Comparison of drug coverage in Canada before and after the establishment of the pan-Canadian Pharmaceutical Alliance.

OBJECTIVES: This study was conducted to determine whether establishment of the pan-Canadian Pharmaceutical Alliance (pCPA) was associated with significant changes in drug listing decisions across Canada. ANALYSIS AND RESULTS: This study included drug indications that received a Common Drug Review or pan-Canadian Oncology Drug Review listing recommendation within 3 years before ('pre-PCPA era' group; n=79) and 3 years after ('PCPA era' group; n=91) the pCPA was established in August 2010. At the time of this study (30 April 2014), nine pCPA-participating jurisdictions had listed 35-59% of drug indications in the pre-pCPA era group and a nearly identical range, 36-59%, in the pCPA era group. Within the pCPA-era group, 31 drug indications (34%) had completed pCPA negotiations ('pCPA negotiation' subgroup); the jurisdictions had listed 39-77% of these drug indications. Comparison of the pCPA era group to the pre-pCPA era group indicated that the proportion listed did not change significantly in any jurisdiction, and time-to-listing increased significantly in New Brunswick and decreased significantly in Alberta, Manitoba, and Ontario. When the pCPA negotiation subgroup was compared to the pre-pCPA era group, the proportion listed increased significantly in British Columbia, Saskatchewan, Manitoba and Newfoundland and Labrador, and time-to-listing increased significantly in New Brunswick and Nova Scotia and decreased significantly in Manitoba and Ontario. A sensitivity analysis suggested more favourable results regarding the pCPA's impact. CONCLUSIONS: While the pCPA might have had a varied effect on time-to-listing, this study's primary analysis did not observe a significant impact on the overall proportion of new drug indications listed across jurisdictions. This may be due to the fact that, at the time of this study, only a limited number of drug indications had completed pCPA negotiations. This study provides a framework for future evaluations of the pCPA's impact as it continues to evolve.

The impact of practice guidelines and funding policies on the use of new drugs in advanced non-small cell lung cancer.

BACKGROUND: Cancer Care Ontario's (CCO) Program in Evidence-based Care has provided a credible basis for policy development and the funding of new and expensive anticancer drugs in the province of Ontario. In November 1997, vinorelbine was approved for the first-line treatment of advanced non-small cell lung cancer (NSCLC) on the basis of evidence-based practice guidelines generated by the Provincial Lung Disease Site Group. In June 1998, gemcitabine was approved as an alternative to vinorelbine for use in selected patients (e.g. significant venous access problems, peripheral neuropathy, severe toxicity to vinorelbine). A provincial drug database was used to determine the impact that these new policies had on the rate of vinorelbine and gemcitabine uptake within the CCO new drug funding programme. METHODS: Drug utilization data for vinorelbine and gemcitabine from October 1997 to June 1999 were obtained from the CCO drug database. Individual patient data consisted of age, gender, first-line agent used, number of treatments, duration of therapy, treatment location (regional cancer centre vs. other) and total cost. Demographic and drug utilization data were analysed descriptively as means, medians, or proportions. Multivariable logistic regression analysis was then used to identify factors associated with the selection of gemcitabine over vinorelbine, as a first-line therapy. RESULTS: Following the approval of the first policy in November 1997, there was a rapid adoption of vinorelbine use in new NSCLC patients. When the gemcitabine policy was approved in June 1998, there was a rapid uptake in its use reaching a stable plateau of approximately 15% of all NSCLC patients within 9 months. The logistic regression analysis identified patient age greater than 65 years [odds ratio (OR) = 1.90, P = 0.001] and treatment in a non-regional cancer setting (OR = 1.71, P = 0.008) as significant predictors of gemcitabine utilization. Overall, the mean drug cost per patient treated with first-line gemcitabine was significantly higher than vinorelbine (Can 2590 dollars vs. Can 1030 dollars, P < 0.001). CONCLUSIONS: The new funding policies were associated with a rapid increase in drug utilization reaching a stable plateau within 9 months. Factors contributing to the usage of these new drugs for NSCLC included patient characteristics, such as age and treatment location.

Are health care providers who work with cancer drugs at an increased risk for toxic events? A systematic review and meta-analysis of the literature.

OBJECTIVE: A systematic review and meta-analysis was conducted to test the hypothesis that oncology health care workers are at an increased risk of cancer, reproductive complications and acute toxic events. DESIGN: A structured literature search of Index Medicus/ MEDLINE, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews and Healthstar was performed from 1966 to December 2004 for human epidemiological studies evaluating the risk of toxic events in health care workers exposed to cytotoxic drugs. Raw data and adjusted odds ratios (OR) reported in eligible studies were combined using a random effects model to calculate point estimates and 95% confidence intervals (CI) for each potential risk outcome. MAIN OUTCOME MEASURES: Adjusted OR for congenital malformations, stillbirths and spontaneous abortions among health care workers exposure to cytotoxic agents compared to a nonexposed control group. RESULTS: The systematic review identified 14 studies evaluating the outcomes of interest, seven of which were suitable for statistical pooling. Due to lack of evidence, we were unable to estimate a pooled OR for the risk of cancer and acute toxic events. However, no significant association was detected between exposure to cytotoxic drugs and; congenital malformations (OR = 1.64; 95% CI: 0.91-2.94) and stillbirths (OR = 1.16; 95% CI: 0.73-1.82). In contrast, an association was identified between exposure to chemotherapy and spontaneous abortions (OR = 1.46; 95% CI: 1.11-1.92). CONCLUSIONS: The results of this systematic review identified a small incremental risk for spontaneous abortions in female staff working with cytotoxic agents. Health policy decision makers should effectively communicate the magnitude of this risk to their staff and implement cost effective interventions for its reduction or elimination.