Surrogate outcomes: experiences at the Common Drug Review

Cost Effectiveness and Resource Allocation

Ron Goeree¹  Rob Hopkins¹  Shoghag Khoudigian³  Angela Rocchi² 

[1] PATH Research, Hamilton, ON, Canada;Axia Research, 2068 Waterbridge Drive, Burlington, ON L7M 3W2, Canada;McMaster University, Hamilton, ON, Canada

关键词: Health technology assessment;    Surrogate outcomes;    Decision-making;    Reimbursement;   

Others  :  809778
DOI  :  10.1186/1478-7547-11-31

 received in 2013-08-16, accepted in 2013-12-10,  发布年份 2013

【 摘 要 】

Background

Surrogate outcomes are a significant challenge in drug evaluation for health technology assessment (HTA) agencies. The research objectives were to: identify factors associated with surrogate use and acceptability in Canada’s Common Drug Review (CDR) recommendations, and compare the CDR with other HTA or regulatory agencies regarding surrogate concerns.

Methods

Final recommendations were identified from CDR inception (September 2003) to December 31, 2010. Recommendations were classified by type of outcome (surrogate, final, other) and acceptability of surrogates (determined by the presence/absence of statements of concern regarding surrogates). Descriptive and statistical analyses examined factors related to surrogate use and acceptability. For thirteen surrogate-based submissions, recommendations from international HTA and regulatory agencies were reviewed for statements about surrogate acceptability.

Results

Of 156 final recommendations, 68 (44%) involved surrogates. The overall ‘do not list’ (DNL) rate was 48%; the DNL rate for surrogates was 41% (p = 0.175). The DNL rate was 64% for non-accepted surrogates (n = 28) versus 25% for accepted surrogates (odds ratio 5.4, p = 0.002). Clinical uncertainty, use of economic evidence over price alone, and a premium price were significantly associated with non-accepted surrogates. Surrogates were used most commonly for HIV, diabetes, rare diseases, cardiovascular disease and cancer. For the subset of drugs studied, other HTA agencies did not express concerns for most recommendations, while regulatory agencies frequently stated surrogate acceptance.

Conclusions

The majority of surrogates were accepted at the CDR. Non-accepted surrogates were significantly associated with clinical uncertainty and a DNL recommendation. There was inconsistency of surrogate acceptability across several international agencies. Stakeholders should consider collaboratively establishing guidelines on the use, validation, and acceptability of surrogates.

【 授权许可】

   
2013 Rocchi et al.; licensee BioMed Central Ltd.

【 图 表 】

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