Pan-Canadian Oncology Drug Review (pCODR): A unique model to support harmonization of cancer drug funding decisions in Canada.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 41-41 ◽  
Author(s):  
Maureen E. Trudeau ◽  
Alexandra Chambers ◽  
Kendra Christiansen ◽  
Helen Mai
Keyword(s):  
Cancer Drug ◽  
Equitable Access ◽  
Review Committee ◽  
Expert Review ◽  
Unique Model ◽  
Consistent Manner ◽  
Local Funding ◽  
Canadian Provinces ◽  
The Cost ◽  
Drug Review

41 Background: Unlike most other countries, Canada has a dedicated HTA process to review cancer drugs. pCODR, a program of CADTH, conducts thorough and objective evaluations of clinical and economic evidence; as well as considering clinician and patient perspectives, and using this information to make recommendations to the participating jurisdictions to guide their drug funding decisions. Previously, Canadian provinces had separate regional drug review processes to inform their local funding decisions. The pCODR process reduces duplication of effort by individual funders and ensures that reviews are done in a timely and consistent manner. Methods: In a retrospective review, we identified all anticancer drugs reviewed by pCODR from July 2011 to March 2018. Results: As of March 31, 2018, pCODR has issued 103 notifications to implement a final recommendation. Of note, 96% of the submissions include patient group input and 88% of the submissions include clinician input. The median time to complete a review is 146 business days. The pCODR Expert Review Committee has issued 21 negative recommendations, while the remainder were either positive recommendations (n = 10), or conditional recommendations (n = 72). The “condition” that must be addressed most frequently in the conditional recommendations is the cost-effectiveness of the drug. Over 75% of the 82 positive and conditional recommendations have received uptake from one or more participating jurisdictions. The concordance rates are as follows: Conclusions: With the implementation of the pCODR process, there is greater harmonization in cancer drug funding decisions and supports equitable access across Canada.[Table: see text]

scholarly journals Impact of the pan-Canadian Oncology Drug Review on provincial concordance with respect to cancer drug funding decisions and time to funding

2017 ◽  
Vol 24 (5) ◽  
pp. 295 ◽  
Author(s):  
A. Srikanthan ◽  
H. Mai ◽  
N. Penner ◽  
E. Amir ◽  
A. Laupacis ◽  
...  
Keyword(s):  
Linear Models ◽  
Drug Product ◽  
Median Number ◽  
Cancer Drug ◽  
Cancer Drugs ◽  
Oncology Drug ◽  
Before And After ◽  
Canadian Provinces ◽  
The Impact ◽  
Drug Review

Background The pan-Canadian Oncology Drug Review (pcodr) was implemented in 2011 to address uneven drug coverage and lack of transparency with respect to the various provincial cancer drug review processes in Canada. We evaluated the impact of the pcodr on provincial decision concordance and time from Notice of Compliance (noc) to drug funding.Methods In a retrospective review, Health Canada’s Drug Product Database was used to identify new indications for cancer drugs between January 2003 and May 2014, and provincial formulary listings for drug-funding dates and decisions between 1 January 2003 and 31 December 2014 were retrieved. Multiple linear models and quantile regressions were used to evaluate changes in time to decision-making before and after the implementation of the pcodr. Agreement of decisions between provinces was evaluated using kappa statistics.Results Data were available from 9 provinces (all Canadian provinces except Quebec), identifying 88 indications that represented 51 unique cancer drugs. Two provinces lacked available data for all 88 indications at the time of data collection. Interprovincial concordance in drug funding decisions significantly increased after the pcodr’s implementation (Brennan-Prediger coefficient: 0.54 pre-pcodr vs. 0.78 post-pcodr; p = 0.002). Nationwide, the median number of days from Health Canada’s noc date to the date of funding significantly declined (to 393 days from 522 days, p < 0.001). Exploratory analyses excluding provinces with incomplete data did not change the results.Conclusions After the implementation of the pcodr, greater concordance in cancer drug funding decisions between provinces and decreased time to funding decisions were observed.

scholarly journals Understanding the reasons for provincial discordance in cancer drug funding— a survey of policymakers

2018 ◽  
Vol 25 (4) ◽  
Author(s):  
A. Srikanthan ◽  
N. Penner ◽  
K.K.W. Chan ◽  
M. Sabharwal ◽  
A. Grill
Keyword(s):  
Online Survey ◽  
Response Rate ◽  
Common Reason ◽  
Cancer Drug ◽  
Free Text ◽  
Political Pressure ◽  
Canadian Provinces ◽  
Equity Of Access ◽  
Drug Review ◽  
Question Survey

