Evaluating the impact of therapeutic and diagnostic innovations in oncology on care trajectories and healthcare resource utilization in Quebec: A population-based study using administrative data
Principal Investigator: Dr. Alice Dragomir
Institution: Université de Montréal
Sponsor: PROVEM
Scientific background
Over the past two decades, oncology has undergone major transformation driven by the emergence of precision medicine, the introduction of innovative anticancer therapies, and the increasing use of advanced molecular diagnostic tests. These innovations have significantly altered cancer care trajectories and the organization of healthcare services.
In publicly funded healthcare systems such as Quebec’s, the adoption of these technologies raises important questions regarding healthcare resource utilization, real-world clinical effectiveness and the economic impact on the healthcare system.
Administrative health data represent a key lever to evaluate, in real-world settings, the impact of therapeutic innovations on care trajectories, resource utilization, and overall healthcare system performance.
Objectives
This project aims to develop analytical and surveillance tools to support the evaluation of therapeutic innovations in real-world settings on:
- Patient care trajectories
- Real-world clinical effectiveness
- Adverse events
- Healthcare resource utilization
The study will also examine variations in the adoption of therapeutic innovations across cancer types, healthcare institutions, and geographic regions.
Population and data mobilized
- Population:
Adult patients diagnosed with cancer in Quebec between 2010 and 2025. - Data sources:
The project mobilizes several provincial administrative health data sources:- Régie de l’assurance maladie du Québec (RAMQ) database
- MED-ECHO hospital discharge database
- These datasets provide detailed longitudinal information on:
- Cancer diagnoses and comorbidities
- Treatment utilization
- Hospitalizations and medical visits
- Healthcare service utilization
- Healthcare costs
The long observation period enables large-scale population-level analysis of care trajectories before and after the introduction of therapeutic or diagnostic innovations across the province.
Methodological approach
This study is based on a population-level observational longitudinal design using administrative health data.
The analytic framework includes:
- Descriptive analyses of patient characteristics and treatment utilization
- Temporal before-after analyses of therapeutic innovations
- Treatment sequence analysis and trajectory visualization
- Survival analyses using Kaplan-Meier curves and Cox proportional hazards models
- Predictive and economic modeling, including Markov models with Monte-Carlo microsimulations to estimate clinical and budgetary impacts of innovations.
This approach enables the estimation of not only clinical impacts of innovations, but also their economic and organizational implications at the health system level.
Project status
Current phase: preparation for access and integration of provincial administrative data.
Upcoming steps include:
- Preparation of analytical dataset
- Cohort description
- Reconstruction of treatment trajectories.
Institutional signature
PROVEM is a platform dedicated to the mobilization and analysis of real-world oncology data in Quebec, integrating clinical, administrative, and patient-reported data to generate multi-level analyses that inform decision-making.