Panel Value Frameworks for Cancer Therapies: Are they Useful in the Context of Canadian Health Technology Assessments and Reimbursement Decisions? 2017 CADTH Symposium Ottawa, April, 24th, 2017 Reiner Banken M.D. M.Sc. Consultant reiner@reinerbanken.com 514 819-8294
Conflicts of interest Work in a governmental HTA agency for many years. Work as a consultant with different companies over the last 12 months. No active industry contract. Ongoing work with the Institute for Clinical and Economic Review in Boston. Support from Colorectal Cancer Association of Canada
A universe of values Societal values Individual values Values of groups Value for money Values of the health system.
Values for assessing medications for public coverage in Québec 7. In exercising the functions described in paragraph 8 of section 5, the institute must first assess the therapeutic value of a medication. If this is not established to its satisfaction, the institute sends a notice to that effect to the Minister. If the institute considers that the therapeutic value of a medication has been established, it sends its recommendation to the Minister after assessing (1) the reasonableness of the price charged; (2) the cost-effectiveness ratio of the medication; (3) the impact that entering the medication on the list will have on the health of the general public and on the other components of the health and social services system; An Act respecting the Institut national d excellence en santé et en services sociaux http://bit.ly/m6qzqt
Which values to include? Should we include the rule of rescue? The rule of rescue applies to identifiable victims for whom the life expectancy returns to normal after rescue. Rarely applicable for cancer patients? A dialogue is needed on which values to include in frameworks for the reimbursement of cancer therapies.
Proposed modified MCDA ICER reports will explicitly delineate other benefits or disadvantages and contextual considerations as the following 10 elements: Unmeasured patient health benefits Relative complexity of the treatment regimen that is likely or demonstrated to significantly affect adherence and outcomes Impact on productivity and ability of the patient to contribute to personal and national economic activity Impact on caregiver burden Impact on public health New mechanism of action that is likely to help patients who have not responded to other treatments Severity of the untreated condition Lifetime burden of illness Lack of availability of any previous treatment for the condition Other ethical, legal, or social considerations that might strongly influence the overall value of an intervention to patients, families and caregivers, the health system, or society Slide from Webinar Febuary, 13, 2017, available at http://icer-review.org/wpcontent/uploads/2016/02/icer-value-assessment-proposed-updates-webinar-021317.pdf
Proposed modified MCDA The average weighting from 1-5 will be used to assign a single ICER from within the range of $50,000-$150,000 per QALY included in the draft evidence report. This single ICER will be used as the threshold at which a single value-based price benchmark will be calculated. Other benefits/contextual considerations average score 1 $50,000 per QALY 2 $75,000 per QALY 3 $100,000 per QALY 4 $125,000 per QALY 5 $150,000 per QALY Associated incremental costeffectiveness ratio used as threshold for final value-based price benchmark Slide from Webinar Febuary, 13, 2017, available at http://icer-review.org/wpcontent/uploads/2016/02/icer-value-assessment-proposed-updates-webinar-021317.pdf
http://www.modernhealthcare.com/article/20170314/news/170319977?
A value framework for Canada? 1. Discussions an a Canadian value framework would be useful for enabling a dialogue on values for reimbursement of cancer therapies. 2. Patient organisations could act as catalysers between the economic, scientific, administrative and political perspectives 3. Considering the growing uncertainties of effectiveness, a framework for developing value would be more appropriate.