Drug coverage based on cost, effectiveness works: study
Last Updated: Thursday, October 8, 2009 | 10:32 AM ET
CBC News
Provincial drug plans often follow the coverage recommendations of Canada's Common Drug Review board. Boards that influence drug coverage in Canada, Britain and Australia all recommended an expensive drug to treat age-related macular degeneration, which shows cost is not necessarily a barrier to gaining coverage, a new study says.
The three countries all have publicly run health-care systems but structure them differently.
Clinical effectiveness of a drug is a common factor used to assess which drugs to reimburse in all three countries, Dr. Braden Manns and Fiona Clement of the University of Calgary and their colleagues reported in Wednesday's issue of the Journal of the American Medical Association.
"Perhaps the main lesson from the experience of the three countries is that systematic, durable, and widely accepted decisions can be made using comparative effectiveness and cost-effectiveness," they concluded.
Ranibizumab, or Lucentis, a costly drug for age-related macular degeneration, was recommended by all three agencies, which shows that expensive medications are funded when there is strong evidence they work in at least some patients, the researchers said.
Different decisions about coverage
The three review boards don't always come to the same decisions about drug coverage.
Of the 199 submissions to the U.K. regulatory body, 174 (87.4 per cent) drugs were recommended for coverage, compared with 60 out of 121 (49.6 per cent) in Canada and 153 out of 282 (54.3 per cent) in Australia.
Insulin glargine, or Lantus, was rejected by a Canadian review board because of its high price. In Australia, the drug was accepted only after the manufacturer revised the application four times and dropped the price. In Britain, it was approved for Type 1 diabetes and a small subset of people with Type 2 diabetes.
The third drug the researchers looked at, teriparatide, or Forteo, for osteoporosis, was rejected by all three review agencies because the evidence relied on a placebo as a control rather than a comparison with other drugs in the same class.
In the U.S., whether a drug has been shown to be effective is not a factor in coverage decisions for Medicare and Medicaid, publicly funded programs that will likely cost taxpayers close to $1 trillion US in the next five years, the researchers said.
Canada's Common Drug Review was established in 2002 to standardize prescription drug coverage. The decisions are based on applications from manufacturers and are not binding on provincial drug plans although they are followed about 90 per cent of the time, Manns said.
In Australia, unfavourable decisions are binding, but the minister can deny coverage for a drug recommended by the committee.
The United Kingdom typically evaluates classes of drugs that have had regulatory approval for longer, compared with the Canadian and Australian systems.
The Canadian Agency for Drugs and Technologies in Health funded the study, and the researchers also received support from the Canadian Health Services Research Foundation, the Alberta Heritage Foundation for Medical Research, and the Canadian Institutes for Health Research.
