Canadian Agency forDrugs and Technologies
in Health
Karen Lee, Director Health Economics
February 25, 2019
Tokyo, Japan

Disclosure• Employed by CADTH• No conflicts to my knowledge• CADTH receives funding from Canada’s federal,provincial, and territorial governments, with the exceptionof Quebec• CADTH charges application fees for three of its programs:• CADTH Common Drug Review• CADTH pan-Canadian Oncology Drug Review• CADTH Scientific Advice

1Presentation•••2

Overview of the Canadian health care system
Use of health technology assessment (HTA) in Canada
Role of CADTHHealth Care Provision in Canada• Health care in Canada determined based on theCanadian Constitution and the Canada Health Act (1984)• Federal government provides financial support toprovinces and territories for the delivery of primary andsupplementary health care services3

Health Care Provision in Canada• 10 provincial and 3 territorial
health systems• Health care (health careservices) are provided to allCanadians4

Health Care Provision in Canada• Health expenditures largely paid by the provinces andterritories in which an individual resides• Mixture of public and private care5

Health Care Provision in Canada
Total Health Expenditures by Source of Finance
1%30%

Private Sector

64%

Social Security Funds
Federal Direct
1%4%

Source: CIHI, National Health Expenditure Trends, 2975-20106

Provincial/TerritorialGovernments
Municipal Governments

Drug Coverage in Canada• No universal program for drug coverage• Mix of private and public coverage• Each province and territory offers coverage for eligible
groups, e.g., income based, high cost drugs, specificconditions

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Health Technology Assessment

8CADTH• An independent, not-for-profit organization responsible
for providing Canada’s health care decision-makers with
objective evidence about the optimal use of healthtechnologies (drugs, diagnostics, devices, andprocedures).
• Created in 1989, CADTH’s products and services aredesigned to meet a broad spectrum of health care needs.

9What We Do• Generation of evidence and analysis
o Clinical reviews/critical appraisal of clinical studies
o Economic evaluations/critical appraisal ofmanufacture submissionso Patient perspectiveo Ethical considerations• Advice and recommendations

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Our Process• Different processes depending on the product• Drug reimbursement recommendationso Review initiated by manufacturero Recommendation based on CADTH’s assessment of
the information provided in the manufacturer’s
submission dossier• Other products
o Based on customer requesto CADTH conducts research

13Drug Reviews — Process
Submission received by manufacturer
CADTH ensures all requirements are met
CADTH conducts:• Systematic review of clinical information• Critical appraisal and re-analyses of submitted
economic evaluations• Review of patient input• Review of additional information as required14

Drug Reviews — Process
Information is provided to the expert committee and arecommendation is madeManufacturer is involved in the process• Ability to comment on the reports• Can request reconsideration based on embargoedrecommendation

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Drug Reviews — How They AreUsed• Participating public drug plans receive therecommendation and evidence reports• Price is negotiated by the plans• CADTH provides support to the plans as required(e.g., pricing support tool, clarification)• Close alignment between CADTH recommendations andpublic reimbursement decisions

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Optimal Use — Process• Topics for drug and non-drug projects are solicited fromcustomers, including drug plans, ministries of health, andlocal payers.
• Topics are prioritized by CADTH based on stakeholerinterest; number of customers who are requesting• Multidisciplinary research team is formed

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Optimal Use — Process• Evidence generation/analysis occurs
o Systematic review of clinical informationo Generation of economic informationo Information on ethics, legal, social implications;patient experience; implementation• Information provided to the expert committee• Recommendation is made18

Optimal Use — How They Are Used
• Recommendations and evidence reports are posted• Customers will use these documents to make policy andpractice decisions and potentially to negotiate
prices/costs

19Thank You20