Evidence of meeting #51 for Health in the 39th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was cdr.
A recording is available from Parliament.
Conservative
Director and Past Chair, Cancer Advocacy Coalition of Canada
Yes. Health Canada judges safety and efficacy; CDR judges on cost-effectiveness. They also go back over the effectiveness, which is not their job. The answer to your question on whether they enhance access to the drugs is no. It is quite the contrary. They turn down two-thirds of the drugs for funding.
Conservative
Patrick Brown Conservative Barrie, ON
In terms of this situation brought before me by this constituent, are you concerned that there are cases in which CDR is turning down a drug that a provincial body is approving? Doesn't there seem to be a waste of evaluation there?
Director and Past Chair, Cancer Advocacy Coalition of Canada
I'm grateful that the provinces see more clearly than CDR has in the past.
Conservative
Patrick Brown Conservative Barrie, ON
In terms of cancer drugs, do you think this double evaluation is wasting time and resources?
Director and Past Chair, Cancer Advocacy Coalition of Canada
To a large extent it is, yes.
Conservative
Steven Fletcher Conservative Charleswood—St. James—Assiniboia, MB
I have one really quick question.
CDR includes--
Conservative
The Chair Conservative Rob Merrifield
Excuse me. I didn't have the name down, but Madame Gagnon wanted to speak, so we'll let her go. Then we'll go back to you, if that's all right. I'm sorry about that.
Bloc
Christiane Gagnon Bloc Québec, QC
Could you clarify something for me? Is the correct acronym in French PEMO or PECMO? In her submission, Ms. Diana Ermel refers to the PEMO, whereas the acronym used in the Library of Parliament briefing notes is PECMO, or JODR, the Joint Oncology Drug Review. Are you talking about the same thing?
Jackie Manthorne Executive Director, Canadian Breast Cancer Network
I apologize that we gave away all our copies of our submission, so I don't have the French-language document. If there is an error, we will correct it before it's distributed further.
Thank you.
Bloc
Christiane Gagnon Bloc Québec, QC
JODR is a joint process, whereas in your submissions, you refer to the PEMO, or Oncology Drug Review.
I thought that was not the same thing.
Executive Director, Canadian Breast Cancer Network
Yes, that's an omission on our part. I apologize.
Bloc
Executive Director, Canadian Breast Cancer Network
I apologize that we created that confusion. We'll correct the translation before it goes any further.
Thank you.
Bloc
Christiane Gagnon Bloc Québec, QC
Thank you.
I have a question for Ms. Ermel.
You stated that you would like to see the joint drug review process centralized so that all provinces and territories as well as the federal government adopt a common approach when reviewing the efficacy and cost of drugs.
What process would be the most appropriate to ensure that more drugs, whether it be new oncology drugs or existing drugs, are reviewed and become more widely available to the public, to patients?
President, Canadian Breast Cancer Network
So what we have said in consulting with women across the country is that it just makes sense to do this once rather than having each province and territory make their own decisions.
In terms of the structure, we don't have a lot of expertise with that. Dr. Hryniuk has said, again, that it's the process and the way the decisions are made, the people involved. I guess for us breast cancer survivors, we feel the priorities on which the decisions are made have to be about what is best for the patients, what are the best drugs for the patient.
I don't know that I'm answering your question very well. Bill wants to say something.
Go ahead.
Director and Past Chair, Cancer Advocacy Coalition of Canada
You're asking about the nexus of the issue. The provinces have to be the final payers, but the provinces have different guidelines for cancer treatment. So they look at their guidelines and say, yes, this is an effective drug for this disease, so we will treat it. Another province will say, our guidelines say this is not an effective drug, so we won't treat it.
What we need are guidelines that cover cancers across the country, so we get rid of that part. If we had national guidelines for cancer treatment, then when CDR or JODR says this drug is effective, all the provinces will say, all our guidelines are the same, we agree, we'll all fund it.
That's what I meant in my presentation. If we don't close the loop and have national guidelines, each province will continue to do its own thing, regardless of what JODR decides, but if we have national guidelines and JODR decides the drug is effective, then with all the provinces having the same guidelines, it would be difficult for one to say, we have the same guidelines, but we don't agree, so we won't use the drug.
You have to close the loop. You have to have the same treatment guidelines, and then you have to have the same adjudicatory process. Right now, we have different guidelines in each province, so each province decides to fund or not fund on its own, regardless of what JODR or CDR says.
Conservative
Steven Fletcher Conservative Charleswood—St. James—Assiniboia, MB
Thank you.
I just want to make a comment on the national guidelines. I assume you're wanting the highest common denominator, not the lowest common denominator.
I wonder if you could comment on CDR in comparison to Quebec, because of course CDR includes all the provinces save Quebec. And could you, from your perspective in oncology, comment on Quebec and their coverage versus the rest of the country, and why there is the difference?
Director and Past Chair, Cancer Advocacy Coalition of Canada
In the 2005 and 2006 report cards, we analyzed the access to the 24 new cancer drugs, province by province. When we came to Quebec, it was very difficult to determine the true access, because although the provincial government will approve a drug, not every hospital is given the money to use the drug. So there's intra-hospital variation in access to the drugs. For the some of the drugs, if you go to hospital A, you'll get them, and if you go to hospital B, you won't get them, even though the province has approved the use of the drug throughout the province. We don't have the resources to drill down on just how much of that is—
Conservative
Steven Fletcher Conservative Charleswood—St. James—Assiniboia, MB
What about doctor to doctor? If you go to doctor A at a family clinic, is it different from...?
Director and Past Chair, Cancer Advocacy Coalition of Canada
I'll let Dr. Knox speak to that. I don't think there's that much variation doctor to doctor.
Oncologist, University Health Network, Princess Margaret Hospital
In my institution or in Quebec?