Our Rapid Response Unit has generated a substantial body of high-quality comprehensive research in a wide breadth of areas that has informed policy decisions for the benefit of Canadians. Some major areas of impact include work in the area of prescription opioids, blood glucose test strips, and cardiovascular health:
Physicians commonly prescribe opioids to patients with chronic pain. However, over the past 20 years, the escalating use of prescription opioids has created a major public health crisis across North America. A series of ODPRN studies investigating the escalating opioid dose and growing numbers of overdose deaths have been used to inform and support Ontario’s Narcotic Strategy.
This research is cited as a key factor in the development and passage of Bill 101, the Narcotics Safety and Awareness Act (NSAA), which received Royal Assent in November 2010. The findings have been incorporated into briefing materials and policies at the local, national and international level, including a presentation to Canada’s Minister of Health in 2014, programming by several Public Health Units across the province, and opioid labeling requirements by the United States Food and Drug Administration (FDA). ODPRN has also worked closely with the Canadian Institute for Health Information (CIHI) to inform methodology that will be used in national surveillance of opioid toxicity.
Blood Glucose Test Strips
Blood glucose test strips (BGTS) are typically prescribed to patients with diabetes, but have limited clinical benefit among certain groups of individuals, leading to potential overuse and significant costs to the healthcare system. The ODPRN analyzed potential cost avoidance that might be achieved by establishing maximum reimbursement policies for test strips in various groups of patients who may not require frequent monitoring.
Since the publication of these findings, the Canadian Diabetes Association (CDA) has recognized that limits on government-funded testing are reasonable in some patients, and has changed their recommendations on optimal testing frequency. Subsequently, the OPDP widely implemented new quantity limits for BGTS in 2013. In a 2016 evaluation of this policy, the ODPRN reported nearly $25 million in cost reductions in the year following the introduction of the policy. Furthermore, this evaluation indicated no negative impact on patient outcomes, including hypoglycemia, hyperglycemia and HbA1c.
Recently, these analyses were replicated in 7 other provinces across Canada, and found that considerable savings would be achieved annually if a quantity limit policy were introduced in public drug programs across Canada. These results have been shared with policy-makers across Canada, including the pan-Canadian Pharmaceutical Alliance (pCPA), and quantity limits have now been introduced in British Columbia and by Health Canada’s Non-Insured Health Benefits, with other provinces considering similar changes.
Treatment for Chronic Hepatitis B
Previously, there were seven treatment options approved by Health Canada for chronic hepatitis B: standard interferon, pegylated interferon, lamivudine, adefovir, entecavir, telbivudine, and tenofovir disoproxil fumarate (TDF). In Ontario, these treatments (with the exception of telbivudine and pegylated interferon) were available through prior authorization. Concern had been raised regarding the alignment of reimbursement criteria and clinical guideline recommendations, specifically concerning first-line treatment options and criteria for treatment initiation. The results of the ODPRN drug class review for chronic hepatitis B illustrate how the various components of the review were applied. Based on the results of the review and feedback from the ODPRN Citizens’ Panel and stakeholders, the recommendations by the ODPRN to the Ministry of Health’s Drugs and Devices Division were to move lamivudine and entecavir to the formulary with specific criteria, and to update the clinical criteria for all other funded medications. It was suggested that TDF not be moved until genericization of the drug. It was also recommended that adefovir no longer be reimbursed, due to minimal evidence and utilization.
More information on our drug class reviews can be found here
Pulmonary Arterial Hypertension
Pulmonary arterial hypertension (PAH) is a rare and potentially life-threatening condition. Prior to 2010, the Ontario Public Drug Programs only funded PAH monotherapy (i.e. one drug at one time) due to the lack of evidence on the effectiveness and safety of PAH combination therapy (i.e. multiple drugs at one time). Clinicians and patients advocated to the MOHLTC that this was an impediment to optimal care. The ODPRN conducted multiple studies on the prescription and utilization of PAH drugs in Ontario; this information contributed to PAH drug funding changes, which were enacted in June 2010. Funding was expanded to include combination therapy of selected PAH drugs, and PAH drug initiation was restricted to Ontario’s five Centres of Excellence.