Reimbursement recommendations before and after adoption of application fees by the Canadian Agency for Drugs and Technologies in Health: a cross-sectional study

Abstract Objectives To determine if the introduction of drug company payment of application fees to the Canadian Agency for Drugs and Technologies in Health (CADTH) had an effect on its reimbursement recommendations to public drug funders for drugs with oncology and non-oncology indications. Methods Drug submissions from 2009 to 2019 (non-oncology drugs) and from 2012 to 2020 (oncology drugs) were analyzed and the CADTH recommendation (reimburse/do not reimburse) was recorded. Drugs indications were categorized as either oncology or non-oncology. Seven covariates that might have affected CADTH’s recommendations were entered into a logistic regression equation and the change in the odds ratio (OR) for recommending reimbursement after the introduction of application fees for both groups of drugs was computed. Key findings CADTH made recommendations for 258 drugs. After the introduction of application fees, there was a 0.8333 (95% CI 0.1640, 3.374) change in the OR of recommending reimbursement versus no reimbursement for drugs with an oncology indication. For drugs with a non-oncology indication, there was a 6.096 (95% CI 2.943, 13.39) change in the OR. Conclusions Industry funding of CADTH creates a conflict of interest that may have changed its recommendations for reimbursement for non-oncology drugs.