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Completed Private
Sector Projects

The following private sector projects have been completed.

Client: Shoppers Drug Mart

Project ID: P2016-006/2017 0970 072 000

Research Question/Objectives: An average 50% of patients with chronic disease discontinue their medication within the first year. Non-adherence accounts for 5% of hospitalizations and $7-9B in health care costs. This study aims to understand what factors contribute to adherent/non-adherent behaviour, to inform future work examining whether targeted incentives can lead to improved adherence and preventative health management in Ontario for 2016. Over the longer term, there is interest to see whether these incentives translate to improved health outcomes (i.e. lower health care utilization or hospitalizations). The practice of offering incentives is not currently permitted in Ontario. Specifically, the research questions of interest are:

  • Identify the variables associated with medication adherence among the study population. Results will identify risk factors of non-adherence, and will inform inclusion and exclusion criteria for Phase 2
  • Explore the relationship between medication adherence, health outcomes and health care utilization among the study population.

Results:


Client: Sanofi Pasteur

Project ID: P2016-002/2017 0970 071 000

Research Question/Objectives: The objective of this research is to utilize linked health administrative databases in Ontario to establish the burden of Clostridium difficile (CDI) in Canada’s most populous province. Through the use of descriptive statistics, regression modeling and matched case-control analysis, this study will answer important questions about CDI which are necessary for optimal decision-making regarding prevention and treatment planning. Specifically , the research questions of interest are:

  • To measure the annual incidence of CDI in Ontario, both overall and in acute care hospitals, long-term care facilities, and community-dwelling populations 
  • To determine the complication rates associated with CDI in these populations, compared to control groups with similar demographics and medical history 
  • To estimate the cost of health care utilization associated with CDI in Ontario.

Results:


Client: imshealth | brogan

Project ID: P2016-009/2017 0970 081 000

Research Question/Objectives: Hypoparathyroidism is a rare disease as noted by NORD and typically is caused by damage to the parathyroid during head and neck surgery. Treatment is chronic and consists of vitamin D and calcium supplements. In contrast to hyperparathyroidism, hypoparathyroidism is not well studied, and only five prevalence studies have been published outside of Canada. This study aims to understand the epidemiology and burden of hypoparathyroidism in Ontario. Specifically, the research questions of interest are:

  • What is the prevalence, incidence, and burden of illness of hypoparathyroidism in Ontario?
  • What treatments are received by hypoparathyroidism patients in Ontario?
  • What are the costs and resource utilization of Ontarians with hypoparathyroidism?

Results:


Client: imshealth | brogan

Project ID: P2016-001/2018 0970 090 000

Research Question/Objectives: Ulcerative colitis and Crohn’s disease are the most prevalent types of inflammatory bowel diseases (IBD), with etiologies rooted in a complex interplay of genetic, microbial, and environmental factors. The overall objective of this retrospective study is to estimate the health care resource utilization and direct medical costs associated with Crohn’s disease and ulcerative colitis patients, when treated with biologic therapies, and compare the difference by type of index biologic used. Specifically, the research objectives of interest are:

  • Determine the health care resource utilization and direct medical cost of IBD study patient cohort treated with a biologic and retained on it for at least 24 months, compared to a non-IBD cohort.
  • Determine the occurrence of disease specific health outcomes for an IBD study patient cohort treated with a biologic and retained on it for at least 24 months, compared to a non-IBD cohort.
  • Estimate and describe the proportion of patients that are primary non-responders and primary responders.

Results:

Client: Hoffmann-La Roche Limited

Project ID: P2017-019/2018 0970 100 000

Research Question/Objectives: Breast cancer is responsible for over one quarter of all new cancer cases among Canadian women. Second to lung cancer, it is the most common cause of cancer death in females and is responsible for almost 137,000 potential life years lost. In the first year after diagnosis average direct health care costs in Ontario are estimated at almost $21,000 (2009 CAD) per patient and lifetime total direct health care costs in Canada are over $300M. Despite the significant clinical and economic burden, recent research studies of the epidemiology, treatment patterns and health care utilization of women with breast cancer in Ontario are limited and do not provide information specific to patient characteristics such as biomarker status (HER2+/-, HR+/-) and TNM staging at diagnosis. The purpose of this study will be to investigate the incidence of breast cancer among women in Ontario and the impact of patient baseline characteristics on patterns of care, clinical outcomes and health care utilization. Specifically, the research objectives of interest are:

  • To determine the epidemiology, treatment patterns and health care resource utilization for women diagnosed with breast cancer.
  • To identify a cohort of incident breast cancer patients and understand their characteristics at diagnosis (e.g. age, disease stage, nodal status, HER2 status, hormone receptor status).
  • To describe patterns of care and clinical outcomes in the cohort.
  • To determine health care resource utilization by disease subtype.

