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Timeliness of Health Technology Assessments and Price Negotiations for Oncology Drugs in Canada
Nigel S B Rawson1,2,3, David J Stewart4,5
1Macdonald-Laurier Institute, Ottawa, Ontario, Canada.
Purpose:
To evaluate whether time targets for Canadian Agency for Drugs and Technologies in Health (CADTH) reimbursement reviews and pan-Canadian Pharmaceutical Alliance (pCPA) price negotiations are being achieved for oncology drugs.
Materials And Methods:
Recommendations, dates of submission and publication, and indications for oncology medicines issued between January 2014 and December 2023 were recorded from CADTH's reimbursement reports webpage. The date any negotiation began and the date it was completed (successfully or not), or when a decision was made not to pursue negotiation was extracted from the pCPA's webpage. The duration of each CADTH review and pCPA negotiation was calculated, together with time between CADTH's recommendation and start of the pCPA negotiation or a decision not to negotiate. Percentages of reviews completed within CADTH's target and of times taken by the pCPA to decide whether to negotiate and by its price negotiations completed within the relevant targets were calculated.
Results:
CADTH achieved its 270-days target in 88.2% to 100% of reviews issued between 2015 and 2019 but only in 65.9% to 73.1% of reviews issued in the last three years of the decade. CADTH's "typical timeline" of 180 days was achieved in under 40% of reviews issued in 2015 and not attained in any review in 2021, 2022 or 2023. The pCPA's target of 60 days for deciding whether to negotiate was achieved for all recommendations issued in 2014 but dropped below 40% for the last seven years of the decade; its target of 130 days for negotiations was achieved for over 85% of the recommendations in 2014 but decreased to only 14.3% in 2016 and then gradually increased to 61.5% in 2023.
Conclusion:
CADTH's "typical timeline" and the pCPA's targets were not met sufficiently to be meaningful. Their processes take too long for cancer drugs.
Insights
Canadian Agency for Drugs and Technologies in Health (CADTH) and pan-Canadian Pharmaceutical Alliance (pCPA) targets for oncology drug reviews and price negotiations are frequently missed. These delays impact timely access to cancer medications for patients.
Area of Science:
- Health Economics
- Health Policy
- Oncology
Background:
- Timely access to oncology drugs is crucial for patient care.
- The Canadian Agency for Drugs and Technologies in Health (CADTH) and the pan-Canadian Pharmaceutical Alliance (pCPA) have established time targets for drug reviews and price negotiations.
- Evaluating adherence to these targets is essential for assessing the efficiency of drug approval and access processes in Canada.
Purpose of the Study:
- To assess whether the Canadian Agency for Drugs and Technologies in Health (CADTH) reimbursement review and pan-Canadian Pharmaceutical Alliance (pCPA) price negotiation time targets are being met for oncology drugs.
- To identify trends in the achievement of these targets over a decade (2014-2023).
Main Methods:
- Data on oncology medicine recommendations, submissions, and publications were extracted from CADTH reports (2014-2023).
- Information on the initiation, completion, or decision not to pursue pCPA price negotiations was gathered from pCPA records.
- Durations of CADTH reviews and pCPA negotiations were calculated, along with the time between CADTH recommendations and pCPA actions.
Main Results:
- CADTH met its 270-day target for most reviews between 2015-2019, but achievement dropped significantly in later years (65.9%-73.1%).
- CADTH's 180-day "typical timeline" was rarely met, especially in 2021-2023.
- pCPA's 60-day target for deciding on negotiations was met in 2014 but declined sharply, while the 130-day negotiation target saw variable achievement, improving to 61.5% by 2023.
Conclusions:
- Neither CADTH's typical timelines nor pCPA's negotiation targets are consistently met.
- The current processes for oncology drug reviews and price negotiations in Canada are excessively lengthy.
- Delays in these processes hinder timely patient access to essential cancer medications.
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