Background Cancer drug-funding decisions between provinces shows discordance. The pan-Canadian Oncology Drug Review (pcodr) was implemented in 2011 partly to address uneven drug coverage and lack of transparency in the various provincial cancer drug review processes in Canada. We evaluated the underlying reasons for ongoing provincial discordance since the implementation of pcodr.Methods Participation in an online survey was solicited from participating provincial ministries of health (mohs) and cancer agencies (cas). The 4-question survey (with both multiple-choice and free-text responses) was administered between 4 March 2015 and 1 April 2015, inclusive. Anonymity was ensured. Descriptive statistics were used to evaluate responses.Results Data were available from 9 provinces (all Canadian provinces except Quebec), with a response rate of 100%. The 12 responses received each came from a senior policymaker with more than 5 years’ experience in cancer drug funding decision-making (5 from mohs, 7 from cas). Responses for 3 provinces came from both a moh representative and a ca representative. The most common reason for funding a drug not recommended by pcodr was political pressure (64%). The most common reason not to fund a drug recommended by pcodr was budget constraints (91%). The most common reason for a province to fund a drug before completion of the pcodr review was also political pressure (57%).Conclusions Political pressure and budgetary constraints continue to affect equity of access to cancer drugs for patients throughout Canada.

VP02 Real-World Evidence (RWE) And CADTH Pan-Canadian Oncology Drug Review

2018 ◽  
Vol 34 (S1) ◽  
pp. 159-160
Author(s):  
Dolly Han ◽  
Missale Tiruneh ◽  
Alexandra Chambers ◽  
Adam Haynes
Keyword(s):  
Cost Effectiveness ◽  
Data Collection ◽  
Real World ◽  
Clinical Benefit ◽  
Cancer Drug ◽  
Duration Of Treatment ◽  
Expert Review ◽  
Oncology Drug ◽  
Real World Evidence ◽  
Drug Review

Introduction:The pan-Canadian Oncology Drug Review (pCODR) program was established by Canada's provincial and territorial Ministries of Health (except Quebec) to assess cancer drug therapies and make recommendations to guide drug reimbursement decisions. The pCODR Expert Review Committee (pERC) makes reimbursement recommendations, providing a rationale for the recommendation and next steps for stakeholders. The objective of this analysis was to identify reviews and reasons pERC has requested real-world evidence (RWE) data collection.Methods:A retrospective analysis of pERC Final Recommendations (January 2012 – May 2017) was conducted. pERC Final Recommendations include drug information, reimbursement recommendation, rationale for recommendation following pERC's Deliberative Framework (clinical benefit, patient-based values, economic evaluation, and adoption feasibility), next steps for jurisdictions to consider to support their funding decisions, summary of deliberations, and evidence in brief. Reviews were included if there was a next step advising the collection of RWE to reduce uncertainty in the drug under review.Results:Out of eighty-four reviews, forty-one (forty-eight percent) included a next step to collect RWE to address a gap in the available evidence. Reasons for RWE data collection, in descending order of frequency, were to inform: sequencing of available therapies; magnitude of clinical benefit and cost-effectiveness or the true cost-effectiveness; duration of treatment and cost-effectiveness; defining the population or disease progression; quality of life; and dosage.Conclusions:In almost half of pERC's recommendation there is an indication that there is a gap in the existing evidence that could potentially be addressed through the collection of RWE. This reflects the rising number of new cancer drugs, limited evidence supporting submissions (for example non-comparative studies), and newer drugs such as immunotherapies which may not have a fixed treatment duration. Further research includes development of mechanisms for RWE data collection to help inform pERC recommendations and assist stakeholders with adoption feasibility of reviewed drugs.

Blockbusters and Bombs

2016 ◽  
Author(s):  
Michael Kinch
Keyword(s):  
Guinea Pig ◽  
Research And Development ◽  
New Technologies ◽  
New Products ◽  
Cancer Drug ◽  
Generic Medicines ◽  
Short Term ◽  
Generic Competition ◽  
The Cost

The first indications of future trouble are identified. For most of history, new medicines arise from nature but this approach came into question as evidenced by the development of the cancer drug Taxol. As understanding of biology and chemistry incraesed, a degree of over-confidence arose as researchers assumed that new technologies would allow them to predict the most effective medicines. These changes were a response to an environment confronting twin pressures in the form of rising generic medicines coupled with ever more costly research and development activities needed to develop new products to replace those devastated by generic competition. These issues were exacerbated by a rising dependence upon “blockbuster” products, which conveyed short-term revenues but inevitably needed to be replaced by even more profitable products once generic competition intervened. Dependence on blockbusters was exemplified by the story of ulcer medicines, which was disrupted by an audacious study by an investigator who used himself as a Guinea pig to make his point. As such risks increased, the industry became more cautious and the race was on to make incremental improvements upon competitors’ products. All the while the cost of developing new medicines continued to escalate.

