The Value of Access
Modelling Outcomes for New Blood Cancer Therapies
Français • March 27, 2025
Key findings
- Disruptions to cancer care during the post-pandemic era have led to extensive backlogs in crucial services, both direct (e.g., imaging, pathological reporting, surgical procedures, and therapies) and indirect (e.g., drug development).
- Pre-existing healthcare challenges along with pandemic-related delays have led to a potential loss of over 30,000 life-years by 2030 due to a heightened risk of mortality for individuals with Hodgkin lymphoma, non-Hodgkin lymphoma, and multiple myeloma.
- Eliminating patient barriers to access newly developed or applied therapies between 2024 and 2030 could prevent the loss of a minimum 46,480 life-years and recover about $765.7 million in economic contributions to society, mitigating considerably the impact of pandemic system shocks to current and future cancer patients.
- Blood cancer experts identified three major barriers to and impacts on access of newly developed or applied therapies for patients: delays in therapy approval and funding pipelines, geographical barriers, and healthcare system capacity challenges.
- Newly developed or applied therapies hold substantial promise for reducing mortality and enhancing economic societal contributions. Future evaluations should include quality of life metrics to assess the value of these therapies more accurately for both patients and society.
Recommendations
- Streamline the therapy approval process—therapies are currently slow to become usable treatment options for Canadian oncologists, when patients need them now.
- Improve treatment options for rural patients—there is a gap in service between rural and urban areas. Expanding digital health technologies and infrastructure near major cancer care facilities can bridge this gap and improve overall healthcare outcomes.
- Increase Canada’s cancer care capacity—our population is growing and so is demand for cancer care. Our healthcare system needs to keep pace, both to meet demand and to adopt new treatments as they emerge.
A shock to the
healthcare system
Delivery of cancer care services across the country has experienced a major disruption since the pandemic. This research examines the effects of these post-pandemic impacts on blood cancer patients and provides recommendations to improve access to newly developed or applied therapies, aiming to mitigate these disruptions.
Direct services impacts
Delays in:
- cancer screening
- imaging
- pathological reporting
- cancer treatment (surgical procedures, systemic therapy, and radiation therapy)
Indirect service impacts
Delayed innovation, production, and delivery of newly developed or applied therapies:
- halt or reduction in clinical trial enrolment
- reduction in clinical trial participation
- research diverted to addressing public health emergencies
The potential impact of increased therapy access for blood cancer patients
Cancer patients are in a race against the disease, and disruptions or delays in their care often have serious consequences. Specifically, blood cancer patients are at increased risk during the post-pandemic period due to complexities surrounding the disease.
In our 2022 report, Tomorrow Can’t Wait: The Value of Breakthrough Cancer Treatments for Canadians, we examined the potential economic and societal impact of newly developed or applied therapies for several cancer types.
This research expands on these results and digs deeper into the potential clinical health and economic impacts of newly developed or applied therapies for multiple myeloma (MM), Hodgkin lymphoma (HL), and four subtypes of non-Hodgkin lymphoma (NHL) to address the increased mortality due to pandemic cancer treatment delays. Each of these blood cancers has unique pathobiology, epidemiology, treatment, and survival. These factors were considered in the clinical and economic modelling we conducted.
Clinical and economic burden of the pandemic on blood cancer patients
In a 2022 study on the long-term impacts of cancer delays in Canada, researchers estimated that the pandemic will result in a total of 30,148 life-years lost by 2030 due to COVID-19 cancer care disruptions for patients with HL, NHL, and MM.1 These costs arise from an expected 5 per cent relative increase in mortality for HL, a 3 per cent relative increase for NHL, and a 1.6 per cent increase in mortality among the MM cohort.2
These increases can be attributed primarily to the decrease in diagnostic and treatment capacity caused by the pandemic in 2021 and onward.3
In addition to this increased burden on health and survival of cancer patients, there are substantial economic impacts on the patient, family, and non-familial caregivers. A recent Canadian study indicated that in 2021, MM, HL, and NHL collectively had the following societal costs:4
- $1.579 billion in direct healthcare system costs (e.g., services provided in hospitals and by physicians as well as some prescription drugs);
- $197 million in direct patient out-of-pocket costs (e.g., drugs/supplements, home care, equipment, and all other expenses incurred by the patient);
- $130 million in direct patient time costs (e.g., time to travel to obtain care, wait for care, and receive care);
- $166 million in indirect patient costs (e.g., lost earnings from employment).
