Trends in Indirect Treatment Comparison (ITC) Methods Used in Reimbursement Submissions in Canada and the US
Author(s)
Emily Aiello, MSc1, Tracy Westley, MSc2, Kabirraaj Toor, MPH3;
1Lumanity, Toronto, ON, Canada, 2Lumanity, Dundas, NB, Canada, 3Lumanity, Vancouver, BC, Canada
1Lumanity, Toronto, ON, Canada, 2Lumanity, Dundas, NB, Canada, 3Lumanity, Vancouver, BC, Canada
OBJECTIVES: The implementation of Joint Clinical Assessment (JCA) in the European Union (EU) will require submissions to consider multiple comparators to meet requirements. The resulting JCA dossier, which includes results of comparative analyses, may be published before reimbursement reviews outside of the EU are undertaken. JCA guidance has outlined recommended methods for ITC; however, it is uncertain how well this will reflect current methodological needs in practice. Our objective is to survey HTA methods used in previous Canadian and US submissions since 2020, focusing on oncology, to summarize trends and determine if JCA dossiers published as the result of the JCA framework will be applicable to the current and evolving reimbursement landscape in North America.
METHODS: Canada’s Drug Agency (CDA-AMC) database was searched between 2020 and 2024 to identify complete oncology reimbursement review submissions. Available published material was reviewed to identify the use of ITC methods, which were broadly categorized as naïve, anchored, and unanchored. Completed assessments from the Institute of Clinical and Economic Review (ICER) in the US were also reviewed for oncology submissions between 2020 and 2024.
RESULTS: Between 2020 and 2024, there were 95 completed CDA-AMC reimbursement reviews in oncology, of which 61 (64%) included ITCs (of the 42 ICER submissions, only one included an ITC). Trends show that while naïve comparisons and Bucher analyses were less frequently used to estimate relative treatment effects between 2020 (26% of ITCs) and 2024 (0% of ITCs), use of network meta-analysis (35% in 2020 and 36% in 2024) and unanchored population-adjusted indirect comparisons (22% in 2020 and 21% in 2024), both cited in JCA guidance, were consistent and remained the most commonly used methods.
CONCLUSIONS: The methods currently available are likely sufficient for the decision problems facing manufacturers; however, this may change as trial designs become more complex to address more specific therapeutic areas.
METHODS: Canada’s Drug Agency (CDA-AMC) database was searched between 2020 and 2024 to identify complete oncology reimbursement review submissions. Available published material was reviewed to identify the use of ITC methods, which were broadly categorized as naïve, anchored, and unanchored. Completed assessments from the Institute of Clinical and Economic Review (ICER) in the US were also reviewed for oncology submissions between 2020 and 2024.
RESULTS: Between 2020 and 2024, there were 95 completed CDA-AMC reimbursement reviews in oncology, of which 61 (64%) included ITCs (of the 42 ICER submissions, only one included an ITC). Trends show that while naïve comparisons and Bucher analyses were less frequently used to estimate relative treatment effects between 2020 (26% of ITCs) and 2024 (0% of ITCs), use of network meta-analysis (35% in 2020 and 36% in 2024) and unanchored population-adjusted indirect comparisons (22% in 2020 and 21% in 2024), both cited in JCA guidance, were consistent and remained the most commonly used methods.
CONCLUSIONS: The methods currently available are likely sufficient for the decision problems facing manufacturers; however, this may change as trial designs become more complex to address more specific therapeutic areas.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HTA8
Topic
Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes
Disease
SDC: Oncology