Cadth 2015 breakfast 3 4. c. volume smith seb panel private payer perspective
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Private payers must consider member experience, workforce retention, and plan sustainability when evaluating specialty drug benefits (SEBs) given the competitive benefits environment. While traditional cost control methods like pricing levers, prior authorizations, and generic incentives may not reduce SEB costs as much as expected, the potential savings from SEBs are still substantial due to overall drug costs. Payers now understand the complexity of SEBs involving patients, biologics, and costs, and want sustainable solutions that don't negatively impact members while remaining open to opportunities.
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Adaptive clinical trial designs are increasingly used in commercial trials due to demands for faster evidence and more efficient trials. However, health technology assessment decision-making typically requires large parallel randomized controlled trials, creating a mismatch. Without long-term placebo/control data or trials that resemble approved treatment algorithms, innovative trial designs risk not providing sufficient evidence for reimbursement decisions. To address this, more education is needed on innovative designs for health technology assessors, and trials should apply these designs to further validate their ability to provide robust evidence for reimbursement.
Cadth 2015 e1 2015 04 cadth v2.0
This document summarizes a panel discussion on integrating evidence, values and ethics into healthcare decision-making using multicriteria decision analysis (MCDA). It discusses how MCDA can help address ethical dilemmas by explicitly considering multiple criteria, including efficacy, safety, costs, and other social values. It outlines the key steps in MCDA, including defining objectives and criteria, assigning weights to criteria, synthesizing evidence on the criteria, scoring performance on criteria, and aggregating scores to determine the overall value of interventions. The document emphasizes that MCDA supports making decisions in a way that is participatory, transparent, systematic and reflective of different stakeholder perspectives to arrive at decisions that optimize health in its widest sense.
Cadth 2015 e4 adaptive design april 2015 final lourenco
Health Canada regulates clinical trials and drug approvals. Adaptive clinical trial designs are increasing and can modify aspects of ongoing trials using accumulating data. Health Canada's main concerns are appropriate scientific questions, error control, and avoiding bias. Examples seen include adaptive randomization, sample size changes, and seamless phase 2/3 designs. Case studies demonstrate increased complexity, new statistical methods, and more simulation use. Health Canada recommends early consultation and education on adaptive designs.
Cadth symposium 2015 d3 pr os va. generic measures cadth 14th april 2015
This document discusses the use of generic and condition-specific patient-reported outcome measures (PROs) in value-based healthcare reimbursement decisions. It compares the EQ-5D-3L generic PRO to the PuQol_UI condition-specific PRO for pressure ulcers. The condition-specific measure was more sensitive to pressure ulcer severity levels compared to the generic measure. Using different PROs can lead to different assessments of treatment value and impact reimbursement decisions. The document concludes that using PROs in reimbursement requires care, as it can impede equitable decision-making and comparing "apples to oranges" treatments.
Cadth 2015 d5 symposium 2015 endonodal trials - version 2
This document discusses methods for incorporating single-arm study data into network meta-analyses (NMAs). Currently, NMAs primarily use data from randomized controlled trials. The document presents two methods for including single-arm evidence: 1) Using single-arm results to create informative priors in Bayesian NMA models, and 2) Creating "virtual comparisons" based on patient characteristics to include single-arm studies directly in the NMA. It provides examples applying these methods in analyses of treatments for cryptococcal meningitis and hepatitis C. The results showed inclusion of single-arm evidence can improve model fit and precision of treatment effect estimates in NMAs.
Cadth 2015 e5 ad panel discussion af
The document discusses guidelines from different committees on oral anticoagulants for atrial fibrillation stroke prevention that show some discordance despite being based on the same three landmark trials. It suggests that values influence guideline committees and prescribing specialists differently, and that patient values through shared decision making should also be considered to tailor therapy to individual patients.
Cadth 2015 e5 noac ad symposium_panel_14apr2015
This document summarizes a symposium on promoting evidence-based use of anticoagulants across Canada. It discusses the prevalence of atrial fibrillation, options for anticoagulation including warfarin and newer oral anticoagulants, and initiatives for collaboration between provinces to educate health professionals and patients on appropriate anticoagulant therapy. Speakers from various provinces outlined academic detailing programs and a CADTH systematic review comparing benefits and harms of anticoagulants.
Cadth 2015 b1 slides allan grill-pcodr-cadth_symposium2015presentationfinal
The document discusses discordance between recommendations from the pan-Canadian Oncology Drug Review (pERC) and provincial funding decisions for cancer drugs in Canada. It presents results from a survey of provincial drug funding decision-makers that identified several potential reasons for discordance, including differences in priorities, clinical evidence, and budget constraints between the levels. Challenges to alignment included issues with clinical trial evidence as well as pressure to expand access, while suggested solutions centered on strengthening consensus around treatment pathways and priorities nationally.
Cadth 2015 breakfast 2 excel hta tools presentation final
The document provides an overview of CADTH Excel-based health technology assessment tools that have been developed or are in development. It summarizes NetMetaXL, an Excel-based tool for conducting network meta-analyses of dichotomous outcomes. The presentation includes a live demo of NetMetaXL and previews of three other CADTH Excel-based HTA tools.
Cadth 2015 d7 burgess cadth 2015 20150414
This document discusses different forms of public engagement that could be appropriate for drug policy decisions. It notes that deliberative public engagement events can incorporate diverse perspectives but may not be fully representative. It advocates for participatory governance with advisory bodies that regularly refresh their engagement to better reflect the public. Experiments with different engagement methods should be assessed to help balance input with decision efficiency.
Cadth 2015 d7 presentation 2015 14 apr15
This document presents a framework for strengthening public and patient engagement in Health Quality Ontario's evidence review process. Key elements of the framework include articulating goals and principles, establishing a common language, describing a menu of engagement approaches matched to process stages, and identifying measures. The framework was developed through a review of literature and practices, expert consultation, and stakeholder dialogue. It recommends increasing transparency, incorporating diverse perspectives throughout stages, and evaluating engagement impacts. The framework provides guidance to enhance public and patient contributions to health technology decision-making in Ontario.
Cadth 2015 d4 lidia engel final
This document discusses challenges associated with going beyond health-related quality of life measures in cost-utility analysis. It notes that while economic evaluations often use quality-adjusted life years (QALYs) based on health-related quality of life instruments like EQ-5D, interventions can provide benefits beyond health alone. There are theoretical, normative, conceptual and methodological challenges to incorporating these broader outcomes. Measuring instruments have been developed to capture non-health domains, but valuing these outcomes poses challenges. Considering non-health outcomes increases complexity, but may provide a more comprehensive assessment.
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- 1. SEBs: Private Payer Perspective Carlyn Volume-Smith, B.Sc.Pharm., M.Sc., Ph.D. Senior Manager, Benefit Services
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- 3. Traditionally…… • Price levers • Drug plan features – Special authorization – Restricted benefits – Management limitations • Generic pricing
- 4. SEBs: a new beast…. • Looked at our traditional sources… – Health Canada – CADTH – Provincial drug plans – Clinical guidelines and experience • % savings from SEBs not as substantial as first thought, but the absolute amount of potential savings is impressive
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