Global Insight Perspective | |
Significance | The latest report from this non-profit advocacy group provides a useful update—three years after the publication of a similar review—on R&D developments, cancer drug reimbursement and access across Canada. |
Implications | Problems with delayed access to treatment appear to have been compounded in comparison to the previous study, while survival improvements in the 15-39 age group have not kept pace with improvements for other age groups. |
Outlook | Cost evaluations for different regions of the country indicate that the burden of payments is differently split between public and private sources. The postcode lottery in access to treatment is expected to remain in the absence of a national catastrophic drug access strategy. Meanwhile, pharmacoeconomic data will be increasingly used in reimbursement decisions for oncology drugs in Canada. |
Delays in Access to Treatment Persist
The report identified several risk factors for treatment delay—including delay in access to PET scanning equipment and planned surgery—but for the purposes of this analysis we will look at the findings on delays in access to drugs. Among 18 new cancer drugs studied since the previous report was published three years ago, the median delay in launch between the United States and Canada was seven months. This delay refers to 10 drugs of the 18 for which Health Canada issued Notices of Compliance (NOCs). Although substantial delays remain, the median delay compares favourably to the 15 months reported for the 24 drugs studied in the 2005 report.
18 New Cancer Drugs Approved Since 2005 Report | |||||
Drug Name | Cancer Indication | Date of Approval in U.S. | Date of Approval in Canada | Approval Timing Difference in Canada vs. U.S. | Drug Cost for Standard Course (C$ unless statedotherwise) |
Alimta | Non-small cell lung cancer | 19.08.2004 | 11.01.2007 | 28.7 months | $23,000 (for 6 cycles) |
Rituxan | First line therapy for low grade NHL | 29.09.2006 | 20.12.2005 | -9.3 months | $27,000 (8 cycles) |
Rituxan | Maintenance of follicular NHL | 29.09.2006 | 28.07.2006 | -2 months | $27,000 (8 doses over 2 years) |
Erbitux | Locally advanced H&N cancer | 01.03.2006 | not approved | 22+ months | $16,000-22,000 (7-8 weekly cycles) |
Revlimid | Relapsed multiple myeloma | 29.06.2006 | not approved | 18+ months | US$74,000 (1 year) |
Revlimid | Myelodysplastic syndrome, 5q- | 27.12.2005 | not approved | 24+ months | US$63,000 (12 cycles, 1 year) |
Gleevec | Adjuvant therapy for gastro-intestinal stromal tumour | not approved | not approved; off-label | n/a | $38,000 (1 year) |
Sutent | Advanced renal cell carcinoma | 26.01.2006 | 17.08.2006 | 6.7 months | $66,000-75,000 (1 year) |
Sutent | Relapsed GIST refractory or intolerant of imatinib | 26.01.2006 | 26.05.2006 | 4 months | $66,000-75,000 (1 year) |
Nexavar | Advanced renal cell carcinoma | 20.10.2005 | 28.07.2006 | 8.3 months | $70,000 (1 year) |
Nexavar | Advanced hepatocellular carcinoma | 16.11.2007 | not approved; off-label | 1.3+ months | $35,000 (6 months) |
Caelyx | Ovarian cancer | 28.06.1999 | 20.01.2001 | 5.8 months | $15,000-16,000 (6 cycles) |
Vidaza | Myelodysplastic syndromes | 19.05.2004 | not approved | 30+ months | US$56,000-61,000 (1 year; 12-13 cycles) |
Sprycel | Ph+ ALL | 28.06.2006 | 07.07.2007 | 12.3 months | $55,000 (1 year) |
Sprycel | Refractory CML | 28.06.2006 | 26.03.2007 | 9 months | $55,000 (1 year) |
Torisel | Renal cell carcinoma | 30.05.2007 | 21.12.2007 | 6.7 months | US$68,000 (1 year) |
Targretin | Cutaneous T-cell lymphoma | 29.12.1999 | not approved | 96+ months | US$40,000-45,000 (8 months) |
Tykerb | HER2/neu positive metastatic breast cancer | 13.03.2007 | not approved | 9+ months | US$14,000-18,000 (6-8 cycles) |
Source: Cancer Advocacy Coalition of Canada | |||||
Approval times for cancer drugs appear to have improved in Canada in comparison to its southern neighbour. However, there are still significant differences in access to drugs and public funding status for the old and new drugs included in the report across the different provinces of Canada.
Outlook and Implications
The latest report from the Cancer Advocacy Coalition of Canada indicates that approval times in comparison to the United States have improved somewhat in Canada for cancer drugs. However, approval and launch of a product does not translate into access. Canadian provinces continue to use different mechanisms to control access to new oncology treatments, including:
- Reimbursement for specific disease indications only (usually in the form of special authorisation or case-by-case request and application);
- Reimbursement for specific patient groups (eg, over 65s);
- Only making reimbursement available in certain institutions within the province; and
- Availability through private payment only or manufacturer's compassionate access programmes.
The barriers to treatment, the report indicates, translate into reduced life expectancy for those who cannot access the treatment. The impact has been particularly bad for the 15-39 age group, which has seen less improvement in survival compared to other age groups since the 2005 report.
The postcode lottery in access to treatment appears unavoidable at this stage as provincial authorities in charge of drug reimbursement can make their own decisions that could in some cases go against national treatment recommendations. Ending the regional disparity can be made possible only through the implementation of a national catastrophic drug access strategy and national consistency in reimbursement decisions. If such a strategy were implemented—which we do not expect to happen within the next three years—it is likely to be accompanied by the introduction of stringent pharmacoeconomic criteria for approval and reimbursement. The introduction of "pay for results" reimbursement schemes such as the one Canada implemented for Taxotere (docetaxel; Sanofi-Aventis, France) in the past appears increasingly likely. Pharma companies should be prepared to provide clinical data indicating which patient groups can benefit from a specific new cancer drug. Even where such data exist, under a national access strategy companies may be required to fund the drug themselves for patients who do not respond to treatment, in exchange for being able to charge a premium price for those that do respond.