Once Health Canada has approved a cancer drug for use in Canada, the country's provinces and territories must decide if the drug will be eligible for public reimbursement. The CADTH pan-Canadian Oncology Drug Review (pCODR) plays an important role in their decision-making processes.
Through the pCODR process, CADTH conducts thorough and objective evaluations of clinical, economic, and patient evidence on cancer drugs, and uses this evaluation to provide reimbursement recommendations and advice to provincial and territorial public drug plans (with the exception of Quebec) and provincial cancer agencies.
A pan-Canadian Process
Because of its pan-Canadian scope, the pCODR process reduces duplication of effort by individual funders and ensures that reviews are done in a timely and consistent manner. To shorten the time between Health Canada regulatory approval and a CADTH reimbursement recommendation, a pCODR application may be made while a drug is still being reviewed by Health Canada; however, the CADTH cancer drug reimbursement recommendation is not issued until Health Canada approves the drug for use in Canada.
The pCODR process brings objectivity and credibility to the cancer drug review process, allowing for greater understanding by all stakeholders while ensuring that individual provinces and territories can make funding decisions informed by evidence that has been carefully evaluated by oncology-specific experts.
Considering the Evidence
The evidence examined during the review comes from many sources, including patient group input; clinical studies demonstrating the safety, efficacy, and effectiveness of the drug compared with alternatives; therapeutic advantages and disadvantages relative to current accepted therapy; cost and cost-effectiveness relative to current accepted therapy; and implementation issues related to adoption feasibility.
CADTH notifies patient groups at the outset of a pCODR review and invites them to provide input. This step in the process captures patients' experiences and perspectives of living with a medical condition for which a drug under review is indicated, their experiences with currently available treatments, and their expectations for the drug under review.
Reimbursement recommendations are made by the CADTH pCODR Expert Review Committee (pERC) comprised of medical oncologists, physicians, pharmacists, economists, an ethicist, and patient members. The drug plans and cancer agencies make their final reimbursement and coverage decisions based on the CADTH recommendations and other factors, such as their program mandates, jurisdictional priorities, and budget impact.