Availability of Results:


Client: imshealth | brogan

Project ID: P2016-008/2018 0970 105 000

Research Question/Objectives: Refractory depression, also called treatment-resistant depression (TRD), is commonly encountered by mental health professionals, even in the context of treatment with appropriate anti-depressants. Up to two thirds of patients with major unipolar depression will not respond to the first medication prescribed and 10 - 33% will not respond to multiple interventions. General consensus is emerging that unipolar major depression is considered resistant or refractory when at least two trials with anti-depressants fail to produce a significant clinical improvement.

Primary objective:

  • To measure the economic burden (direct costs) of TRD to the Ontario health care system compared to major depressive disorder (non-TRD) patient population and the general population. 

Secondary objectives:

  • To describe the Ontario TRD patient population in terms of clinical and demographic characteristics
  • To quantify the depression-related health care resource utilization (HCRU) of TRD patients in Ontario compared to the non-TRD patient population and to the general population
  • To measure incremental HCRU and incremental costs of TRD patients by the number of anti-depressant failures
  • To determine the average number of failed anti-depressant lines before MDD patients progress to an electroconvulsive therapy (ETC).

Availability of Results:

Client: Amgen Canada Inc.

Project ID: P2017-018/2018 0970 103 000

Research Question/Objectives: Osteoporosis and the clinical fractures associated with the disease have significant consequences on human health and quality of life and represent a major burden to society. As with many other chronic and asymptomatic diseases, osteoporosis is under diagnosed and undertreated. The rates of treatment for osteoporosis are also sub-optimal, even among patients who have suffered hip or other fragility fractures. Studies conducted in a variety of different populations indicate that the rates of BMD testing and treatment following fragility fractures are generally <50%, and often <10%. The purpose of this study will be to describe the real-world management (including screening and treatment) and Health Resource Utilization (HRU) of patients subsequent to a primary fragility fracture in Ontario, Canada.

Research Objectives

Primary Objectives:

  • To describe the incidence of primary fragility fractures in patients over (65+).
  • To describe the real-world management, including screening and treatment, and resource utilization following a primary fragility fracture.

Secondary Objectives:

  • To characterize the publicly-insured Ontario fragility fracture patient.
  • To describe patient management, including screening and treatment, prior to a fragility fracture in patients (65+).
  • To describe the rate of subsequent fractures, related procedures, complications, hospitalizations and mortality subsequent to a primary fragility fracture.

Exploratory Objectives:

  • To describe the persistence to osteoporosis treatments in patients (65+) who have had a fragility fracture.
  • To describe comorbidities of interest and steroid-use in patients over (65+) who have had a fragility fracture.
  • To describe opioid pain medications in patients (65+) prior to, and following a fragility fracture.
  • To describe the HRU costs for matched patients who have not had a fragility fracture.
  • To describe mortality for matched patients who have not had a fragility fracture.

Availability of Results:


Client: IQVIA Solutions Canada Inc.

Project ID: P2018-043/2019 0970 154 000

Research Question/Objectives: Kidney disease, known as nephropathy, is a complication associated with long-term diabetes. Approximately half of all patients diagnosed with type 2 diabetes will develop chronic kidney disease, which increases their risk of kidney failure and cardiovascular disease. Chronic kidney disease in diabetic patients is a major but under-recognized contributor to the burden of diabetes, both to the patient and healthcare system. The objective of the current research project is to study Ontario patients with DM and CKD, to quantify the economic burden to the public payer. In addition, the current project team would like to know the prevalence of these patients.

Research objectives:

  • Estimate the prevalence of patients with DM and CKD in Ontario.
  • Describe the demographic and baseline characteristics of patients with DM and CKD and who are incident for DM-related outcomes (death, kidney transplant, dialysis, double serum creatinine).
  • Calculate the per-patient healthcare costs from the Ontario public payer’s perspective for patients with DM and CKD who are incident to DM-related outcomes death, kidney transplant, dialysis, double serum creatinine.

