Evidence, values, and funding decisions in Canadian cancer systems

Peacock, Stuart; Regier, Dean A.; Raymakers, Adam; Chan, Kelvin K.

doi:10.1177/0840470419870831

Cited by 7 publications

(3 citation statements)

References 25 publications

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“…There is currently a gap in examining underlying values which our study attempts to fill. There is a rich literature on the values to guide what services ought to be funded, particularly in a context where health technologies have exponentially growing price tags, with studies from Australia [ 33 , 34 ], or Canada [ [35] , [36] , [37] , [38] ]. Because of their focus on what to fund, identified values are centered around the benefits or effectiveness of health technologies and their safety or risks [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Population-based integrated care funding values and guiding principles: An empirical qualitative study

Laberge,

Brundisini,

Daniel

et al. 2024

Heliyon

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Section: Discussionmentioning

confidence: 99%

Population-based integrated care funding values and guiding principles: An empirical qualitative study

Laberge,

Brundisini,

Daniel

et al. 2024

Heliyon

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“…Once a submission is reviewed, pERC provides provincial and territorial decision makers with recommendations regarding whether a drug should be reimbursed. Some provinces have also established their own review boards such as the Priorities Evaluation Committee in BC and the Ontario Steering Committee on Cancer Drugs in ON [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Despite pCODR support in reimbursement recommendations, it is known that resource allocation occurs differently across provinces. Public coverage for the same drug can differ province to province, which has led to concern about possible “fragmentation” of the cancer system across Canadian provinces [ 8 ]. Dependent on the jurisdiction, one drug might be covered under a public plan, whereas it will not be covered in another.…”

Section: Introductionmentioning

confidence: 99%

Describing Sources of Uncertainty in Cancer Drug Formulary Priority Setting across Canada

et al. 2021

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Over the years, there have been significant advances in oncology. However, the rate that therapeutics come to market has increased, while the strength of evidence has decreased. Currently, there is limited understanding about how these uncertainties are managed in provincial funding decisions for cancer therapeutics. We conducted qualitative interviews with six senior officials from four different Canadian provinces (British Columbia, Alberta, Quebec, and Ontario) and a document review of the uncertainties found in submissions to the pan-Canadian Oncology Drug Review (pCODR). Participants reported considerable uncertainty related to a lack of solid clinical evidence (early-phase clinical trials: generalizability, immature data, and the use of unvalidated surrogate outcomes). Proposed strategies to deal with the uncertainty included risk-sharing agreements, collection of real-world evidence (RWE), and ongoing collaboration between federal groups and provinces. The document review added to the reported uncertainties by classifying them into five main categories: trial validity, population, comparators, outcomes, and intervention. This study highlights how decision makers must deal with significant amounts of uncertainty in funding decisions for cancer drugs, most of which stems from methodological limitations in clinical trials. There is a critical need for transparent priority-setting processes and mechanisms to reevaluate drugs to ensure benefit given the high level of uncertainty of novel therapeutics.

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How vision and leadership shaped the U.S. National Cancer Institute's 50-year journey to advance the evidence base of cancer control and cancer care delivery research

Kaluzny¹,

O’Brien²

2020

Health Policy OPEN

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In 1971, Congress passed the National Cancer Act, landmark legislation that reorganized the National Institutes of Health's National Cancer Institute (NCI). The Act included a new focus on cancer control, including the requirement that the NCI award research grants and contracts, in collaboration with other public agencies and private industry, to conduct cancer control activities related to the diagnosis, prevention, and treatment of cancer. The requirement placed the NCI at the nexus of a rapidly changing science and a complex and dynamic healthcare delivery system and involved an evolutionary transformation to advance cancer control and cancer care delivery research along the cancer care continuum. Analysis is based on a qualitative ethnographic approach using historical records, oral histories, and targeted interviews. The multimethod approach provided the opportunity to describe to the vision, leadership, and struggle to build an infrastructure, expand expertise, and forge collaboration with the NCI and a complex and changing healthcare system. As the 50th anniversary of the National Cancer Act approaches in 2020, the process and these achievements are at risk of being taken for granted or lost in the flow of history. Documenting the process, milestones, and key players provides insight and guidance for continuing to improve cancer care, advance research, and reduce cancer incidence and mortality. Cancer care is a microcosm of the larger healthcare system providing insight and lessons on the importance of developing and maintaining a research infrastructure and the role of multi- level collaboration and partnerships involving both the private and public sectors.

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Evidence, values, and funding decisions in Canadian cancer systems

Cited by 7 publications

References 25 publications

Population-based integrated care funding values and guiding principles: An empirical qualitative study

Population-based integrated care funding values and guiding principles: An empirical qualitative study

Describing Sources of Uncertainty in Cancer Drug Formulary Priority Setting across Canada

How vision and leadership shaped the U.S. National Cancer Institute's 50-year journey to advance the evidence base of cancer control and cancer care delivery research

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