Evaluation of the clinical benefit of cancer drugs submitted for reimbursement recommendation decisions in Canada

Researchers compared the clinical evidence and benefit of cancer drugs that receive a positive reimbursement recommendation in Canada vs. drugs that receive a negative recommendation. Based on clinical trial documentation and documents from the pan-Canadian Oncology Drug Review (pCODR), 104 cancer drugs with a solid tumor indication were submitted for reimbursement decisions between July 2011 and February 2020. The pCODR recommended in favor of 78 submissions and against 26. Phase III randomized trial design was represented in more than 92% of the positive submissions but only about 54% of the negative ones. Drugs that got the thumbs up from pCODR also were more likely to have a substantial benefit according to the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS) than were drugs that got a thumbs down. Still, only one-half of the 78 drugs backed by the review board demonstrated improved overall survival. Moreover, those survival benefits were modest at best. Many cancer medications lacking substantial clinical benefit nonetheless earn reimbursement in the Canadian market, despite pCODR’s vetting of evidence quality, extent of clinical benefit, and cost-efficacy, according to the study authors.