Availability of Results: January 2021


Client: IQVIA Solutions Canada Inc.

Project ID: P2018-044/2019 0970 155 000

Research Question/Objectives: Nonalcoholic steatohepatitis (NASH) is a type of nonalcoholic fatty liver disease (NAFLD), a condition where fat builds up in a patient's liver. As steatosis continues, inflammation and fibrosis develop. If advanced, NASH can cause complications such as cirrhosis and portal hypertension. Left untreated, liver transplantation due to liver failure may be required.

Research objectives:

  • To describe the prevalence of type 2 diabetes with chronic kidney disease in Ontario.
  • To determine the cost to the Ontario healthcare system to treat type 2 diabetes with chronic kidney disease.

Availability of Results: March 2021


Client: IQVIA Solutions Canada Inc.

Project ID: P2017-029/2020 0970 170 000

Research Question/Objectives: Complex perianal fistulas (CPAF) are a complication for people living with Crohn’s disease. Historically, perianal fistulizing Crohn’s disease has been difficult to treat with currently available therapies and often leads to pain, swelling, infection and incontinence. In general, existing therapies are limited and associated with complications and a high failure rate. The ability to identify patients with a CPAF in administrative databases has never been established. The objective of the current research project is to estimate the surgical recurrence that receive CPAF surgical and project team interested to evaluate the treatment patterns of perianal fistula.

Research objectives:

  • Estimate the surgical recurrence rate over a 5-year period for patients that receive a CPAF surgical in Ontario hospitals.
  • Describe the treatment patterns of complex perianal fistulas in Ontario.
  • What is the most accurate diagnosis code to identify and study patients with a CPAF in administrative databases?

Availability of Results: January 2021


Client: IQVIA Solutions Canada Inc.

Project ID: P2018-041/2020 0970 171 000

Research Question/Objectives: Complex perianal fistulas (CPAF) are a complication for people living with Crohn’s disease. Historically, perianal fistulizing Crohn’s disease has been difficult to treat with currently available therapies and often leads to pain, swelling, infection and incontinence. In general, existing therapies are limited and associated with complications and a high failure rate. The ability to identify patients with a CPAF in administrative databases has never been established. The objective of the current research project is to validate the procedure codes.

Research objective:

  • To validate the use of procedure codes to identify patients with CPAFs in administrative databases.

Availability of Results: August 2021


Client: IQVIA Solutions Canada Inc.

Project ID: P2019-058/2020 0970 172 000

Research Question/Objectives: The development of atopic dermatitis as an infant and the subsequent progression of allergic rhinitis and asthma in later childhood is known as the atopic march. Research into each of these conditions has shown an impact to the patients and the health care system. However, to date, limited research has been performed on understanding the prevalence and the cost to the health care system to treat moderate to severe patients. The objective of the current research project is to determine the co-morbidity of patients with asthma, atopic dermatitis and nasal polyps.

Research objectives:

  • Determine the demographic characteristics and the co-morbidity overlap of patients with asthma, atopic dermatitis, and nasal polyps.
  • Measure the total direct health care costs of moderate-to-severe asthma, atopic dermatitis, and nasal polyps patients.
  • Identify the prevalence and recurrence rates of nasal polyp surgeries.

Availability of Results: November 2020


Client: Amgen Canada Inc.

Project ID: P2016-015/2018 0970 092 000

Research Question/Objectives: There are minimal data available in Canada describing the prevalence of Atherosclerotic Cardiovascular Disease (ASCVD) as defined in the Canadian Cardiovascular Society dyslipidemia guidelines, nor are there data on the progression of the disease over time and the association with healthcare utilization. With the recent availability of new non-statin medications to lower low density lipoprotein – Cholesterol (LDL-C levels) and demonstrated improvement in morbidity and mortality outcomes in patients treated with these drugs, there is a need to understand the real-world burden of illness and cost of ASCVD to the Canadian healthcare system. Specifically, the research objectives of interest are:

  • To describe the incidence, prevalence, patient characteristics (including comorbidities), and health resource utilization of patients with ASCVD in Ontario, Canada.
  • To describe the time from first ASCVD event to second event, and subsequent event(s), and/or mortality, if applicable.
  • To describe the type of second and/or subsequent event(s) relative to the type of primary event.

Availability of Results:


Client: Bayer Inc.

