Supplementary data: The impact of willingness-to-pay threshold on price reduction recommendations for oncology drugs: a review of assessments conducted by the Canadian Agency for Drugs and Technologies in Health

These are peer-reviewed supplementary materials for the article 'The impact of willingness-to-pay threshold on price reduction recommendations for oncology drugs: a review of assessments conducted by the Canadian Agency for Drugs and Technologies in Health' published in the Journal of Comparative Effectiveness Research.Table 1: Manufacturer and CADTH reported base-case ICERs across all recommended oncology submissions (2020-2022).Table 2: Cancer type, price reduction, time for engagement and time to negotiation of all the oncology drugs that completed negotiation processSince late 2020, the Canadian Agency of Drugs and Technologies in Health (CADTH) has been using a threshold of $50,000 (CAD) per quality-adjusted life-year (QALY) for both oncology and non-oncology drugs. When used for oncology products, this threshold is hypothesized to have a higher impact on the time to access these drugs in Canada. We studied the impact of price reductions on time to engagement and negotiation with the pan-Canadian Pharmaceutical Alliance for oncology drugs reviewed by CADTH between January 2020 and December 2022. Overall, 103 assessments reported data on price reductions recommended by CADTH to meet the cost–effectiveness threshold for reimbursement. Of these assessments, 57% (59/103) recommendations included a price reduction of greater than 70% off the list price. Eight percent (8/103) were not cost-effective even at a 100% price reduction. Of the 47 assessments that had a clear benefit, in 21 (45%) CADTH recommended a price reduction of at least 70%. The median time to price negotiation (not including time to engagement) for assessments that received at least 70% vs >70% price reduction was 2.6 vs 4.8 months. This study showed that there is a divergence between drug sponsor’s incremental cost–effectiveness ratio (ICER) and CADTH revised ICER leading to a price reduction to meet the $50,000/QALY threshold. For the submissions with clear clinical benefit the median length of engagement (2.5 vs 3.3 months) and median length of negotiation (3.1 vs 3.6 months) were slightly shorter compared with the submissions where uncertainties were noted in the clinical benefit according to CADTH. This study shows that using a $50,000 per QALY threshold for oncology products potentially impacts timely access to life saving medications.

本数据集为发表于《比较有效性研究杂志》的论文《支付意愿阈对肿瘤药物价格降低建议的影响：加拿大药物与医疗技术署评估综述》的同行评审补充材料。表1展示了2020年至2022年间，所有推荐肿瘤药物提交的制造商及加拿大药物与医疗技术署（CADTH）报告的基准情况下的成本-效果比（ICER）。表2列出了所有完成谈判过程的肿瘤药物的癌症类型、价格降低、参与时间和谈判时间。自2020年末以来，CADTH已对肿瘤和非肿瘤药物采用每质量调整生命年（QALY）50,000加元（CAD）的阈值。当应用于肿瘤产品时，该阈值预计将对加拿大获得这些药物的时间产生更大的影响。本研究旨在探讨价格降低对CADTH于2020年1月至2022年12月期间审查的泛加拿大药品联盟肿瘤药物参与时间和谈判时间的影响。总体而言，103项评估报告了CADTH为满足成本-效益阈值而推荐的价格降低的数据。在这些评估中，57%（59/103）的建议包括超过原价70%的价格降低。8%（8/103）即使在100%的价格降低下也不具有成本效益。在具有明确益处的47项评估中，CADTH对21项（45%）建议至少70%的价格降低。对于至少70%和>70%价格降低的评估，价格谈判的中位时间（不包括参与时间）分别为2.6个月和4.8个月。本研究表明，药物赞助商的增量成本-效果比（ICER）与CADTH修订的ICER之间存在差异，导致降价以满足每QALY 50,000加元的阈值。对于具有明确临床益处的提交，参与的中位时间（2.5个月 vs 3.3个月）和谈判的中位时间（3.1个月 vs 3.6个月）与根据CADTH在临床益处中存在不确定性的提交相比略短。本研究表明，对肿瘤产品使用每QALY 50,000加元的阈值可能对及时获得救命药物产生影响。