER estimates between models were not reported. Economic model choice was not justified by a majority of the submissions, and uncertainties in the model assumptions, particularly survival benefit were the key limitations identified by CADTH in the submissions. Nearly 60% of the submissions included did not provide direct clinical evidence of comparative effectiveness with comparator chosen in the economic model, and the effectiveness data was deemed uncertain by CADTH. Of the submissions that received reimbursement recommendation, more than 90% were conditional based on the incremental cost effectiveness ratio being improved to meet an acceptable threshold.

CONCLUSIONS: This review demonstrated that nearly 80% of the submissions received a reimbursement recommendation. Although the majority of submissions used PSM, the justifications for model choice were not adequately reported, and substantial uncertainties were noted by CADTH with the modeling approaches chosen.