QALYs: What are they and how do they impact patient access to new cancer medicines?
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January 24, 2023
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QALYs: What are they and how do they impact patient access to new cancer medicines?
- 1. QALYs: What are they and how do they impact patient access to new cancer medicines? January 24, 2023 1pm EST
- 2. Hot Topics Expert Webinar Series 2 pCPA and provincial listings | Wednesday Nov. 23, 2022 @1pm Eastern Why timelines for public reimbursement of cancer medicines are getting longer and how this impacts patients To register, please visit www.cancertaintyforall.ca/hot_topics Funding algorithms | Tuesday Dec. 13, 2022 @1pm Eastern What goes into decisions on what medicines patients can access across different lines of treatments? QALYs | Tuesday Jan. 24, 2023 @1pm Eastern How arbitrary decisions on cost-effectiveness impact patients’ access to some novel cancer treatments Surrogate endpoints | Tuesday Feb. 21, 2023 @1pm Eastern Are drug review processes flexible enough to expedite patients’ access to new cancer medicines?
- 3. 3 Send in your questions! • We will address your questions in the last 15 minutes of the webinar • Click on the “Chat” panel / button any time to submit your questions • If it is addressed to one of the panelists in particular, please say who
- 4. Today’s panel 4 Speakers Moderator Bill Dempster CEO 3Sixty Public Affairs Robert Bick CanCertainty Campaign Co-Lead Lindy Forte Lead – Market Access & Pricing EVERSANA Louise Binder Health Policy Consultant
- 5. 5 © 2023 EVERSANA. All Rights Reserved. CONFIDENTIAL. QALYs What are they, how are they measured and why are they used? Lindy Forte, MSc Sr. VP, Market Access & Pricing EVERSANA Canada
- 6. 6 © 2023 EVERSANA. All Rights Reserved. CONFIDENTIAL. Scores range from perfect health (1) to dead (0) One QALY is one year of perfect health Generic measure of disease burden Includes both the quality and the quantity of life lived What is a QALY? What does a QALY look like? What is a QALY?
- 7. 7 © 2023 EVERSANA. All Rights Reserved. CONFIDENTIAL. • The measurement of health-related quality of life (HRQoL) values involves first defining health states of interest and then asking individuals’ (healthy or those with the condition) their preferences related to those states. • Time Trade Off • Would you rather: • Live 10 years with diabetes requiring multiple insulin injections daily, OR • Live 8 years with perfect health? • Visual Analogue Scale • On a scale of 1 to 100, how would you rate • Living 10 years with breast cancer having 2 recurrences that require medication and multiple medical visits • Living 8 years with perfect health? How is a QALY measured?
- 8. 8 © 2023 EVERSANA. All Rights Reserved. CONFIDENTIAL. • Used to assess the long-term “value” of medical interventions Why is the QALY used?
- 9. 9 © 2023 EVERSANA. All Rights Reserved. CONFIDENTIAL. INCREMENTAL BENEFIT INCREMENTAL COST How is the QALY used in Healthcare Decisions? Incremental benefits (QALYs) are measured relative to incremental costs (usually resulting from higher drug costs) vs.
- 10. 10 © 2023 EVERSANA. All Rights Reserved. CONFIDENTIAL. How is the QALY Measured Against Cost? • QALYS can be in the order of A ratio of the added cost relative to the added benefit is created Result examples: • the incremental cost of “new intervention A” in a rare disease is $1,000,000/QALY vs no treatment • the incremental cost of “new intervention B” in breast cancer is $155,000/QALY vs current standard of care Note: Typical ICERs in Canada are far in excess of CADTH’s threshold for cost-effectiveness of $50,000/QALY
- 11. 11 © 2023 EVERSANA. All Rights Reserved. CONFIDENTIAL. People with Cancer or Rare Disease Can’t Achieve High QALYs “burden of disability and shorter lifespan” “and generate high ICERs” Not Patient Focussed “don’t consider all positive attributes of a new treatment” “dehumanizing” QALYs are subjective “depends who you ask” ICER Thresholds for Funding are Too Low “and subjective” Some Common Criticisms of the Use of QALYs and ICERs
- 12. CanCertainty Hot Topics Expert Webinar Series Analysis of HTA Process Change for Oncology Drugs 2020 – 2022 Louise Binder Health Policy Consultant Save Your Skin Foundation January 24, 2023 12
- 13. What Problem Are We Addressing • In late 2020 oncology patient groups began identifying changes in CADTH recommendations regarding cost/QALY thresholds for oncology drugs with reference to $50,000 per QALY rather than the previous $100,000 QALY • By 2021 it became clear this was a policy shift, not just individual decisions • Requests to set up a meeting with CADTH representatives went unanswered 13
- 14. How did we go about developing this article • Analyzed all CADTH Oncology final Recommendation Reports from January 2020 to January 2022 • Total of 56 analyzed recommendations • Tabulated the cost/QALY thresholds used in each recommendation Binder, L.; Ghadban, M.; Sit, C.; Barnard, K. Health Technology Assessment Process for Oncology Drugs: Impact of CADTH Changes on Public Payer Reimbursement Recommendations. Curr. Oncol. 2022, 29, 1514–1526. https://doi.org/ 10.3390/curroncol29030127 14
- 15. Study Findings January 2020 – September 2020 • Recommendations included cost/QALY thresholds of: • $100,000 • $50,000 and $100,000 • No reference to threshold value September 2020 – January 2022 • Single cost/QALY threshold of $50,000 predominantly referred to in final recommendations Binder, L.; Ghadban, M.; Sit, C.; Barnard, K. Health Technology Assessment Process for Oncology Drugs: Impact of CADTH Changes on Public Payer Reimbursement Recommendations. Curr. Oncol. 2022, 29, 1514–1526. https://doi.org/ 10.3390/curroncol29030127 0 1 2 3 4 5 6 7 8 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Apr-21 May-21 Jun-21 Jul-21 Aug-21 Sep-21 Oct-21 Nov-21 Dec-21 Jan-22 Recommendation Reports Issued (count) Date Recommendation Issued No threshold value referenced in recommendation $50,000 AND $100,000 presented $100,000 $50,000 15
- 16. Study Findings cont’d Binder, L.; Ghadban, M.; Sit, C.; Barnard, K. Health Technology Assessment Process for Oncology Drugs: Impact of CADTH Changes on Public Payer Reimbursement Recommendations. Curr. Oncol. 2022, 29, 1514–1526. https://doi.org/ 10.3390/curroncol29030127 • CADTH has moved towards a $50,000 cost/QALY threshold for oncology drugs • The lower threshold has resulted in recommendations to public payers for high price reductions as a condition for reimbursement • Examples of high price reductions include: Drug Price Reduction Cancer Drug 1 90% Cancer Drug 2 93% Cancer Drug 3 100% price reduction would not make it cost effective at the $50k cost/QALY 16
- 17. Potential Implications • Drugs may not be sent to pCPA for negotiation • pCPA negotiations may take longer • May have increased failure of negotiations • CADTH may expand its significant policy and procedural changes impacting patients without prior consultation or notification 17
- 18. 18 Discussion
- 19. NEXT WEBINAR 19 Robert Bick CanCertainty Campaign Co-Lead Surrogate Endpoints| February 21, 2023 @1pm Eastern Are drug review processes flexible enough to expedite patients’ access to new cancer medicines? Kristian Thorlund Senior Strategic Advisor Cytel Tara Bourgoin Senior Consultant IQVIA (invited)