Quantifying the Potential Impact of Autonomous Vehicle Adoption on Government Finances

2019 ◽  
Vol 2673 (5) ◽  
pp. 72-83 ◽  
Author(s):  
Jacob Terry ◽  
Chris Bachmann
Keyword(s):  
Autonomous Vehicles ◽  
Public Discourse ◽  
Autonomous Vehicle ◽  
Primary Objective ◽  
Transportation Industry ◽  
Gas Tax ◽  
Vehicle To Infrastructure ◽  
Potential Impact ◽  
Canadian Provinces ◽  
The Cost

There is some understanding that autonomous vehicles will disrupt public sector policies and the existing transportation industry, but this disruption is often loosely defined and tends to ignore how it would affect governments financially. The primary objective of this paper is to quantify the short-term impact of introducing autonomous vehicles on government finances. The analysis focuses on eight Canadian governments, encompassing four government tiers. Public discourse and academic literature are used to generate nine predicted changes (forecast variables) in future adoption scenarios. Using the predicted rate of autonomous vehicle adoption, the remaining variables are converted into financial changes by combining them with government financial records, infrastructure inventory datasets, and project cost estimates. The results suggest that, while revenue impacts are fairly minimal, and mostly impact Canadian provinces, the cost of implementing the expected vehicle-to-infrastructure (V2I) communication upgrades could be expensive for governments with smaller populations, especially municipalities. The revenue analysis indicates the biggest shift is likely to be a loss in gas tax, which affects federal and provincial revenues, yet this share is relatively small compared with the size of these governments’ budgets. The expense analysis suggests that, although provinces have extensive road networks, the cost of upgrading all of their highways may not be unreasonable compared with their yearly revenue intake. On the other hand, municipalities would require substantial new funds to be able to make the same upgrades.

A deterministic inventory model in reverse supply chain

2019 ◽  
Vol 15 (1) ◽  
pp. 318-338 ◽  
Author(s):  
Sasmita Mohapatra ◽  
Ajay Kumar Behera ◽  
Rabindra Mahapatra ◽  
Harish Das
Keyword(s):  
Design Methodology ◽  
Current Model ◽  
Environmental Damage ◽  
Reverse Supply Chain ◽  
Retail Outlet ◽  
Present Value ◽  
Content Type ◽  
Unique Model ◽  
The Cost ◽  
The Mathematical Model

Purpose The purpose of this paper is to present a unique model for the production–recycling–reuse of aluminium refreshment cans. It is presumed that disposed-off 250-ml aluminium cans are collected from the retail outlet. The cans are thereafter arranged into non-tainted and tainted categories. Design/methodology/approach The current model considers all the factors, i.e. producing, recycling and remanufacturing, whereas the previous models provide emphasis only one factor. Six procedures were considered in the improvement of the mathematical model. Findings In this paper, a recycling–reuse model that remanufactures non-tainted aluminium beverage cans and uses regrind from damaged non-tainted aluminium beverage cans mixed with parent aluminium material in the production of new cans was developed and analysed to reduce the amount of aluminium beverage cans that are disposed off in a scrapyard. The model is assumed to have no shortcomings, and the different percentages regarding the classes of cans are taken to be deterministic. Originality/value The model incorporates several unique aspects, including accounting for the cost of land use and associated environmental damage through the calculation of a present value that is charged to the manufacturer.

scholarly journals Profiles, Proxies, and Assumptions: Decentralized, Communications-Resilient Planning, Allocation, and Scheduling

2019 ◽  
Vol 33 ◽  
pp. 9504-9509
Author(s):  
Ugur Kuter ◽  
Brian Kettler ◽  
Katherine Guo ◽  
Martin Hofmann ◽  
Valerie Champagne ◽  
...  
Keyword(s):  
Subject Matter ◽  
Disaster Response ◽  
Large Scale ◽  
Subject Matter Expert ◽  
Decision Makers ◽  
Military Operations ◽  
Expert Review ◽  
Realistic Problem ◽  
The Cost ◽  
Distributed Decision

Degraded communications are expected in large-scale disaster response and military operations, which nevertheless require rapid, concerted actions by distributed decision makers, each with limited visibility into the changing situation and in charge of a limited set of resources. We describe LAPLATA, a novel architecture that addresses these challenges by separating mission planning from allocation/scheduling for scalability but at the cost of some negotiation. We describe formal algorithms that achieve near-optimal performance according to mission completion percentage and subject matter expert review: assumption-based planning and replanning, profileassisted cooperative allocation, and schedule negotiation. We validate our approach on a realistic problem specification and compare results against subject matter expert solutions.

Sign in / Sign up

Export Citation Format

Share Document