Low-dose methotrexate and serious adverse events among older adults with chronic kidney disease
Muanda FT, Blake PG, Weir MA, Ahmadi F, McArthur E, Sontrop JM, Urquhart BL, Kim RB, Garg AX. JAMA Netw Open. 2023; 6(11):e2345132. Epub 2023 Nov 27.
The Canadian Common Drug Review (CDR) was established in 2003 to provide a single process for making formulary recommendations to most Canadian publicly funded drug plans. This paper considers the most common challenges faced by the CDR: (a) determining the effectiveness of a drug (particularly interpreting the importance of surrogate markers and changes in QOL measures); (b) the massive rise in the cost of new drugs, which, in general, does not seem to accompanied by a massive increase in effectiveness; (c) interpreting complex pharmacoeconomic evaluations which often do not provide straightforward answers about the cost effectiveness of a drug; (d) prescription creep (the tendency for drugs in the real world to be used in patients who were not studied in clinical trials, thus raising concerns about a drug's real-world cost effectiveness; and (e) ethical and societal issues, particularly the reimbursement of expensive drugs for rare diseases.
Laupacis A. Pharmacoeconomics. 2006; 24(11):1157-62.
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