ga

Skip to content

My Files [0]

These are the files you have added to your collection.

  • You don't have any documents yet, feel free to browse the website and add documents.

CADTH » Events » CADTH Symposium Archives » 2010 CADTH Symposium » Speaker Presentations » Concurrent Session 1 – Oral Presentations: Policy Challenges

Concurrent Session 1 – Oral Presentations: Policy Challenges

Association of Copayments with Compliance and Employee Sick Days / Short-Term Disability (ACCESS): A Real-World, Randomized Study

  • Presenting Author: Dr. Laureen Rance, TELUS Health Solutions
  • Co-author: Dr. Pieway Hwang, TELUS Health Solutions

Background: Private payers are increasingly turning to approaches such as copayment increases for plan members in an effort to control rising drug costs. However, evidence suggests an inverse relationship between copayment amount and medication compliance, with resulting negative outcomes. Given this plus the importance of compliance and existing poor compliance, more data to inform copayment policies are warranted. The ACCESS Study is designed to evaluate whether eliminating copayments for selected drugs is associated with better compliance. Secondary objectives are to measure the impact on persistence, sick days, and short-term disability claims. Study rationale, design, and implementation will be described. 

Methods: Enrollees in the drug plan of the TELUS Corporation (a Canadian telecommunications company with more than 26,000 employees nationally) will be randomized to “current copayment” or “no copayment” for a period of 12 months. Outcomes include compliance (measured by the Medication Possession Ratio), measures of persistence (i.e., days to discontinuation, six-month discontinuation rates, and persistence rates [no discontinuations or gaps > 30 days]), sick days, and short-term disability claims. Data analysis will be performed using data currently collected as part of prescription claims adjudication and casual absence / short-term disability data that are currently tracked by TELUS.

Discussion: This study combines the advantages of randomization with those of real-world drug utilization patterns gained from prescription claims data. To our knowledge, this is the first Canadian controlled trial of copayment reductions. Results may provide evidence to support policy and innovative approaches with regard to drug benefit design and delivery.

An Evidence-Based Framework for Evaluating New Fee Requests in Nova Scotia —Successes and Challenges in the First Year

  • Presenting Author: Dr. Anne Tweed, Nova Scotia Department of Health
  • Co-author: Angela Purcell, Nova Scotia Department of Health

Historically, new physician fees were regularly added to the fee schedule with little or no rigorous scientific appraisal. They were accepted based on the clinical judgment of the physician.

Recently we have implemented a new evidence-based framework for assessing new fees. It is based on the model that has been used by Pharmacare for some years. This evidence-based framework for fees provides a transparent and rational process for evaluating new fee requests. It has highlighted differences in opinion with respect to what constitutes sufficient evidence to insure a new procedure or technology.

Although the concept of evidence-based medicine is widely accepted, there are differences of opinion regarding the level of evidence necessary for adoption and funding of a new technology. Physicians seem to be early adopters and innovators and willing to accept lower levels of evidence when promoting a new technique compared with the levels of evidence that the paying agencies would prefer. New technology rarely has high levels of evidence available prior to physician adoption, unlike new drugs.

Physicians would like to be sure a technology is unlikely to cause harm and that it might be effective or will provide insight into an underlying disease. Paying agencies would like to be sure that it is safe, effective, comparatively effective, and cost-effective.

This paper will discuss our successes and challenges during the first year of implementation.

Pharmacogenetics and the Evaluation Challenges associated with Personalized Medicine

  • Presenting Author: Catherine Street and Astrid Perrot-Daley, Population Therapeutics Research Group, Memorial University of Newfoundland
  • Co-authors: Dr. K. Adam Baker and Dr. Wayne Gulliver, Newlab Life Sciences Inc.; Dr. Roy West and Dr. Proton Rahman, Memorial University of Newfoundland

Personalized medicine is purported to be the answer to spiralling drug costs. The Common Drug Review is currently the mechanism by which information on cost-effectiveness is determined and provided to the participating provincial drug programs.

Currently, the process and timeline followed in the Common Drug Review does not allow for the undertaking of pharmacogenetic testing of drugs. The Population Therapeutics Research Group (PTRG) believes that for specific high-cost families of drugs where there is an indication of a genetic influence on the drug’s metabolism, the inclusion of pharmacogenetic information within the Common Drug Review will enhance the review process. This would enable the development of appropriate prescribing guidelines under the provincial prescription drug programs. This pharmacogenetic analysis would need to occur between approval for market and publication of the outcome of the results of the Common Drug Review.

By analysis of a case study, the presentation will explore how, through the use of PTRG’s state-of-the-art heritability information technology platform, it is possible to identify potential genetic influences on the effectiveness and adverse event profile of a specific drug. Discussion as to how this research may then be extended to gene identification, the development of a diagnostic chip, and final agreement of prescribing guidelines will highlight to the audience the potential value of this area of research and the resulting clinical impact.

The presentation will be of interest to those with a clinical background, pharmaceutical companies, patients, researchers, regulatory body staff, and information technology experts.

A Discrete Choice Experiment Investigating Preferences for Funding Drugs Used to Treat Orphan Diseases

  • Presenting Author: Dr. Emmanouil Mentzakis, McMaster University
  • Co-authors: Patricia Stefanowska, Ontario Ministry of Health and Long-Term Care; Professor Jeremiah Hurley, McMaster University

Policy debate about funding criteria for drugs used to treat rare, orphan diseases is gaining prominence. This study presents evidence from a discrete choice experiment investigating the preferences of the public regarding public funding for drugs used to treat rare diseases and common diseases. We find that, other things equal, the respondents do not prefer to have the government spend more for drugs used to treat rare diseases, that respondents are not willing to pay more per life-year gained for a rare disease than a common disease, and that the public weighs relevant attributes of the coverage decisions (e.g., costs, disease severity, treatment effectiveness) similarly for both rare and common diseases. The results confirm the importance of severity and treatment effectiveness in preferences for public funding. Though the first study of its kind, the results send a cautionary message regarding the special treatment of orphan drugs in coverage decision-making.