- Malagón and others, “Predicted Long-Term Impact of COVID-19 Pandemic-Related Care Delays on Cancer Mortality in Canada.”
- Malagón and others.
- Malagón and others.
- Garaszczuk and others, “The Economic Burden of Cancer in Canada from a Societal Perspective.”
Quantifying the benefits of enhanced access
We observed a substantial benefit to both patients and society through increased access to the nine newly developed or applied therapies indicated for multiple myeloma (MM), Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL). (See Table 1.)
Table 1
Therapies that were included for both clinical and economic modelling
| Therapy name: generic (brand) |
Cancer type (subtype) | Indications | Source |
|---|---|---|---|
| Pembrolizumab (Keytruda®) |
Hodgkin lymphoma (cHL) |
Adult and pediatric patients with refractory or relapsed classical Hodgkin lymphoma (cHL), as monotherapy, who have failed autologous stem cell transplant (ASCT) or who are not candidates for multi-agent salvage chemotherapy and ASCT | Canada’s Drug Agency, “pCODR Expert Review Committee (pERC) Final Recommendation – Pembrolizumab (Keytruda) Classical Hodgkin Lymphoma” |
| Selinexor (Xpovio®) |
Multiple myeloma | In combination with bortezomib (V) and dexamethasone (d) for the treatment of adult patients with multiple myeloma (MM) who have received at least one prior therapy | Canada’s Drug Agency, “pCODR Expert Review Committee (pERC) Final Recommendation – Selinexor” |
| Isatuximab (Sarclisa®) |
Multiple myeloma | In combination with carfilzomib and dexamethasone for the treatment of adult patients with relapsed or refractory multiple myeloma who have received 1 to 3 prior lines of therapy | Canada’s Drug Agency, “pCODR Expert Review Committee (pERC) Final Recommendation – Isatuximab” |
| Daratumumab (Darzalex®) |
Multiple myeloma | In combination with lenalidomide and dexamethasone for the treatment of patients with newly diagnosed multiple myeloma who are ineligible for autologous stem cell transplant | Canada’s Drug Agency, “pCODR Expert Review Committee (pERC) Final Recommendation – Daratumumab (Darzalex) for Multiple Myeloma” |
| Axicabtagene ciloleucel (Yescarta®) |
Non-Hodgkin lymphoma (DLBCL) | For the treatment of adult patients with diffuse large B-cell lymphoma (DLBCL) or high-grade B-cell lymphoma (HGBL) that is refractory to first-line chemoimmunotherapy or that relapses within 12 months of first-line chemoimmunotherapy | Canada’s Drug Agency, “pCODR Expert Review Committee (pERC) Final Recommendation – Axicabtagene Ciloleucel” |
| Polatuzumab vedotin (Polivy®) |
Non-Hodgkin lymphoma (DLBCL) | Polatuzumab vedotin, in combination with bendamustine and rituximab, is indicated for the treatment of adult patients with relapsed or refractory diffuse large B-cell lymphoma, not otherwise specified, who are not eligible for autologous stem cell transplant and who have received at least one prior therapy | Canada’s Drug Agency, “pCODR Expert Review Committee (pERC) Final Recommendation – Polatuzumab Vedotin (Polivy) for DLBCL” |
| Brentuximab vedotin (Adcetris®) |
Non-Hodgkin lymphoma (pcALCL) | For the treatment of adult patients with pcALCL or CD30‑expressing MF who have had prior systemic therapy | Canada’s Drug Agency, “pCODR Expert Review Committee (pERC) Final Recommendation – Brentuximab Vedotin (Adcetris) for Primary Cutaneous Anaplastic Large Cell Lymphoma or CD30-Expressing Mycosis Fungoides” |
| Pralatrexate (Folotyn®) |
Non-Hodgkin lymphoma (PTCL) | For the treatment of patients with relapsed or refractory PTCL | Canada’s Drug Agency, “pCODR Expert Review Committee (pERC) Final Recommendation – Folotyn for Peripheral T-Cell Lymphoma” |
| Brentuximab vedotin (Adcetris®) |
Non-Hodgkin lymphoma (ALCL, PTCL) | For the treatment of previously untreated adult patients with systemic anaplastic large cell lymphoma (sALCL), peripheral T-cell lymphoma – not otherwise specified (PTCL-NOS), or angioimmunoblastic T-cell lymphoma (AITL) whose tumours express CD30, in combination with cyclophosphamide, doxorubicin, and prednisone (CHP) | Canada’s Drug Agency, “pCODR Expert Review Committee (pERC) Final Recommendation – Brentuximab Vedotin (Adcetris) for Peripheral T-Cell Lymphoma” |
Source: The Conference Board of Canada.
