AFFORD - Appropriate eFfective eFficient Oncology Reimbursement Decisions

Two out of five Canadians will experience cancer during their lives. Despite benefits such as a longer and higher quality of life, most patients cannot afford cancer drugs. Canadians rely on government to fund the most appropriate drugs for them. Governments have limited budgets; Provinces choose whether or not to fund new drugs. Decisions, often based on recommendations of regional committees, have varied across jurisdictions; drugs available in one Province are often unavailable in another. Recently, the pan Canadian Oncology Drug Review (pCODR) was formed to increase consistency by making recommendations relevant to all Canadian regions. pCODR and Provincial committees rely on multiple criteria: reports of clinical effects, economic costs, ethical principles, patient perspectives, etc. Studies show that committees experience challenges, two of which we address: (i) committee members as knowledge users have different expectations of what economic analyses should offer compared to producers of economic analyses; (ii) there is no explicit, standardized method to balance multiple criteria in the decision process. pCODR has identified a need for a guidance tool to use in the decision process. We will develop this tool from our analysis of current choices of pCODR committees, their priorities, and their needs. Using mixed methods we will assess: (i) the gap in expectations between producers and users of economic analyses; and (ii) current approaches to weighing multiple criteria. Using a round-table discussion and iterative interviews we will evaluate reactions of committee members to the analysis of their own choices. Using thematic analysis, we will develop the guidance tool and an academic conceptual framework. The impact will be far-reaching; pCODR recommendations to all jurisdictions will be arrived at in a systematic, standardized, and transparent manner. Patients will better understand why a specific drug was or was not recommended for funding.