In healthcare, as in so much else in life, it comes down to one key question: Who is going to pay?
In Canada, it’s complicated. The payer can be the government, but it can also be private health insurance or even users, out of their own pocket, sometimes travelling to other jurisdictions. Treatments approved for use by Health Canada, do not guarantee access: payors such as provincial and territorial governments weigh the costs of new treatments and their benefits for patients, to arrive at a funding decision. This equation is especially tricky when it comes to immunotherapies for cancer, such as CAR-T cell therapy. This therapy can save the lives of patients for whom all other options have failed, but they tend to be very expensive in and of themselves, are tailor-made for the patient and often require other healthcare services, such as hospital stays and extensive monitoring.
That’s where William W.L. Wong comes in. He’s not the usual BioCanRx-funded researcher – his doctorate is in computer science specialized in decision-analytical modeling, rather than the more familiar fields. But, as part of the School of Pharmacy at the University of Waterloo, he is one of a new breed of health researchers, using his quantitative skills to develop economic frameworks for evaluating new drugs, including immunotherapies. It’s all part of a field called health technology assessment.
Health technology assessment (HTA), Dr. Wong explains, comprises three parts: clinical evidence of a drug’s safety and efficacy (or, as he puts it, showing that “it works”); economic assessment that it is cost effective; and social/ethical analysis focused on areas such as equality of access. It is the second part of the equation that is his focus.
“For governments to make drugs available for reimbursement, they need strong evidence of its value for money,” Dr. Wong says. His project is addressing the need for that evidence for cellular therapies in three ways:
- An environmental scan to determine the capacity required to support the implementation of CAR-T therapy in Canada. Specifically, his team wants to find out where health professionals believe CAR T-cell therapy fits in the clinical treatment pathway, who the target population is, how and where it is to be developed and administered to patients, how patients are to be monitored and what measures are to be taken to reduce health risks, what resources are required (including personnel, materials and technology) in the entire process, length of time for different processes, and what the key barriers and facilitators are.
- A mathematical simulation model to predict the cost effectiveness of CAR-T therapy and examine the affordability of different CAR-T therapy strategies, to assist payers in making funding decisions.
- An assessment of knowledge gaps that researchers can address to make CAR-T therapy more attractive to payers.
The project is part of a new research area for BioCanRx, health technology assessment. HTA is usually performed late in the process, on a drug or therapy is, as they say, “ready for prime time.” But the Cancer Stakeholder Alliance (CSA), a group of patients and health charities that provides input and recommendations to BioCanRx, was concerned that HTA needed to be addressed earlier in the process, hence the term ‘early HTA’. They believed that it is important to ensure that potentially life-saving immunotherapies are developed with an eye on the funding decision-making process, so that new therapies can be made available with public funding as soon as possible. At the group’s urging, BioCanRx issued a funding call for research projects in early HTA.
Funded under that call, Dr. Wong’s project will provide a policy framework to support the decision-making process regarding the implementation of, and reimbursement for, future CAR-T cell therapy (though CAR-T therapy has advanced beyond the early HTA stage since the call was issued). His work will also assist researchers with making informed decisions regarding the future development of such therapies.
Dr. Wong didn’t envision a future in healthcare when he began his computer science studies. But for him, it’s the right place to be.
“Health is a very challenging area,” he says. “I can see the impact of my work.” For instance, “most Canadian hepatitis C-related reimbursement policy is informed by my research.” And now, Dr. Wong is excited to see his work have similar impacts in the cancer field.