B5 - Capturing the cost impact of CDR Recommendations - Milev - Salon CPresentation Transcript
Capturing the Cost Impact of CDRRecommendationsSandra Milev, CADTHKaren Lee, CADTHCADTH SymposiumSt. John’sMay 6, 2013
It is CDR 10TH Anniversary!Common Drug Review (CDR), a pan-Canadian programestablished to evaluate the clinical effectiveness and costeffectiveness of new drugs in order to make formularyrecommendations for publicly provided drug plans since2003• 236 CDR recommendations• 89,680 reviewed articles• 70 pharmaceutical manufacturers• 75 patient groups
CDR Impact Tool PilotObjective: To quantify the value that can be contributed toCDR recommendationsCan we capture the CDR impact?
How can we capture the CDR impact?Cost Impact ToolCapture currentpublic drug planexpendituresCapture potentialcost impact ofimplementing CDRrecommendationsQuantify the value attributed to CDR recommendationsHealth Outcome Impact ToolNational Estimate
What does costing tool include/exclude?Includes direct drug cost impact onlychange in practice resulting from implementing the CDRrecommendationCost of indicated therapiesCondition–related drug costsDrug costs of adverse events treatmentCost of administration feesExcludes non-drug cost impact and indirect cost impactcost of hospital admissions, physician costs, lab costs, indirectcosts Costing tool do not form basis for making recommendations.
What data sources were used?• current state of reimbursement of drugs for the condition• number of claimspublic plans claim level data (IMS Brogan Pharmastat)CDR recommendations• clinical effectiveness• cost-effectiveness• drug costs• changes to the markets• market uptake of new agentsformularies, published literature
What methodology was used?Data AnalysisFor each drug, two scenarios were created, (1) currentscenario and (2) counterfactual (what-if) scenario.Current scenariodescribes the current mix of available interventions withan implemented CEDAC/CDEC recommendation and thecost associated with it.Counterfactual scenariodescribes a scenario if the CEDAC/CDECrecommendation was not been implemented and the costassociated with it.
What is the current scenario?Current scenario describes the current market share:without the submitted drug, if the drug wasn’t listed to the publicdrug planswith the submitted drug, if the drug was listed to the public drugplans.
What is counterfactual scenario?Counterfactual scenario describes a scenario if theCEDAC/CDEC recommendation was not been implemented.Current scenario Counterfactual scenarionegative CDEC recommendation
What else can be counterfactual scenario?Counterfactual scenario describes a scenario if theCEDAC/CDEC recommendation was not been implemented.Current scenario Counterfactual scenariopositive CDEC recommendation
What is the Time Horizon?CEDAC/CDECRecommendationAt least 3 years historical claimsdata of the comparators3 years cost impactanalysis, disaggregated overtimeEnsuring that costs and savings relate to same time period, typically anannual period. Differences may arise if costs are incurred in earlyperiods
Was forecasting needed?Forecasting• If CEDAC recommendationwas made prior to 2009, noforecasting was needed, i.e.retrospective analysis• If CEDAC/CDECrecommendation was madepost 2009 forecasting usingcentral moving averageforecast was used
How was the market size determined?• Claims level data, using claimsstandardization and appropriatecomparators as per CDECrecommendations.• Claims standardization of 30 daysclaims was applied.• The market uptake of the new drug wasdetermined by proxy drug, private drugplans, public drug plan that have listed adrug, or RAMQ.• Assumed stable market
How is cost impact calculated at the end?The absolute difference in the total costs associated withthe two scenarios was used as a measure of the costimpact.C= C1d + C1AE +C1CR +C1AF –C2d -C2AE-C2CR-C2AFCd= drug costs for current drugs mixCAE=drug costs for adverse events managementCCR = condition related drug costs (if applicable)CAF = administration fees 6 case studies
Case studies• Spectrum of drug submissions with different issues to testmethodology to develop methods to address in full project• Different time of submission to assess both use of forecastingand examination of historic data• Different CDR recommendations• Single indication drugs only
Case study I – new combination therapyTelmisartan / Amlodipine FDC (Twynsta)Indication anti-hypertensionDate ofRecommendationDecember 16th, 2011CDECRecommendationDo ListReasons Bioequivalent to the same doses of itsindividual components givenseparately; cost is less than the cost ofits individual componentsManufacturersubmittedCost- minimization analysis
Case study I – new combination therapyYear 1 Year 2 Year 3 TotalCurrent Scenario $100,531,647 $106,546,644 $111,988,726 $319,067,017Counterfactual $106,094,939 $115,130,485 $122,633,383 $343,858,807Cost Impact - $5,563,292 - $8,583,840 - $10,644,656 -$24,791,788listedCurrent ScenarioNot listedmarket shares were re-distributed to the comparatorsCounterfactual Scenario
Case study II - OAB new treatmentOxybutynin chloride gel (Gelnique)Indication prevention of overactive bladder andurinary urgencyDate ofRecommendationMay 24, 2012*CDECRecommendationDo Not ListReasons Uncertain comparative clinical benefitManufacturersubmittedCost- minimization analysis*forecast required
Case study II-OCGnot listed0% market shareCurrent Scenariolistedmarket share growthbased on darifenacin andsolifenicin market uptake(2%,4%,6%)Counterfactual ScenarioYear 1 Year 2 Year 3 TotalCurrent Scenario $34,103,155 $35,423,598 $36,744,042 $131,361,274Counterfactual $34,453,266 $36,150,933 $37,875,712 $133,570,390Cost Impact -$350,111 -$727,335 -$1,131,670 -$2,209,116• costs include drug costs only.• no administration fees were applicable• confidential price, daily cost used based on Pharmastat• for Quebec
Case study IIIAmbrisentan (Volibris)Indication idiopathic (primary) pulmonary arterialhypertension and pulmonary arterialhypertension [PAH] associated with connectivetissue disease in patients with WHO functionalclass II or III symptoms who have not respondedto conventional therapy”Date ofRecommendationDecember 17, 2008CEDACRecommendationList with criteriaManufacturersubmittedCost- minimization analysis
Case Study IIIlisted10% market share after 3 yearsNot listedmarket shares were re-distributedto the comparators3 years totalCurrent Scenario $86,941,959Counterfactual $87,130,257Cost Impact $188,297Current Scenario Counterfactual Scenariono cost impact
What are the main assumptions?• Stability on the market• Off label use not considered• Drug costs only relevant• All benefit/cost borne my public drug plans• Claims based only analysis, such that number ofclaimants was estimated
What are the study limitations?• Only direct-pay claims were used for the analysis andreimbursement claims (paper-based claims) were excluded.• The units dispensed reflect the average number of tablets,millilitres of liquid, etc. and for some dosage forms the number ofunits may not be reliable due to inconsistent reporting.• Claims level data does not include indication.• Data from PEI and Manitoba were not available in the formatneeded for the analysis and therefore was not included in theanalysis.• Methods not applicable for each submission
What is next?• Expanding the project pilot• Addressing study limitations• Understanding the limits of claims level data and how tobest address them/ exploring alternative data sources• Conducting sensitivity analysis• Identifying areas that can have significant resource impactHealth Outcome Impact• Piloting techniques to link cost impact and cost-effectiveness, and deriving a health outcome impact (QALYimpact)