(020) Health Technology Assessment Reports for Non-Oncology Medications in Canada from 2018 to 2022: A comparison Between Manufacturer and Common Drug Review analyses

Background: Identifying key differences between a manufacturer's submitted health technology assessment (HTA) and the Canada's Common Drug Review (CDR) economic reanalysis is an important step toward understanding reimbursement recommendations. We conducted a comparison of the manufacturers’ analysis with the CDR reanalysis with respect to incremental costs utility ratio (ICUR) and 3-year budget impact analysis (BIA).

Objectives: To identify HTA differences between manufacturer's submissions and the re-analyses conducted by the Canadian HTA agency responsible for making reimbursement recommendations to the public drug plans.

Methods: A pair of reviewers extracted data from the manufacturers' clinical and economic reports that are publicly available from 2018 to 2022. Wilcoxon rank test was used to assess the difference between incremental QALY, ICUR, and BIA in the manufacturers submission and the CDR reanalysis. Chi-square tests and logistic regression were used to assess the relationship between the variables and the final CDR recommendation.

Results: Of 178 reports assessed, 31 received a "do not reimburse" recommendation and 147 received a "reimburse with criteria or conditions". The median ICUR in the manufacturers’ analyses was $138,658/QALY, which was 2.5-fold lower than the results in the re-analyses by CDR which was $380,251/QALY (p < 0.001). The median CDR re-analysis for 3-year BIA was $4,575,102 which was 27% higher than the manufacturer's submitted 3-year BIA (p < 0.001).

Conclusions: Manufacturers’ economic analyses tend to underestimate costs or overestimate the effects of the medications when compared to the methodology used by the Canadian HTA agency and the CDR advisory committee.