Project ID: P2018-053/2020 0970 192 000

Research Question/Objectives: Approximately 90% of prostate cancer patients who progress to metastatic castration resistant prostate cancer (mCRPC) will develop bone metastases that cause skeletal related events (SREs) e.g. spinal cord compression and fractures and their related treatments. This SRE results in decreased quality of life (QoL) as well as increased health care resource utilization (e.g. opiate use, emergency department visits, hospitalizations) throughout their disease journey. Radium-223 is a first-in-class targeted alpha therapy with a significant, clinically meaningful overall survival benefit.

Specifically, the research objectives of interest are:

  • Evaluate the relative merit of the placement of Ra-223 in the treatment sequence on overall survival.
  • Evaluate the relative merit of the placement of Ra-223 in the treatment sequence on other composite efficacy endpoints like progression free survival (PFS) and symptomatic skeletal event-free survival (SSE-FS).
  • Evaluate the relative merit of the placement of Ra-223 in the treatment sequence on the prevalence and time to event data of different safety endpoints (e.g. fracture, hospitalization).
  • Evaluate the predictive value of the changes in biochemical markers on survival or progression outcomes.
  • Describe the real-world resource utilization based on the placement of Ra-223 in the treatment sequence by disease phase.

Availability of Results: November 2021


Client: Sanofi Pasteur Canada

Project ID: P2018-049/2020 0970 212 000

Research Question/Objectives: Annual seasonal influenza epidemics remain a serious public health concern each year across Canada. Influenza vaccines are the most effective method to prevent influenza and its related complications. In Ontario, pharmacists were authorized under the Universal Influenza Immunization Program (UIIP) in 2012 to administer influenza vaccines to people 5 years and older. The research being proposed will utilize linked health administrative databases to perform a long-term analysis of the administration of influenza vaccine by pharmacists in Ontario and examine temporal and geographic trends in influenza and pneumonia hospitalizations.

Specifically, the research objectives are:

  • Identify month-to-month (and year-to-year) changes in influenza immunization trends among family physicians and pharmacists after changes were implemented to Ontario’s pharmacy immunization policy.
  • Compare and contrast the immunization trends (month-to-month) among family physicians and pharmacies by several meaningful demographic, health-related, and socioeconomic stratifications (e.g. age group, geography, etc.).
  • Examine geographic and temporal trends in influenza/pneumonia.

Availability of Results: October 2021


Client: Boehringer Ingelheim (Canada) Ltd.

Project IDs: P2018-037/2019 0970 147 000 and P2019-059/2020 0970 147 001

Research Question/Objectives: Systemic Sclerosis (SSc) is a relatively uncommon condition characterized by autoimmunity, vasculopathy and fibrosis and is clinically manifested by multi-organ involvement. Diagnosis of SSc can be difficult due to its clinical heterogeneity and variety of organ manifestations. Interstitial lung disease (ILD) is a frequent complication of the disease that is associated with increased morbidity and mortality. There is no gold standard definition of ILD in the presence of SSc. The objective of the current research project is to develop longitudinal population based estimates of the prevalence, incidence and survival of SSc and SSc-ILD using administrative data in Ontario from sources such as DAD and NACRS using ICD 10 CA codes. To broaden the potential definition of SSc and SSc-ILD, we will also examine OHIP billing records to test an exploratory algorithm to define SSc and SSc-ILD in the community setting. If feasible, we may look to combine the community definition and hospital/ambulatory care definitions to estimate prevalence and incidence of SSc and SSc-ILD. The project team is interested in looking at data over a 10 year period to allow for long-term survival estimates to be generated as well.

Research objectives:

  • Describe the prevalence and incidence of SSc and SSc-ILD in Ontario.
  • Describe the prevalence and incidence of SSc and SSc-ILD in Ontario by age groups and gender.
  • Describe the survival of patients with SSc and SSc-ILD in Ontario.
  • Identify the demographic profile of patients with SSc and SSc-ILD in Ontario.

Availability of Results:

Phase One

Phase Two


Client: Sunnybrook Research Institute

Project ID: P2017-024/2018 0970 108 000

Research Question/Objectives: Cancer costs in Canada are high and steadily increasing. In order to determine updated costs specific to certain cancer types, Ontario administrative data that will include utilization of publicly available health resources (e.g., hospitalizations, physician services, same day surgeries, medications, etc.) as well as outcomes (e.g., survival) will be used.

