Background: We evaluated clinical practice guideline (
cpg) recommendations from Cancer Care Ontario’s Program in Evidence-Based Care (
pebc) for molecularly targeted systemic treatments (
tts) and subsequent funding decisions from the Ontario Ministry of Health and Long-Term Care.
Methods: We identified
pebc cpgs on tt published before June 1, 2010, and extracted information regarding the key evidence cited in support of
cpg recommendations and the effect size associated with each
tt. Those variables were compared with
mohltc funding decisions as of June 2011.
Results: From 23 guidelines related to 17
tts, we identified 43 recommendations, among which 38 (88%) endorsed
tt use. Among all the recommendations, 38 (88%) were based on published key evidence, with 82% (31 of 38) being supported by meta-analyses or phase
iii trials. For the 38 recommendations endorsing
tts, funding was approved in 28 (74%; odds ratio related to
cpg recommendation: 29.9;
p = 0.003). We were unable to demonstrate that recommendations associated with statistically significant improvements in overall survival [
os: 14 of 16 (88%) vs. 8 of 14 (57%);
p = 0.10] or disease- (
dfs) or progression-free survival [
pfs: 16 of 21 (76%) vs. 3 of 5 (60%);
p = 0.59] were more likely to be funded than those with no significant difference. Moreover, we did not observe significant associations between funding approvals and absolute improvements of 3 months or more in
os [6 of 6 (100%) vs. 3 of 6 (50%),
p = 0.18] or
pfs [6 of 8 (75%) vs. 10 of 12 (83%),
p = 1.00].
Conclusions: For use of
tts, most recommendations in
pebc cpgs are based on meta-analyses or phase
iii data, and funding decisions were strongly associated with those recommendations. Our data suggest a trend toward increased rates of funding for therapies with statistically significant improvements in
os.
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