Canadian Agency for Drugs and Technologies in Health (CADTH) is an independent, not-for-profit organization providing health care decision-makers with objective evidence to help make informed decisions about the optimal use of health technologies. CADTH’s pan-Canadian Oncology Drug Review (pCODR) conducts thorough and objective evaluations of clinical, economic, and patient evidence on cancer drugs, and provide recommendations and advice for reimbursement to provincial and territorial public drug plans* and provincial cancer agencies.

1. • Ambrish Singh1, Salman Hussain2
• 1Independent Research, New Delhi, India
• 2Jamia Hamdard, Hamdard University, New Delhi, India
Presented at
pCODR decisions and access to anticancer
treatments in Canada

2. Background: CADTH
Canadian Agency for Drugs and Technologies in Health (CADTH) is
an independent, not-for-profit organization providing health care
decision-makers with objective evidence to help make informed
decisions about the optimal use of health technologies:1
Drugs Diagnostic tests Medical devices

3. Background: pCODR
CADTH’s pan-Canadian Oncology Drug Review (pCODR) conducts
thorough and objective evaluations of clinical, economic, and patient
evidence on cancer drugs, and provide recommendations and advice
for reimbursement to provincial and territorial public drug plans* and
provincial cancer agencies.2
*with the exception of Quebec
pCODR plays an important role in public reimbursement
decision-making for oncology drugs in Canada.

4. pCODR Review
Background: Process for coverage
Clinical
Economic
Patient evidence
Evaluation for Marketing
authorization
pERC Recommendation
New anti-cancer
drug submission
Payers
Final reimbursement
and coverage decisions
Process for reimbursement & coverage of new anti-cancer drugs in Canada2
Payers mandate
Jurisdictional
priorities
Budget impact

5. Objective
To examine the impact of the pCODR HTA decision on access of
anticancer drugs in Canada’s provincial public drug plans
First study to assess the impact of pCODR decisions on
access to new treatment for cancer in Canada’s public drug plans.

6. Methods: Overview
Time Frame
All anti-cancer drug
approved/under review by
Health Canada and
reviewed by pCODR till 26th
Sep, 2017 were studied
Data source:
CADTH (pCODR)3 and
Health Canada4
Data:
Drug indication
Submission type
Submission date
Recommendation date
Final recommendation
Subsequent provincial
funding status etc.
Recommendation rate:
percentage of drug submissions
with particular pCODR
recommendation
Recommendation gap: time
taken for the final pCODR
recommendation
Coverage rate: percentage of
drugs included in public
formulary after positive pCODR
recommendation
Coverage gap: gap in days from
positive recommendation to
subsequent coverage in
provinces
AnalysisData

7. Results: Recommendation rate
8%
52% Conditional recommendation
Positive recommendation
Others
Positive recommendation:
Nine submission for seven drugs
covering six indications
‘Genitourinary tumor’ indication
received maximum positive
recommendations.
Conditional recommendation:
62 submission for 45 drugs
covering 46 indications
‘Lymphoma & myeloma tumor’
indication received maximum
conditional recommendations
Recommendation for 119 submissions
Stringent process to grant positive recommendation

8. Positive
recommendation
Days
Conditional
recommendation
Results: Recommendation gap
Average recommendation gap for
positive recommendations was
180
Ranged from 141 to 219 days
Average recommendation gap for
conditional recommendations was
172 days
Ranged from 129 to 398 days
180 172
Stringent process to grant positive recommendation

9. Map for a representative purpose only
Results: Coverage rate
180 172
Coverage rate for drugs with
positive recommendation was
100% for all provinces except:
89% for Newfoundland and
Labrador (NL)
67% for Prince Edward Island
100%
<90%
<70%

10. Results: Coverage gap
180 172
Coverage gap for drugs with
positive recommendation varied
noticeably:
British Columbia had a maximum
coverage gap of 433 days
Saskatchewan has the minimum
coverage gap of 165 days
Minimum coverage gap
Maximum coverage gap
Map for a representative purpose only

11. Discussion
Subsequent Health Canada’s approval only a fraction of oncology drugs
receive positive pCODR recommendation
Provincial drug plans take their own time to include these in the
reimbursement formularies
While HTA is crucial for appropriate allocation of limited resource; efforts
should also be to reduce access barriers once positive recommendation is
given
Reducing access barrier to the positively recommended oncology drugs holds
particular importance; 12-6 months of delay may lead to disease advancement causing
impaired patients outcomes and increased financial burden

12. Conclusion
Positive HTA
Provincial
reimbursement
inclusion

13. Conclusion: Cont.
Simultaneous pCODR and payer assessment
Uniformity in provincial payers assessment
Addressing any special payer concern from the start

14. References
1. CADTH. 2018. About CADTH. [ONLINE] Available at: https://www.cadth.ca/about-
cadth. [Accessed 9 May 2018].
2. CADTH. 2018. About the pan-Canadian Oncology Drug Review (pCODR). [ONLINE]
Available at: https://cadth.ca/pcodr/about-pcodr. [Accessed 9 May 2018].
3. CADTH. 2018. Find a Review (pCODR). [ONLINE] Available
at: https://cadth.ca/pcodr/find-a-review. [Accessed 9 May 2018].
4. Health Canada. 2018. Drug Product Database online query. [ONLINE] Available
at: https://health-products.canada.ca/dpd-bdpp/index-eng.jsp. [Accessed 9 May 2018].

15. Thank You