This study will investigate the outcomes and public health care costs of resources associated with:

  • ovarian cancer with a BRCA mutation
  • locally advanced non-small cell stage III lung cancer
  • locally advanced or metastatic urothelial cancer
  • recurrent or metastatic squamous cell carcinoma of the head and neck.

Availability of Results: April 2022


Client: IQVIA Solutions Canada Inc.

Project ID: P2018-030/2020 0970 178 000

Research Question/Objectives: This study will be conducted to better understand glycemic control in people with Type 2 diabetes (T2DM) in Canada and associated costs for the management of patients with this disease, including understanding the costs and resources for cardiovascular complications for this patient population. In addition, this project explores clinical inertia, a measure of the untimely treatment of uncontrolled diabetes.

To do so, the study will investigate the following:

  • Population descriptions of a comprehensive cohort of T2DM patients using demographics, clinical characteristics, and medications.
  • Prevalence and incidence of different comorbidities.
  • Describe the level of glycemic control in the cohort, overall and for different lines of therapy separately.
  • Describe cost per patient and the categorical and continuous relationship between glycemic control and health care resource utilization costs.
  • Estimate the HCRU/cost per selected comorbid event.

Availability of Results: April 2022

Client: Parexel International

Project ID: P2018-065/2020 0970 211 000

Research Question/Objectives: Human Immunodeficiency Virus (HIV) patients' adherence to antiretroviral therapy (ART) in Canada has been shown to be suboptimal for subsets of patients. Patient adherence is critical to ART effectiveness in both preventing progression to acquired immunodeficiency syndrome (AIDS) and in developing ART drug resistance. In recent years, a variety of highly-efficacious treatment regimens have been developed that have turned HIV infection into a chronic yet manageable condition. New and in-development therapies with simplified administration may further address the patient adherence gap, however there is a lack of granular evidence surrounding the current unmet need, and therefore how these treatments should fit in the care pathway.

Specifically, the research objectives of interest are:

  • Describe the rates of adherence by treatment regime, treatment experience, age, and sex.
  • Compare adherence of patients with different clinical characteristics, describe adherence rate change over time, understand co-morbid co-prescribed medication.

Availability of Results: June 2022

Client: Janssen Inc.

Project ID: P2019-060/2020 0970 193 000

Research Question/Objectives: Patients with advanced prostate cancer may experience a myriad of complications which may contribute to significant morbidity and health care cost. The team is interested in examining whether there are geographic variations in the manner in which patients are managed or the type of therapy they receive. In clinical trials, many patients receive many lines of therapy (often 2 or three) but it is not clear whether this occurs generally in Ontario - understanding this will aid in assessing the generalizability of trial results to the Ontario population. The research team is also interested in understanding how physicians order tests for the monitoring and investigation of patients with advanced prostate cancer, both to assess the appropriateness of test utilization for resource stewardship and to assess the potential for delays in diagnosis due to underutilization. The team seeks to characterize these by assessing physician interactions, hospitalizations, procedures, and prescriptions. Finally, utilizing data from OLIS, allows an assessment of the association between common laboratory test and survival in advanced patients with prostate cancer. Validation in the ICES dataset would prove generalizability and lend credibility to the use of these common, low-cost tests, which may improve patient risk stratification and counseling.

Research objectives:

  • Understanding geographic variations in care for men with advanced prostate cancer, including consultation with a medical oncologist, consultation with a radiation oncologist, receipt of local therapy, receipt of newer anti-cancer agents, receipt of multi lines of systemic therapy.
  • Characterizing the common sequences of systemic therapy used in patients with advanced prostate cancer.
  • Understand practice patterns for physicians treating advanced prostate cancer including frequency of laboratory tests and imaging tests.
  • Understand characteristics, complications, and treatments of patients with advanced prostate cancer.
  • Examine the prognostic role of common lab tests on survival of patients with advanced prostate cancer.

Availability of Results: August 2022

Client: Janssen Inc.

Project ID: P2020-070/2021 0970 231 000

Research Question/Objectives: The study aim is to estimate the incidence and prevalence of patients with prostate cancer who fall into one of the four disease states.

Specifically, the research objectives of this study are:

  • Characterize the distribution of patients with prostate cancer in Ontario, through disease diagnosis and localized disease states: Localized -non-metastatic castration resistant (nmCRPC), metastatic, castration sensitive (mCSPC), metastatic castration resistant (mCRPC).
  • Demonstrate the economic burden of illness through health resource utilization cost.

Availability of Results: September 2022



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