Background
Methods
Identification of DRDs
Collection of data on included DRDs
Data extraction
Data analysis
Creation of variables
Variable | Values | Details |
---|---|---|
Recommendation | 0 if negative 1 if positive | • Negative: do not list • Positive: list, list with conditions, list with criteria, list if price reduced or cost-effectiveness improved |
Submission characteristics | ||
Year of recommendation | Continuous variable | • Year of final recommendation |
Type of submission | 0 if new submission 1 if resubmission | • Type of submission according to CADTH classification |
Presence of RCTs | 0 if no 1 if yes | • RCTs were included in the systematic review |
Therapeutic class of drugs | 0 if alimentary tract & metabolism 1 if Antineoplastic & immunomodulating 2 if other | • Classification of drugs based on ATC codes |
Characteristics of disease | ||
Type of condition | 0 if cancer 1 if non-cancer | • Classification based on ICD-10 |
Prevalence | 0 if ultra-orphan 1 if orphan | • Ultra-orphan: < 1 in 100,000 people • Orphan: < 1 in 2000 people |
Clinical need | 0 if no or not stated 1 if yes | • Need for alternative treatment options, no existing treatment or “unmet need” |
Clinical safety/efficacy | ||
Safety issues | 0 if yes 1 if no | • Concerns over potential serious life-threatening adverse events or unknown safety profiles |
Improvements in biomarker/ surrogate outcome | 0 if no, inconsistent or not measured 1 if yes | • Biomarker is “a defined characteristic that is measured as an indicator of normal biological process, pathogenic process, or responses to an exposure or intervention, including therapeutic interventions” [17]. • Surrogate outcome is “an endpoint that is used in clinical trials as a substitute for a direct measure of how a patient feels, functions, or survives” [17]. • Meaningful improvements defined as statistically significant differences or non-inferiority in biomarker/ surrogate outcomes (e.g. weight, 6 min walk test, progression-free survival) |
Improvements in clinical outcomes | 0 if no, inconsistent or not measured 1 if yes | • Clinical outcome is “an outcome that describes or reflects how an individual feels, functions or survives” [17]. • Meaningful improvements defined as statistically significant differences or non-inferiority in clinical outcomes (e.g. survival, transplantation) |
Improvements in PRO | 0 if no, inconsistent or not measured 1 if yes | • PRO is “a measurement based on a report that comes directly from the patient about the status of a patient’s health condition without amendment or interpretation of the patient’s response by a clinician or anyone else” [17]. • Meaningful improvements defined as statistically significant differences or non-inferiority in PRO (e.g. QOL, rating of pain intensity, SF-36) |
Quality of evidence | ||
Availability of comparative data | 0 if no 1 if yes | • Based on availability of direct head-to-head comparative studies (where comparators were available) |
Consistency between population in trials and indications | 0 if no 1 if yes | • Present when ‘final recommendation’ document stated that data from trials included all subgroup of the indicated population • Not present when for example submitted indication includes mild, moderate, and severe forms of disease but trial data limited to mild-moderate forms of disease |
Bias in outcome measures | 0 if yes 1 if no | • Present when indicated in the final recommendation document • Bias in outcome measurements (e.g., subjective outcomes classified by non-blinded investigators) |
Long term data | 0 if no 1 if yes | • Presence of long-term data where long-term data is important given the course of disease • Present when indicated in the final recommendation document |
Other study design issues | 0 if yes 1 if no | • Concerns over other aspects of study design (e.g., small sample size, carry-over effects associated with withdrawal trial methodology) • Present when indicated in the final recommendation document |
Cost/ cost-effectiveness | ||
Daily treatment cost | Continuous variable in $CDN/ patient | • Average daily treatment cost of drugs per patient |
ICER | Continuous variable in $CDN/QALY | • ICER calculated by CADTH or by manufacturer if no ICER calculated by CADTH was available |
Statistical analysis
Results
Factors | n | Positive recommendations | % Positive | p-value |
---|---|---|---|---|
All | 103 | 82 | 79.6 | – |
