Skip to main content Accessibility help
×
Home

Use of Real-World Data Sources for Canadian Drug Pricing and Reimbursement Decisions: Stakeholder Views and Lessons for Other Countries

  • Don Husereau (a1), Edward Nason (a2), Tarun Ahuja (a3), Enkeleida Nikaï (a4), Eva Tsakonas (a5) and Philip Jacobs (a6)...

Abstract

Background

Canada has a long history of the use of clinical evidence to support healthcare decision making. Given improvements in data holdings and analytic capacity in Canada and stakeholder interest, the purpose of this study is to reflect on perceptions of the value of real-world evidence in pricing and reimbursement decisions, barriers to its optimal use in pricing and reimbursement, current initiatives that may lead to its increased use, and what role the pharmaceutical industry may play in this.

Methods/Results

To capture stakeholder perceptions, ninety-one participants identified as key stakeholders were identified according to background roles and geography and invited to participate in four round table discussions conducted under Chatham House rule. Important themes emerging from these discussions included: (i) the need to understand what “real world” evidence means; (ii) barriers to using real world evidence from differences in access, governance, inter-operability, system structures, expertise, and quality across Canadian health systems; (iii) differing views on industry's role.

Conclusions

The use of real-world data in Canada to inform pricing and reimbursement decisions is far from routine but nascent and slowly increasing. Barriers, including interoperability concerns, may also apply to other federated health systems that need to focus on the networking of healthcare administrative data across provincial jurisdictional boundaries. There also appears to be a desire to see better use of pragmatic trials linked to these administrative data sets. Emerging initiatives are under way to use real world evidence more broadly, and include identification of common data elements and approaches to networking data.

