Thanks very much for the opportunity to appear here.
My name is Joel Lexchin. I'm an MD. I teach health policy at York University, as you pointed out. I also work as an emergency physician, and I have authored a number of books prescribing guidelines for general practitioners and emergency doctors.
What I want to present now are the results of some research that I have undertaken with a colleague of mine, Barbara Mintzes.
There's been a lot of criticism about the decisions the CDR, the common drug review, makes. We wanted to compare the decisions that CDR makes to decisions made by comparable bodies in other countries, for the same drugs, with the same indications.
Initially, we identified 47 drugs that CDR had made decisions on, up to the end of September of 2006. We set up a series of criteria for how we would choose the comparator agencies. They had to evaluate at least half the drugs the CDR did. They had to publish material on their websites, in either English or French. And there were a few other criteria that I won't go into.
We ended up with two organizations, the Pharmaceutical Benefits Advisory Committee, or PBAC, which is in Australia, and the Scottish Medicines Consortium, which is in Scotland.
Out of the 47 drugs that the CDR had evaluated, the Australian body had looked at and made recommendations on 31, and the Scottish agency had made recommendations on 29. The recommendations broadly fall into three categories from each of these organizations. The first is fund without restriction, the second is fund with restriction, and the third is no funding at all.
When we look at the drugs that are in common between CDR and the Australian group, there are 31, as I said, and between CDR and the Scottish group, there are 29. When you look at these three different categories, you find that all the agencies do the same thing. The percentage they recommended for full funding is broadly the same, the percentage they recommended for restricted funding is broadly the same, and the percentage they entirely rejected is broadly the same.
The second thing we did was to look at individual drugs. Were the recommendations for the individual drugs the same or not? We found that although some of the recommendations for the individual drugs were the same, there wasn't a lot of agreement among the Canadian agency and the other two, nor was there in fact much agreement between the Scottish agency and the Australian agency. We concluded that in applying the criteria all three agencies do, which is looking at the clinical effectiveness of the product and doing pharmaco-economic analysis, they're all equally as lenient or as strict in broad terms.
For individual drugs, they take into consideration things like what price the drug is being offered at in the individual country, what other drugs are available in that country for the same condition, what the prices of those are, and how many people are affected with the disease. They then make their decisions. Because these are locally based decisions, you would expect them to be different from country to country.
The conclusion from this piece of research is that the CDR is not out of line with other international agencies that do the same thing--in other words, that use a combination of clinical data and pharmaco-economic analysis in making their decisions. They don't make the same decisions as other agencies, but they don't make them because of local factors. In fact, the three agencies we examined all make different decisions about the same drugs because of local factors.
Our conclusion is that what the CDR is doing is a good thing. They're doing an appropriate job. The drugs they reject are rejected because of things that are specific to Canada. It's the same for the ones they approve. They are approved because of factors specific to Canada. It's the same thing for the other agencies.
Thanks very much.