PCL201H1 Lecture Notes - Lecture 28: Cetuximab, Etanercept, Pharmacoeconomics

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14 Sep 2016

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Winter 2014
Lecture 28 Pharmacoeconomics
Health expenditure varies across OECD countries
o US spending the highest, 2.5x the OECD average
o Canada also one of the top
o Hospitals taking the biggest share of expenses at 28.4%
Expenses increasing over the years
Drug spending in Canada
o $30 billion in 2008, with prescription drugs accounting for 84%
o $900/year/Canadian
o US at highest level of total per capita on drugs, Canada 2nd
Tommy Douglas, father of universal health system, pushed for socialized medicine and changed
the healthcare in Canada compared to US
o Healthcare in Canada is regulated by the provincial government
o $0.42/$1 of tax spent on healthcare
o New stuff’s getting more expensive, and the government has only a limited fund for
healthcare and related research; must consider costs and tradeoffs
o Scenario where you can only fund one new drug:
Metastatic colorectal cancer is the leading case of cancer
Tumor in colon, rectum, and appendix, spreads to liver
Cetuximab, a EGFR inhibitor, is the first drug to show efficacy to this
type of cancer
$60,000 per course
Extends life from 4.6 months to 6.1 months
Rheumatoid arthritis is an auto-immune disease affecting 1% of the
Average onset at 35 years of age
Affects skin, joints, organs, cardiovascular system
Etanercept is a tumor necrosis factor-alpha inhibitor to improve quality
of life
$20,000/year for lifetime
o Many factors affecting the choice: clinical outcome, cost-benefit, type of disease,
patient, etc.
o National Framework for Cost-effectiveness Determination
Drug reimbursement-economic studies/budget impact = value of drug
Canadian Agency for Drugs and Technologies in Health
o Formulary - list of approved drugs and which ones are covered by benefits/plans
Formularies vary between different providers, and even between hospitals
o Perspective who cares about the drug?
Health care system
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