Increased access to six of these therapies (excluding selinexor and isatuximab) could avert up to 37,770 life-years lost for patients and could add $596.5 million in potential economic contribution to society.
The impact potential of selinexor and isatuximab varied by autologous stem-cell transplantation (ASCT) (15,259 to 22,525 life-years, $296 million to $437 million) and non-ASCT (8,710 to 19,618 life-years, $169 million to $381 million) cohorts, as well as by treatment line, from second through to fourth line. Clinical and economic impacts were highest for earlier treatment lines due to the higher population exposure and lack of compounded attrition. Furthermore, ASCT models had more of an impact than non-ASCT models due to the deeper response and longer-term remission offered with transplant.
Canada’s Drug Agency (CDA) (formerly The Canadian Agency for Drugs and Technologies in Health) Reimbursement Review Reports and Project Orbis were reviewed for the last five years (October 2018–October 2023) to build a list of recently approved therapies.1 This list was then assessed using our inclusion criteria, which yielded nine therapies eligible for modelling. Of these, one therapy was indicated for HL, three for MM, and five for NHL. (See Table 2.)
Table 2
Therapies that were included for both clinical and economic modelling
| Therapies | Cancer type (subtype) |
Potential clinical value* (life-years gained) |
Potential economic value* (lost production averted) |
|---|---|---|---|
| Pembrolizumab (Keytruda®) | cHL | 1,308 | $24,846,731 |
| Selinexor (Xpovio®) and isatuximab (Sarclisa®) – Second line (ASCT) | MM | 22,525 | $437,458,917 |
| Selinexor (Xpovio®) and isatuximab (Sarclisa) – Third line (ASCT) | MM | 19,822 | $384,963,847 |
| Selinexor (Xpovio®) and isatuximab (Sarclisa®) – Fourth line (ASCT) | MM | 15,259 | $296,343,137 |
| Selinexor (Xpovio®) and isatuximab (Sarclisa®) – Second line (non‑ASCT) | MM | 19,618 | $381,012,605 |
| Selinexor (Xpovio®) and isatuximab (Sarclisa®) – Third line (non-ASCT) | MM | 14,517 | $281,949,328 |
| Selinexor (Xpovio®) and isatuximab (Sarclisa®) – Fourth line (non-ASCT) | MM | 8,710 | $169,150,781 |
| Daratumumab (Darzalex®) | MM | 34,442 | $463,871,289 |
| Axicabtagene ciloleucel (Yescarta®) | NHL (DLBCL) | 883 | $51,070,662 |
| Polatuzumab vedotin (Polivy®) | NHL (DLBCL) | 630 | $31,976,712 |
| Brentuximab vedotin (Adcetris®) | NHL (pcALCL) | 185 | $7,408,778 |
| Pralatrexate (Folotyn®) | NHL (PTCL) | 15 | $1,218,165 |
| Brentuximab vedotin (Adcetris®) | NHL (ALCL) | 170 | $10,568,644 |
| Brentuximab vedotin (Adcetris®) | NHL (PTCL) | 137 | $5,520,259 |
Source: The Conference Board of Canada.
(For a more detailed explanation of our modelling inputs, approach, and its limitations, see Methodology).
Clinical model (life-years gained)
Clinical benefits of increased therapy access for patients with MM, HL, and NHL were calculated using the number of cases multiplied by the progression-free survival of the newly developed or applied therapies for each age group. The same calculation was performed using the inputs of the current standard of care or comparator therapy listed in the CDA Reimbursement Review Reports. The life-years gained for the current market comparator therapy or standard of care was then subtracted to yield a value of life-years gained for the newly developed or applied therapy. (See Methodology, Chart 1, for a comparison of the current standard of care/comparator therapy and the newly developed or applied therapy.)
Economic model (societal contribution)
For each age group, the total life-years gained for the newly developed or applied therapy from the Clinical Model were multiplied by the average total income rate and annual median total income to determine the value of societal contribution.
Our model illustrates the potential clinical and economic impacts of these therapies by assuming universal access for all eligible MM, HL, and NHL patients. However, we recognize that current access is more complex, shaped by national and provincial factors.
- Canadian Agency for Drugs and Technologies in Health, “Reimbursement Review Reports.”
To gain deeper insight into the factors influencing access, we interviewed hematological oncology physicians and experts across medicine, pharmacy, and patient advocacy, identifying the key drivers shaping access to these therapies.
Enhancing therapy approval to benefit Canadians
Streamlining the drug approval process will improve access to newly developed or applied blood cancer therapies. Specifically, the experts raised issues like addressing approval and funding lags (e.g., reimbursement approval timelines, time-to-patient access) to overcome the effects of Canada’s small market size, which is an important factor when manufacturers are deciding whether to launch new medications here.
Experts recommend that policy officials concentrate on ways to expedite processes within the approval pipeline, including the pre-marketing study review. When other major markets have already thoroughly evaluated pre-market studies, this step extends therapy review time, draws from an already strained resource pool, and delays patient access with limited value. While steps are being taken to reduce this redundancy—projects such as 2019 Project Orbis initiative—additional steps could further streamline the review process.
At the provincial level, assessments and pricing policies are also major influences on market consideration and delayed access. Experts reported that additional provincial price negotiations that follow a pan-Canadian Pharmaceutical Alliance (pCPA) negotiation delay the time to market for therapies. This, along with provinces opting not to participate in pCPA negotiations and deciding to not list a drug, creates inequitable access and therapy funding in only select locations.
Furthermore, experts noted that, if a drug is approved and funded, rigid recommendation criteria restrict physicians from funded use of the treatment outside of the listing recommended therapeutic indication, even if it is endorsed for additional treatment regimes in other healthcare jurisdictions (e.g., the U.S.).
While this restriction is meant to reinforce patient safety recommendations, more emphasis on concurrent drug submission and review could allow patients to access additional treatment opportunities.
Once treatments are approved, rural patients face new barriers
Canada’s large geographic size and distributed population mean rural residents do not have the same access to newly developed or applied therapies as residents in urban areas. Canadians in rural settings may face challenges with primary care (e.g., access, therapeutic knowledge) and the need to travel far for specialists and care settings, and incur additional costs compared with their urban counterparts.
For rural patients, the need to travel (sometimes great distances) to cancer treatment sites increases time and financial burdens (e.g., lodging, travel, food, time off from paid work) for both them and their families. Furthermore, clinical trials and delivery of complex therapies may not be available at smaller care centres, reducing access to potentially life-saving treatment.
To compound this issue, Canadians, especially those in rural areas, are facing a primary care physician shortage, which can affect cancer screening, post-treatment monitoring, and result in acute care interaction with advanced stage disease.
The experts we spoke with see increased use of digital health technology (telemedicine, remote care) for rural healthcare sites as a potential solution to these geographic and access challenges. These digital tools can also enhance communication and care planning for oncology patients.
Expediting approval of and access to newer drugs that can be delivered effectively in community cancer programs would also improve outcomes for those unable or unwilling to receive more complex treatments in large urban academic settings.
Lastly, lowering the financial burden of travelling for treatment by increasing patient housing in proximity to major cancer care centres could provide a solution to therapy access if treatments are unavailable at smaller sites.
Canada’s cancer care capacity needs immediate attention
Investments in Canada’s cancer treatment centres can also address resource constraints related to cancer care site capacity, physician and staff capacity, and the healthcare resources that are required to administer these novel treatments.
Treatment site capacity
Launching clinical trials in Canada demands a rigorous process, taking time and resources. Academic and larger cancer treatment centres have considerable capacity and resource advantages over smaller sites for facilitating clinical trials for new or applied therapies.
Additionally, complex treatment modalities, like cellular therapy for blood cancer, need accreditation before administration, which can limit the number of care sites capable of handling these specialized requirements (minimum administration quantities, training requirements/expertise).
Increasing the capacity of smaller cancer treatment sites to expand the range of novel treatments they can support will require investments in both human and physical resources.
Physician and staff capacity
Prior to a therapy recommendation from Canada’s Drug Agency (CDA), provincial oncology drug programs must prepare for upcoming regimens that can include indication and clinical trial review, drafting of new or updated order sets, and population inclusion/exclusion criteria.
This administrative burden continues after therapy approval when point-of-care treatment staff must receive training on the new therapy administration. Experts noted that this can delay access to therapies, especially in busy treatment centres where meeting patient needs has been challenged by human resource shortages.
With the number of new treatment tools increasing, there is opportunity to expand the roles of other healthcare professionals in cancer care. In a 2023 synthesis report that identified models and approaches to enhance pharmacist roles in Canada, the McMaster Health Forum found pharmacists could provide patient consultations and education; assist with decision-making, advice, and consultations with other providers as part of a broader oncology team; and provide administrative and clinical support to assist cancer care providers.1
Expanding clinical trials and compassionate access participation to allow for gradual uptake of newly developed or applied therapies could also help. Sites that can facilitate this early therapy administration will likely be better equipped to deliver the therapy should it become funded.
For smaller sites that may not have the capacity to operate such trials, experts recommended increased administrative support from provincial health authorities to introduce or enhance trial participation.
Healthcare resource capacity
Current health resources are not evolving in parallel with the changing population and its treatment needs. With advances in cancer treatments allowing patients to live longer, and with older patients undergoing care at more vulnerable stages, the strain on the healthcare system is growing.
Newly developed or applied therapies are expensive and often resource intensive, which can reduce system capacity, especially for non-physician cancer care team members (e.g., oncology nurses, pharmacists). Experts suggested that healthcare resources advance in line with population needs by expanding treatment sites and aligning budget considerations with modern care approaches and costs.
- McMaster Health Forum, “Identifying models and approaches to enhance the role of pharmacists in cancer care.”
Insights into value
The Canadian healthcare system’s foundation of universality is falling short for blood cancer patients. Access to newly developed or applied therapies for multiple myeloma (MM), Hodgkin lymphoma (HL), and non-Hodgkin lymphoma (NHL) has the potential to avert at least 46,480 life-years being lost and to generate $765.7 million in lost economic societal contribution by 2030. Exploring and prioritizing actionable changes to address barriers and facilitators to novel therapy access can help to deliver value to the system, practitioners, and patients.
Assessing the value of different levels of access to newly developed or applied therapies goes beyond the scope of our model. While our approach offers insights into clinical and economic outcomes under an idealized scenario of universal access, the reality is far more complex. This complexity extends across all levels of healthcare—systemic, clinical, and patient.
System level
At the system level, decision-makers focus on value in terms of cost-effective therapy implementation, necessitating a focus on budget and costs associated with novel therapy reimbursement and delivery. This focus may restrict access to certain drug regimens due to financial constraints.
Clinical level
Clinicians, on the other hand, may view value through the lens of increased progression-free survival, overall survival, or patient satisfaction with their care journey. However, experts we interviewed highlighted that patients often have heightened expectations of what new therapies may achieve for their condition, which can lead to unrealistic perceptions of treatment accessibility and outcomes.
Patient level
From the patient’s perspective, value is found in fulfilling their care needs, improving quality of life, and minimizing out-of-pocket expenses. Experts agreed that, as the cost and resource demands of care rise, it is crucial for both physicians and patients to align their expectations with the realities of treatment. While an increase in progression-free survival might suggest a positive outcome, it does not always equate to improvements in quality of life or functional status.