Medicine reimbursement recommendations in Canada, Australia, and Scotland

Objective: This study was undertaken to compare the recommendations made by the Canadian Common Drug Review (CDR) regarding whether drugs should be listed on provincial and federal formularies with recommendations made by similar bodies in other countries. Study Design: Retrospective cohort analysis. Methods: All recommendations made by CDR until September 30, 2006, were accessed. Two comparable agencies, the Australian Pharmaceutical Benefits Advisory Committee (PBAC) and the Scottish Medicines Consortium (SMC), were identified, and recommendations were obtained from the Web sites of all 3 agencies. We examined whether each of the agencies put equal proportions of drugs into each of 3 categories: unrestricted listing, listing with criteria, and do not list. Second, we compared recommendations on individual drugs. Results: CDR made recommendations on 47 drugs. PBAC and SMC made recommendations about 31 and 29 of these products, respectively. There was no statistically significant difference in the percentage of drugs assigned to each category of recommendation in comparisons between CDR and PBAC, and between CDR and SMC. There was moderate agreement between CDR and PBAC for recommendations on individual drugs and poor agreement between CDR and SMC. Conclusions: CDR is no different from other similar agencies in terms of the number of drugs recommended for full or restricted listing, or against listing. There is a relatively low level of agreement on recommendations about individual drugs among the different agencies. These differences appear to be because of pharmacoeconomic evaluations and likely reflect discrepancies between countries in national markets and health systems.