Copyright

Corresponding author

Author for correspondence: Don Husereau, E-mail: donh@donhusereau.com

References

Hide All
1.Sackett, DL (1969) Clinical epidemiology. Am J Epidemiol 89, 125128.
2.Desai, S, lsmail, SJ, Lerch, R, Warshawsky, BF, Gemmill, I (2015) Canada's National Advisory Committee on Immunization: Celebrating 50 years. Can J Infect Dis Med Microbiol 26, 126128.
3.No Authors listed (1979) The periodic health examination. Canadian Task Force on the Periodic Health Examination. Can Med Assoc J 121, 11931254.
4.Battista, RN, Côté, B, Hodge, MJ, Husereau, D (2009) Health technology assessment in Canada. Int J Technol Assess Health Care 25(Suppl 1), 5360.
5.Martin, J, Polisena, J, Dendukuri, N, Rhainds, M, Sampietro-Colom, L (2016) Local health technology assessment in Canada: Current state and next steps. Int J Technol Assess Health Care 32, 175180.
6.Sackett, DL, Rosenberg, WMC, Gray, JAM, Haynes, RB, Richardson, WS (1996) Evidence based medicine: What it is and what it isn't. BMJ 312, 7172.
7.Rocchi, A, Miller, E, Hopkins, RB, Goeree, R (2012) common drug review recommendations: An evidence base for expectations? PharmacoEconomics 30, 229246.
8.Panteli, D, Arickx, F, Cleemput, I, et al. (2016) Pharmaceutical regulation in 15 European countries review. Health Syst Transit 18, 1122.
9.Royle, P, Kandala, N-B, Barnard, K, Waugh, N (2013) Bibliometrics of systematic reviews: Analysis of citation rates and journal impact factors. Syst Rev 2, 74.
10.Jamali, A, Nedjat, S, Heidari, K, et al. (2015) Worldwide inequality in production of systematic reviews. Med J Islam Repub Iran 29, 309.
11.Rocchi, A, Menon, D, Verma, S, Miller, E (2008) The role of economic evidence in Canadian oncology reimbursement decision-making: To lambda and beyond. Value Health 11, 771783.
12.Jacobs, P, Roos, NP (1999) Standard cost lists for healthcare in Canada. Issues in validity and inter-provincial consolidation. PharmacoEconomics 15, 551560.
13.Roos, NP, Black, C, Frohlich, N, et al. (1996) Population health and health care use: An information system for policy makers. Milbank Q 74, 331.
14.Fisher, ES, Malenka, DJ, Wennberg, JE, Roos, NP (1990) Technology assessment using insurance claims. Example of prostatectomy. Int J Technol Assess Health Care 6, 194202.
15.Klemp, M, Frønsdal, KB, Facey, K, HTAi Policy Forum (2011) What principles should govern the use of managed entry agreements? Int J Technol Assess Health Care 27, 7783.
16.Lucyk, K, Lu, M, Sajobi, T, Quan, H (2015) Administrative health data in Canada: Lessons from history. BMC Med Inform Decis Mak 15, 69.
17.Morin, SN, Flegel, K (2017) A national health care data network is overdue. CMAJ 189, E951.
18.Chatham House (2019) Chatham House Rule. https://www.chathamhouse.org//node/44.
19.Institute of Health Economics (2017) Real-world evidence: What role can it play in real-world decision making? Summary Report. https://www.ihe.ca/advanced-search/real-world-evidence-what-role-can-it-play-in-real-world-decision-making-summary-report.
20.Institute of Health Economics (2016) About the real-world evidence into decision making roundtable. https://www.ihe.ca/events/past/conferences/rwedm/about-rwedm.
21.Institute of Health Economics (2014) About the Real World Evidence Roundtable. https://www.ihe.ca/events/past/conferences/real-world-evidence/about-rwe.
22.Scott, PJ, Rigby, M, Ammenwerth, E, et al. (2017) Evaluation considerations for secondary uses of clinical data: Principles for an evidence-based approach to policy and implementation of secondary analysis. A position paper from the IMIA Technology Assessment & Quality Development in Health Informatics Working Group. Yearb Med Inform 26, 5967.
23.Council of Canadian Academies (2015) Accessing health and health-related data in Canada: The expert panel on timely access to health and social data for health research and health system innovation. Ontario: Council of CanadianAcademies.
24.Garrison, LP, Neumann, PJ, Erickson, P, Marshall, D, Mullins, CD (2007) Using real-world data for coverage and payment decisions: The ISPOR Real-World Data Task Force report. Value Health 10, 326335.
25.McCabe, CJ, Stafinski, T, Edlin, R, Menon, D (2010) Access with evidence development schemes: A framework for description and evaluation. PharmacoEconomics 28, 143152.
26.Wodchis, W, Bushmeneva, K, Nikitovic, M, McKillop, I (2013) Guidelines on person-level costing using administrative databases in Ontario. https://tspace.library.utoronto.ca/handle/1807/87373.
27.Elshaug, AG, Moss, JR, Littlejohns, P, et al. (2009) Identifying existing health care services that do not provide value for money. Med J Aust 190, 269273.
28.Government of Alberta (2015) Government introduces new eye care program, saving millions for patients and taxpayers. https://www.alberta.ca/release.cfm?xID=386013C86CA06-B059-36C8-B0F92434C5C65946.
29.IC/ES (2019) Data & analytic services. https://www.ices.on.ca/DAS.
30.University Hospital Foundation. (2017) https://www.universityhospitalfoundation.ab.ca/jahip-competition.
31.Kalkman, S, van Thiel, G, Zuidgeest, MGP, Goetz, I (2017) Challenges of informed consent for pragmatic trials. J Clin Epidemiol doi:10.1016/j.jclinepi.2017.03.019
32.Kim, SYH, Miller, FG (2014) Informed consent for pragmatic trials--the integrated consent model. N Engl J Med 370, 769772.
33.Campbell, D (1969) Reforms as experiments. Am Psychol 24, 409429.
34.Canadian Institute for Health Information (2018) Pan-Canadian oncology drug data minimum data set. https://secure.cihi.ca/estore/productSeries.htm?pc=PCC1715.
35.Ivers, NM, Grimshaw, JM (2016) Reducing research waste with implementation laboratories. Lancet 388, 547548.
36.Canadian Institutes of Health Research (2012) SPOR SUPPORT Units. http://www.cihr-irsc.gc.ca/e/45859.html.
37.Chan, KK. Generating real world evidence to promote sustainability of cancer drug funding. www.cqco.ca/common/pages/UserFile.aspx?fileId=365985.
38.Government of Canada (2017) Remarks from the Honourable Jane Philpott, Minister of Health, to the Economic Club of Canada - May 16, 2017. https://www.canada.ca/en/health-canada/news/2017/05/economic_club_ofcanada-may162017.html?wbdisable=true.
39.Canadian Institutes of Health Research (2018) SPOR National Data Platform Webinar - Frequently asked questions - CIHR. http://www.cihr-irsc.gc.ca/e/50891.html#;1.
42.Suissa, S, Henry, D, Caetano, P, et al. (2012) CNODES: The Canadian Network for Observational Drug Effect Studies. Open Med 6, e134e140.
43.Birtwhistle, R, Keshavjee, K, Lambert-Lanning, A, et al. (2009) Building a pan-Canadian primary care sentinel surveillance network: Initial development and moving forward. J Am Board Fam Med 22, 412422.
44.Hennessy, DA, Flanagan, WM, Tanuseputro, P, et al. (2015) The Population Health Model (POHEM): An overview of rationale, methods and applications. Popul Health Metr 13, 24.
45.Canadian Centre for Applied Research in Cancer Control. About Canadian Centre for Applied Research in Cancer Control. https://cc-arcc.ca/.
46.Canadian Institutes of Health Research (2010) Strategy for patient-oriented research. http://www.cihr-irsc.gc.ca/e/41204.html.
47.Collier, R (2011) Federal government unveils patient-oriented research strategy. CMAJ 183, E993E994.
48.Canadian Research Data Centre Network (2017) About the CRDCN. https://crdcn.org/about-crdcn.
49.Canadian Institute for Health Information (2017) About CIHI. Information on Canada's health systems. https://www.cihi.ca/en/about-cihi.
50.Khan, S, Moore, JE, Gomes, T, et al. (2014) The Ontario Drug Policy Research Network: Bridging the gap between research and drug policy. Health Policy 117, 392398.
51.Dolan, D, Grainger, J, MacCallum, N, et al. (2012) The Institute for Clinical Evaluative Sciences: 20 years and counting. Healthc Q 15, 1921.
52.Roos, NP, Roos, LL, Freemantle, J (2011) Administrative data and the Manitoba Centre for Health Policy: Some reflections. Healthc Policy 6, 1628.
53.Chamberlayne, R, Green, B, Barer, ML, et al. (1998) Creating a population-based linked health database: A new resource for health services research. Can J Public Health 89, 270273.

Keywords

Type Description Title
UNKNOWN
Supplementary materials

Husereau et al. supplementary material
Husereau et al. supplementary material 1

 Unknown (5.8 MB)
5.8 MB

Use of Real-World Data Sources for Canadian Drug Pricing and Reimbursement Decisions: Stakeholder Views and Lessons for Other Countries

  • Don Husereau (a1), Edward Nason (a2), Tarun Ahuja (a3), Enkeleida Nikaï (a4), Eva Tsakonas (a5) and Philip Jacobs (a6)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed