Faculty
Schulich School of Medicine & Dentistry
Supervisor Name
Dr. Shehzad Ali
Keywords
CADTH, ICER, Pharmacoeconomic, Appraisal, CDR
Description
The Canadian Agency for Drugs and Technologies in Health (CADTH) is a health technology assessment (HTA) agency. CADTH conducts appraisals on health technologies and makes reimbursement recommendations to Canadian public drug plans to guide their reimbursement decisions. When being considered for reimbursement, drug companies submit pharmacoeconomic reports, which typically include long-term decision models. These models make assumptions and use parameters that may favour one intervention over the other. In this study, we comprehensively review the last year of drug submissions appraised by CADTH, with the aim of identifying, categorizing, and critically reviewing key methodological flaws made by drug companies in their submitted economic models. We focus on modelling choices considered questionable by the CADTH appraisal committee which were subsequently altered in the reanalysis or were raised as significant limitations of the model. We identify methodological issues that have the highest impact on the incremental cost-effectiveness ratio (ICER) and the reimbursement decision. We identify the flaws in presented economic models of thirty-two drugs appraised by CADTH under the Common Drug Review (CDR) in 2020. These model limitations and incorrect assumptions fall under fourteen broad categories, with the three most common types of incorrect assumptions relating to treatment effect (88%), utility data (81%) and costs (72%). The findings of our study will help improve the quality of future drug submissions and assist reimbursement agencies in identifying important gaps that can influence decision-making.
Acknowledgements
I would like to thank Dr. Shehzad Ali for his continued guidance throughout this internship. I would also like to thank the USRI program and staff for this opportunity, and for their continued support.
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Document Type
Poster
Included in
Catch Me If You Can: Questionable Modelling Assumptions and Parameter Choices and Their Impact on Drug Reimbursement Decisions
The Canadian Agency for Drugs and Technologies in Health (CADTH) is a health technology assessment (HTA) agency. CADTH conducts appraisals on health technologies and makes reimbursement recommendations to Canadian public drug plans to guide their reimbursement decisions. When being considered for reimbursement, drug companies submit pharmacoeconomic reports, which typically include long-term decision models. These models make assumptions and use parameters that may favour one intervention over the other. In this study, we comprehensively review the last year of drug submissions appraised by CADTH, with the aim of identifying, categorizing, and critically reviewing key methodological flaws made by drug companies in their submitted economic models. We focus on modelling choices considered questionable by the CADTH appraisal committee which were subsequently altered in the reanalysis or were raised as significant limitations of the model. We identify methodological issues that have the highest impact on the incremental cost-effectiveness ratio (ICER) and the reimbursement decision. We identify the flaws in presented economic models of thirty-two drugs appraised by CADTH under the Common Drug Review (CDR) in 2020. These model limitations and incorrect assumptions fall under fourteen broad categories, with the three most common types of incorrect assumptions relating to treatment effect (88%), utility data (81%) and costs (72%). The findings of our study will help improve the quality of future drug submissions and assist reimbursement agencies in identifying important gaps that can influence decision-making.