Building a National Reassessment Process for Oncology Drugs: Lessons Learned by the Canadian Real-World Evidence for Value of Cancer Drugs (CanREValue) Collaboration through a Simulated Reassessment Exercise.

The CanREValue Collaboration established the Reassessment & Uptake Working Group to develop a preliminary process to reassess funded cancer drugs in Canada. A simulated exercise was conducted to evaluate the proposed reassessment process using a real-world case. We invited 32 attendees including representatives from Health Canada and Health Technology Assessment (HTA) agencies, along with payers, clinicians, academics, and patient representatives. A case was developed using a real-world study on a publicly funded cancer drug. In facilitated group sessions, participants were asked to deliberate upon the evidence presented in the case to issue reassessment recommendations. Several themes were identified through the deliberation discussions. While the generalizability of real-world evidence (RWE) is perceived as a strength, trust in the RWE depends largely on the source of the real-world data. The attendees suggested several improvements to the proposed reassessment process including evidence requirement for reassessment, recommendation categories, and a priori study protocols. This exercise generated important insights on the evidence required for conducting reassessment and considerations for improvements of the proposed reassessment process. Building upon lessons from this exercise, future work would continue to refine the reassessment process as part of the overall CanREValue framework.

An expert on every street corner? Methods for eliciting distributions in geographically dispersed opinion pools.

Recent publications outline developments in eliciting probabilistic opinions from clinical experts with which to inform structural assumptions and parameter estimates in health economic models. We outline approaches taken to date to elicit probabilistic distributions from experts within the health economic literature and outline the appropriate considerations and the resulting process in developing a new elicitation program with the aim of allowing low-cost elicitation of expert opinion from a heterogeneous and geographically dispersed opinion pool while preserving the essential features of good practice elicitation methods.

The cost-effectiveness of a law banning the use of cellular phones by drivers.

OBJECTIVE: To assess the cost-effectiveness of a law banning the use of cellular phones by drivers in the Canadian province of Alberta. METHOD: Cost-effectiveness analysis using a probabilistic decision-analytic model and publicly available data. We adopted a societal perspective. Health gains were measured in terms of quality-adjusted life-years. Costs include those associated with awareness raising, enforcement and the welfare loss associated with the reduction in cellular phone use, less savings in health care and other costs associated with automobile accidents. RESULTS: A ban promotes health and releases resources worth more than the costs. There is an 80% chance that a ban will be 'cost saving', and a 94% chance that a ban will cost less than Can$50,000/QALY. The results are sensitive to the additional risk posed by cellular phone use while driving, and the rate and pattern with which drivers comply with a ban. CONCLUSION: Under our base line assumptions a cellular phone ban is likely to be cost saving from a societal perspective. The results are sensitive to parameters for which there is very little information or for which the available information is contradictory.