International Journal of Technology Assessment in Health Care

GENERAL ESSAYS

Economic evaluations conducted by Canadian health technology assessment agencies: Where do we stand?

Jean-Eric Tarridea1, Catherine Elizabeth McCarrona1, Morgan Lima1, James M. Bowena1, Gord Blackhousea1, Robert Hopkinsa1, Daria O'Reillya1, Feng Xiea1 and Ron Goereea1

a1 McMaster University/St. Joseph's Healthcare Hamilton

Abstract

Objectives: To examine the production of Health Technology Assessments (HTAs) with economic evaluations (EEs) conducted by Canadian HTA agencies.

Methods: This research used a three-step approach: (i) the Web sites of five Canadian organizations promoting HTA were searched to identify HTA reports with EEs; (ii) HTA agencies were surveyed to verify that our information was complete with respect to HTA activities and to describe the factors that influence the HTA process in Canada (i.e., selection of HTA topics, execution, dissemination of results and future trends); (iii) HTAs with EEs were appraised in terms of study design, retrieval of clinical and economic evidence, resource utilization and costing, effectiveness measures, treatment of uncertainty as well as presence of a budget impact analysis (BIA), and policy recommendations.

Results: Two hundred forty-nine HTA reports were identified of which 19 percent included EEs (n = 48). Decision analytic techniques were used in approximately 75 percent of the forty-eight EEs and probabilistic sensitivity analyses were commonly used by all agencies to deal with parameter uncertainty. BIAs or policy recommendations were given in 50 percent of the evaluations. Differences between agencies were observed in terms of selection of topics, focus of assessment and production of HTA (e.g., in-house activities). Major barriers to the conduct of HTAs with EEs were capacity, a lack of interest by decision makers and a lack of robust clinical information.

Conclusions: The results of this research point to the need for increased HTA training, collaboration, evidence synthesis, and use of pragmatic “real world” evaluations.

Footnotes

This project was funded by a 2006 Canadian Agency for Drugs and Technologies in Health (CADTH) Capacity Building Grants Program. Daria O'Reilly and Jean-Eric Tarride each hold a 2007 Career Scientist Award, Ontario Ministry of Health and Long-Term Care. The authors thank the respondents of the HTA survey and their Agencies for assistance for completing this research. Special thanks to Christine Henderson, Jan Watson, and Donna Wilcockson from the Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton, for help in developing this manuscript.