Therapeutic class of drug | 0.711 | |||
Alimentary tract & metabolism | 11 | 10 | 90.9 | |
Antineoplastic & immunomodulating | 78 | 61 | 78.2 | |
Others | 14 | 11 | 78.6 | |
Type of condition | 0.879 | |||
Cancer | 66 | 53 | 80.3 | |
Endocrine | 16 | 12 | 75.0 | |
Others | 21 | 17 | 80.9 | |
Type of submission | 0.070 | |||
New | 92 | 71 | 77.2 | |
Resubmission | 11 | 11 | 100.0 |
All new submissions | Non-Cancer drugs | Cancer drugs | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Factors | n | Positive recommendations | % Positive | p-value* | n | Positive recommendations | % Positive | p-value* | n | Positive recommendations | % Positive | p-value* |
All | 92 | 71 | 77.2 | 35 | 27 | 77.1 | 57 | 44 | 77.2 | |||
Type of condition | 0.996 | |||||||||||
Cancer | 57 | 44 | 77.2 | |||||||||
Non-cancer | 35 | 27 | 77.1 | |||||||||
Submission characteristics
| ||||||||||||
Presence of RCTs | 0.083 | 0.033 | 0.727 | |||||||||
No | 22 | 14 | 63.6 | 7 | 3 | 42.9 | 15 | 11 | 73.3 | |||
Yes | 70 | 57 | 81.4 | 28 | 24 | 85.7 | 42 | 33 | 78.6 | |||
Therapeutic class of drug | 0.714 | 0.418 | NA | |||||||||
Alimentary tract & metabolism | 10 | 9 | 90.0 | 10 | 9 | 90.0 | ||||||
Antineoplastic & immunomodulating | 68 | 51 | 75.0 | 11 | 7 | 63.6 | ||||||
Others | 14 | 11 | 78.6 | 14 | 11 | 78.6 | ||||||
Characteristics of disease
| ||||||||||||
Prevalence | 1.000 | 1.000 | 1.000 | |||||||||
Ultra- orphan | 14 | 11 | 78.6 | 8 | 6 | 75.0 | 6 | 5 | 83.3 | |||
Orphan | 78 | 60 | 96.9 | 27 | 21 | 77.8 | 51 | 39 | 76.5 | |||
Clinical need | 0.051 | 0.419 | 0.070 | |||||||||
No/ not stated | 28 | 18 | 64.3 | 20 | 14 | 70.0 | 8 | 4 | 50.0 | |||
Yes | 64 | 53 | 82.8 | 15 | 13 | 86.7 | 49 | 40 | 81.6 | |||
Clinical safety/ efficacy
| ||||||||||||
Safety issues | 0.021 | 0.226 | 0.102 | |||||||||
Yes | 33 | 21 | 63.6 | 11 | 7 | 63.6 | 22 | 14 | 63.6 | |||
No | 59 | 50 | 84.7 | 24 | 20 | 83.3 | 35 | 30 | 85.7 | |||
Improvements in biomarker/surrogate outcomes | 0.316 | 0.228 | 0.006 | |||||||||
No/ inconsistent/ not measured | 27 | 19 | 70.4 | 17 | 15 | 88.2 | 10 | 4 | 40.0 | |||
Yes | 65 | 52 | 80.0 | 18 | 12 | 66.7 | 47 | 40 | 85.1 | |||
Improvements in clinical outcomes | 0.005 | 0.073 | 0.084 | |||||||||
No/ inconsistent/ not measured | 66 | 46 | 69.7 | 25 | 17 | 68.0 | 41 | 29 | 70.7 | |||
Yes | 26 | 25 | 96.1 | 10 | 10 | 100.0 | 16 | 15 | 93.7 | |||
Improvements in PRO | 0.010 | 0.299 | 0.042 | |||||||||
No/ inconsistent/ not measured | 67 | 47 | 70.1 | 29 | 21 | 72.4 | 38 | 26 | 68.4 | |||
Yes | 25 | 24 | 96.0 | 6 | 6 | 100.0 | 19 | 18 | 94.7 | |||
Quality of evidence
| ||||||||||||
Availability of comparative data | 0.427 | 1.000 | 0.510 | |||||||||
No | 33 | 27 | 81.8 | 14 | 11 | 78.6 | 19 | 16 | 84.2 | |||
Yes | 59 | 44 | 74.6 | 21 | 16 | 76.2 | 38 | 28 | 73.7 | |||
Consistency between population in trials and indications | 0.130 | 0.431 | 0.345 | |||||||||
No | 48 | 34 | 70.8 | 21 | 15 | 71.4 | 27 | 19 | 70.4 | |||
Yes | 44 | 37 | 84.1 | 14 | 12 | 85.7 | 30 | 25 | 83.3 | |||
Bias in outcome measures | 0.503 | 0.216 | 1.000 | |||||||||
Yes | 54 | 43 | 79.6 | 12 | 11 | 91.7 | 42 | 32 | 76.2 | |||
No | 38 | 28 | 73.7 | 23 | 16 | 69.6 | 15 | 12 | 80.0 | |||
Long term data | 0.186 | 0.390 | 0.346 | |||||||||
No | 62 | 45 | 72.6 | 25 | 18 | 72.0 | 37 | 27 | 73.0 | |||
Yes | 30 | 26 | 86.7 | 10 | 9 | 90.0 | 20 | 17 | 85.0 | |||
Other study design issues | 0.202 | 1.000 | 0.044 | |||||||||
Yes | 58 | 42 | 72.4 | 19 | 15 | 78.9 | 39 | 27 | 69.2 | |||
No | 34 | 29 | 85.3 | 16 | 12 | 75.0 | 18 | 17 | 94.4 | |||
Cost/ cost-effectiveness
| ||||||||||||
Daily treatment cost | 1.000 | 0.298 | 0.258 | |||||||||
≤ 150 | 19 | 15 | 78.9 | 13 | 12 | 92.3 | 6 | 3 | 50.0 | |||
150–500 | 52 | 40 | 76.9 | 8 | 5 | 62.5 | 44 | 35 | 79.6 | |||
> 500 | 21 | 16 | 76.2 | 14 | 10 | 71.4 | 7 | 6 | 85.7 | |||
ICER in $CDN/QALYs a | 0.647 | 1.000 | 0.194 | |||||||||
≤ 100,000 | 12 | 11 | 91.7 | 2 | 2 | 100.0 | 10 | 9 | 90.0 | |||
100,000-500,000 | 48 | 37 | 77.1 | 7 | 6 | 85.7 | 41 | 31 | 75.6 | |||
> 500,000 | 16 | 13 | 81.2 | 12 | 11 | 91.7 | 4 | 2 | 50.0 |
Variables in the model | OR (95%CI) |
---|---|
Presence of RCTs (ref.: no) | 2.9 (0.7; 11.8) |
Safety issues (ref: yes) | 4.0 (1.2; 13.6) |
Improvements in clinical outcomes (ref: yes) | 20.6 (2.2; 189.7) |
Improvements in patient reported outcomes (ref: yes) | 12.1 (1.3; 110.5) |
Consistency between population in trial and indications (ref: no) | 3.5 (0.9; 12.7) |