Grant: Operating Grant: PHSI for Cancer Control

Drug costs represent a rapidly growing expense for health care systems. In cancer care, the emergence of new treatments has become a regular occurrence and easily outpaces budget growth. As a result, provincial funders must use evidence to prioritize and fund selected drugs from the pipeline of new drugs awaiting funding. Our team believes that the prioritization process should not only consider the evidence for the drugs in the pipeline when allocating resources, but also for drugs that are already being funded. Decisions to fund these drugs would have been made based on controlled clinical trials, where the population or environment may not reflect practice in the "real world". Our goal is to develop and test a framework for the generation and use of real world evidence (RWE) of cancer drugs to enable (i) reassessment of cancer drugs by recommendation-makers; and (ii) refinement of funding decisions or renegotiations/disinvestment by decision-makers/payers across Canada. Our project has 4 objectives: (1) to develop an understanding of the current state of RWE in health care; (2) to develop and refine a framework for the generation and use of RWE dedicated to (i) policy/process and (ii) methodological applications of RWE; (3) to conduct multi-province RWE evaluations using the framework developed in Objective 2; and (4) to employ knowledge translation strategies to establish and integrate a working RWE framework into sustainable practice of participating provinces and on a national level. Our team will assemble a national panel of clinical, methodological, and policy experts to create adoptable RWE frameworks for cancer drug funding decisions. The RWE framework will not only support evidence-based policy reform, price renegotiations, and reallocation of funding from low- to high-value settings, but will also drive accountability and sustainability of the cancer system in an innovative way that can be replicated by all provinces and by other areas of health care.