HTA decisions and access to mental health treatments in Canada’s public drug plans

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Article Brief

Authors

Kimberley Tran (M.A.), Nigel SB Rawson (Ph.D.), Brett J Skinner (Ph.D.)

Objective

To examine how health technology assessment (HTA) decisions affect access to new drug treatments for mental health in Canada’s public drug plans, and to briefly discuss this in the context of the societal economic burden of mental illness and quality of life impacts on people living with mental illness and their caregivers.

Data and Method

The study used publicly available and proprietary sources of secondary data, and a selective literature review. The drugs studied included all New Drug Submissions (NDSs) that received a Notice of Compliance (NOC) from Health Canada and were reviewed by the Common Drug Review (CDR) between 2004 and 2015. Data were obtained from Health Canada, the Canadian Agency for Drugs and Technologies in Health (CADTH), QuintilesIMS and Statistics Canada.

Results

A higher percentage of non-mental health drugs compared to mental health drugs were recommended positively (with or without conditions) for public drug plan coverage by the CDR. The CDR took less time to provide recommendations for non-mental health drugs compared to mental health drugs. Schizophrenia and bipolar disorder are the only two mental health indications that received any positive (with or without conditions) recommendations from the CDR over this period. In contrast, 100% of the drugs for attention deficit hyperactivity disorder (5), dementia/Alzheimer’s disease (2), major depressive disorder (4) received negative CDR recommendations for listing. Public drug plans eventually covered many of the drugs rejected by the CDR, but only after lengthy waits. It was estimated that in 2015, spending by the public drug plans of 9 provinces (excl. Quebec) and the federal NIHB on the direct costs of new mental health drugs represented less than 1% (0.9%) of the more than $54.6 billion in annual societal costs associated with the economic burden of mental illness in Canada.

Conclusions

Canada’s HTA decisions on mental health drugs have been inconsistent with eventual listings in public drug plans and use in clinical practice. A wide choice of therapy is important to be able to find the best option for each patient in treating mental illnesses. All the drugs included in this study were approved by Health Canada as safe and effective treatments. Yet, the CDR recommended only a fraction of these drugs for reimbursement in public drug plans and took a long time to issue its recommendations. Waits to access caused by HTA and public drug plans can be costly. The economic costs of mental illness far outweigh investment in access to treatments in public drug plans.

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