Drivers of Change: How HTA, Evidence and Policy Affect Perceptions of Value and Health Care Practice. Canadian Association for Population Therapeutics 2014

Abstract

Objectives:

Previous Canadian EQ - 5D based cost - effectiveness studies commonly use UK or US valuations, as Canadian tariffs were o nly recently made available. The implications of using non - Canadian tariffs to inform decision - making are unclear. We aim to re - evaluate a previous cost - effectiveness study of therapies for metastatic pancreatic cancer, originally performed using US utilit ies, with weights from Canada and various countries to determine the impact of using non - country specific tariffs.

Methods:

EQ - 5D utilities were derived using tariffs from Canada, US, UK, Denmark, France, Germany, Japan, the Netherlands and Spain for the 10 health states in the pancreatic cancer model. Incremental cost - effectiveness ratios (ICERs) were generated, and probabilistic sensitivity analyses (PSA) were performed.

Results:

Canadian utilities are generally lower than the corresponding US values an d higher than those of UK. Compared to the Canadian - valued scenarios, US and UK estimates were statistically different for 5 and 10 scenarios, respectively. Overall, 60% (54 of 90) of the non - Canadian utilities were significantly different, clinically, fro m the Canadian values. Canadian ICERs were about 5% greater than those of the US and 9% lower than those of the UK. The minimum willingness - to - pay threshold at which the chemotherapy regimen GEM - CAP is the most cost - effective based on PSA was $5,239 less f or the US and $11,986 more for the UK compared to the Canadian threshold value.

Conclusions:

Using non - country specific tariffs, there are significant differences among the derived utilities, ICERs and PSA results. Past Canadian EQ - 5D based cost - effective ness studies and related funding decisions may need to be re - visited using Canadian tariffs.