Canada has a publicly-funded healthcare system with a complex drug funding process. After Health Canada approval to market a drug, the pan-Canadian Oncology Drug Review (pCODR) makes a non-binding funding recommendation to the Canadian provinces (except Quebec), which each then decide whether the drug will be publicly funded. We identified the determinants of funding in this process.
We analyzed drugs for advanced lung (n = 15), breast (n = 8), colorectal (CRC) (n = 7), melanoma (n = 10), and neuroendocrine (NET) (n = 3) cancer undergoing the funding decision process from 2011-2019. Determinants of funding assessed in the model included list price, cancer type, drug class, and pCODR recommendation. The primary outcome was the correlation between list price and time-to-funding (TTF: Health Canada approval to first provincial funding). Secondary outcomes included an exploratory analysis of predictors of drug funding.
We analyzed 43 drugs: targeted agents 72%, immunotherapy 20%, chemotherapy 7%. 72% were funded in at least 1 province. Median TTF was 379 days (IQR 203-601). Median list price (28-day course) was $8213 (IQR 5391-9445). Higher list price was not correlated with TTF (correlation coefficient -0.20, p = 0.28). There was no association between list price and pCODR recommendation, or the decision to fund in at least 1 province. A positive pCODR recommendation correlated with the provinces’ funding decisions (p < 0.001), where 89% of drugs with a positive recommendation were funded and 100% of drugs with a negative recommendation were not funded. Tumour type was predictive of TTF (p < 0.001): CRC drugs slowest at a median of 2541 days (IQR 702-4379), and NET drugs quickest at a median of 0 days (IQR 0-502). Cancer type predicted decision to fund in at least 1 province (p = 0.005), with funding for 100% of NET drugs at the high end and 29% of CRC drugs at the low end. Drug class was predictive of TTF (p = 0.01): 465 days (IQR 245-702) for targeted agents, 443 days (IQR 298-587) for chemotherapy, and 339 days (IQR 164-446) for immunotherapy.
Determinants of drug funding include cancer type, drug class, and pCODR recommendation, but not list price. Factors other than cost are more heavily weighted in the funding decisions of cancer drugs in Canadian provinces.
Paul Wheatley-Price and Joanna Gotfrit.
Has not received any funding.
All authors have declared no conflicts of interest.