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Describing Sources of Uncertainty in Cancer Drug Formulary Priority Setting across Canada

1
School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
2
Canadian Control Research, BC Cancer, Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, BC V5Z 4E6, Canada
3
Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
4
W. Maurice Young Centre for Applied Ethics, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2021, 28(4), 2708-2719; https://doi.org/10.3390/curroncol28040236
Received: 30 May 2021 / Revised: 5 July 2021 / Accepted: 12 July 2021 / Published: 17 July 2021
(This article belongs to the Special Issue Access to Cancer Drugs in Canada)
Over the years, there have been significant advances in oncology. However, the rate that therapeutics come to market has increased, while the strength of evidence has decreased. Currently, there is limited understanding about how these uncertainties are managed in provincial funding decisions for cancer therapeutics. We conducted qualitative interviews with six senior officials from four different Canadian provinces (British Columbia, Alberta, Quebec, and Ontario) and a document review of the uncertainties found in submissions to the pan-Canadian Oncology Drug Review (pCODR). Participants reported considerable uncertainty related to a lack of solid clinical evidence (early-phase clinical trials: generalizability, immature data, and the use of unvalidated surrogate outcomes). Proposed strategies to deal with the uncertainty included risk-sharing agreements, collection of real-world evidence (RWE), and ongoing collaboration between federal groups and provinces. The document review added to the reported uncertainties by classifying them into five main categories: trial validity, population, comparators, outcomes, and intervention. This study highlights how decision makers must deal with significant amounts of uncertainty in funding decisions for cancer drugs, most of which stems from methodological limitations in clinical trials. There is a critical need for transparent priority-setting processes and mechanisms to reevaluate drugs to ensure benefit given the high level of uncertainty of novel therapeutics. View Full-Text
Keywords: health technology assessment; oncology; cancer drugs; uncertainty; qualitative interviews; reimbursement recommendations health technology assessment; oncology; cancer drugs; uncertainty; qualitative interviews; reimbursement recommendations
MDPI and ACS Style

Jenei, K.; Peacock, S.; Burgess, M.; Mitton, C. Describing Sources of Uncertainty in Cancer Drug Formulary Priority Setting across Canada. Curr. Oncol. 2021, 28, 2708-2719. https://doi.org/10.3390/curroncol28040236

AMA Style

Jenei K, Peacock S, Burgess M, Mitton C. Describing Sources of Uncertainty in Cancer Drug Formulary Priority Setting across Canada. Current Oncology. 2021; 28(4):2708-2719. https://doi.org/10.3390/curroncol28040236

Chicago/Turabian Style

Jenei, Kristina, Stuart Peacock, Michael Burgess, and Craig Mitton. 2021. "Describing Sources of Uncertainty in Cancer Drug Formulary Priority Setting across Canada" Current Oncology 28, no. 4: 2708-2719. https://doi.org/10.3390/curroncol28040236

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