General Essays

Health technology assessment: A comprehensive framework for evidence-based recommendations in Ontario

Ana P. Johnson^a1, Nancy J. Sikich^a2, Gerald Evans^a3, William Evans^a4, Mita Giacomini^a5, Murray Glendining^a6, Murray Krahn^a7, Les Levin^a8, Paul Oh^a9 and Charmaine Perera^a10

^a1 Queen's University

^a2 Ministry of Health and Long Term Care

^a3 Queen's University and Kingston General Hospital

^a4 Hamilton Health Sciences and McMaster University

^a5 McMaster University

^a6 Hamilton Health Sciences

^a7 University of Toronto and Toronto General Hospital

^a8 Ministry of Health and Long Term Care and University of Toronto

^a9 University of Toronto

^a10 Ministry of Education

Abstract

Objectives: This study describes the development of a framework for health technology decisions, for Ontario Health Technology Advisory Committee (OHTAC) in Ontario, Canada.

Methods: OHTAC convened a “Decision Determinants Sub-Committee” in January 2007, which undertook a systematic literature review and conducted key informant interviews to develop an explicit decision-making framework.

Results: The “Decision Determinants Sub-Committee” offered recommendations about decision criteria, and the process by which decisions are made. Decision criteria include (i) overall clinical benefit, (ii) consistency with societal and ethical values, (iii) value for money, and (iv) feasibility of adoption into the health system. The decision process should be transparent and fair and should use a deliberative process in delivering recommendations.

Conclusions: This methodology is currently being pilot tested in a live environment: OHTAC. It will be evaluated and revised according to its feasibility, acceptability, and perceived usefulness.

Keywords:

• Health technology assessment;
• Health technology policy analysis;
• Ontario health technology advisory committee;
• Medical advisory secretariat;
• Prioritization

Footnotes

This research was undertaken, in part, thanks to funding from the Canada Research Chairs Program for Dr. Ana Johnson. Funding is provided by the Ministry of Health and Long-Term Care for those with Ministry affiliation. The authors acknowledge personal support from the F. Norman Hughes Chair in Pharmacoeconomics for Dr. Murray Krahn, all other members of the Ontario Health Technology Advisory Committee (OHTAC) in the Ministry of Health and Long Term Care for their support, and the contribution from the following individuals regarding their views on processes for recommendations related to different settings: Dr. Anthony Culyer, Dr. Alan Detsky, Dr. Gord Guyatt, Mr. Ronald Sapsford, and Mr. Frank Wagner.