Inclusion of drugs in provincial drug benefit programs: Should "reasonable decisions" lead to uncontrolled growth in expenditures?

Ontario's Drug Quality and Therapeutics Committee (DQTC) reviews submissions by pharmaceutical manufacturers who wish to have their drugs included in the formulary of the Ontario Drug Benefits Program. In making its decisions and developing its recommendations, the committee uses cost-effectiveness information.1 However, despite the use of such information and the assessment of a previous commentator that the DQTC “makes reasonable decisions in … very difficult circumstances,” program expenditures rose by 10% annually between 1996/97 and 1998/99 and by 15% in 2000/01.1 This growth in expenditures has led both the premier of Ontario and the minister of health and long-term care to question the program's affordability.1 In this commentary we explain why the cost-effectiveness approach that has been used by the DQTC has led to these continuous and considerable increases in expenditures.