title: Application of a policy framework for the public funding of drugs for rare diseases.
abstract: BACKGROUND
  In many countries, decisions about the public funding of drugs are preferentially based on the results of randomized trials. For truly rare diseases, such trials are not typically available, and approaches by public payers are highly variable. In view of this, a policy framework intended to fairly evaluate these drugs was developed by the Drugs for Rare Diseases Working Group (DRDWG) at the request of the Ontario Public Drug Programs.
  
  
  OBJECTIVE
  To report the initial experience of applying a novel evaluation framework to funding applications for drugs for rare diseases.
  
  
  METHODS
  Retrospective observational cohort study.
  
  
  METHODS
  Clinical effectiveness, costs, funding recommendations, funding approval.
  
  
  RESULTS
  Between March 2008 and February 2013, eight drugs were evaluated using the DRDWG framework. The estimated average annual drug cost per patient ranged from 28,000 to 1,200,000 Canadian dollars (CAD). For five drugs, full evaluations were completed, specific funding recommendations were made by the DRDWG, and funding was approved after risk-sharing agreements with the manufacturers were negotiated. For two drugs, the disease indications were determined to be ineligible for consideration. For one drug, there was insufficient natural history data for the disease to provide a basis for recommendation. For the five drugs fully evaluated, 32 patients met the predefined eligibility criteria for funding, and five were denied based on predefined exclusion criteria.
  
  
  CONCLUSIONS
  The framework improved transparency and consistency for evaluation and public funding of drugs for rare diseases in Ontario. The evaluation process will continue to be iteratively refined as feedback on actual versus expected clinical and economic outcomes is incorporated.
authors.affiliation: Schulich School of Medicine & Dentistry, Western University; and London Health Sciences Centre, 790 Commissioners Road East, London, ON, Canada, N6A 4L6, Eric.winquist@lhsc.on.ca.
authors.forename: Eric
authors.initials: E
authors.lastname: Winquist
authors.forename: Doug
authors.initials: D
authors.lastname: Coyle
authors.forename: Joe T R
authors.initials: JT
authors.lastname: Clarke
authors.forename: Gerald A
authors.initials: GA
authors.lastname: Evans
authors.forename: Christine
authors.initials: C
authors.lastname: Seager
authors.forename: Winnie
authors.initials: W
authors.lastname: Chan
authors.forename: Janet
authors.initials: J
authors.lastname: Martin
mesh_terms: D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005378:Financial Support; D006291:Health Policy; D006801:Humans; D009864:Ontario; D035583:Rare Diseases / Q000188:drug therapy* / Q000191:economics; D012051:Reimbursement Mechanisms / Q000458:organization & administration*; D012189:Retrospective Studies