Ottawa - It’s a document you’d be forgiven for not knowing exists, but for those in the know, today’s arrival of CADTH’s fourth edition of the Guidelines for the Economic Evaluation of Health Technologies: Canada is highly anticipated in Canada and abroad.
This set of guidelines from CADTH, which stands for the Canadian Agency for Drugs and Technologies in Health, is critical to decisions being made about who covers payment for medications, medical devices, and methods of treating and diagnosing Canadian patients. It sets out the best practices for determining the economic value of health technologies, compared with existing approaches and, as such, affects the lives of virtually all Canadians.
“In a world where health care budgets are under pressure and new technologies are coming on the market all the time, having the best information to assess their value to Canadians is critical for those making the tough financial decisions,” said Karen Lee, Director of Health Economics at CADTH. “These guidelines provide an important way to fairly compare the value, not simply cost, of different technologies.”
Guidelines for the Economic Evaluation of Health Technologies: Canada was first published in 1994 and updated in 1997 and 2006. The guidelines are downloaded 12,000 times a year and have been used by other countries as a model for evaluating new health technologies and developing their own guidelines.
Since 2006, the available methods of analyzing data have advanced significantly, largely due to the exponential increase in computing power available to health economists. These new methods allow for more complex calculations that enable more refined estimates of costs and effects.
"CADTH's updated guidelines recognize the substantial advances that have been made in the methods of economic evaluation over the last decade and will promote the application of high-quality economic evaluation methods to inform resource allocation decisions in Canada," said Mark Sculpher, professor of Health Economics at York University in the UK and the director of the Programme on Economic Evaluation and Health Technology Assessment.
These advances include probabilistic analysis, which accounts for the fact that any data going into an analysis often have a measurable level of uncertainty that comes with it. Probabilistic analysis accounts for the uncertainty of information included, providing a more realistic sense about the accuracy of the estimate of cost-effectiveness. As a result, the new guidelines recommend that the extent of uncertainty must be considered, not just the resulting estimate.
The updated guidelines also point to emerging areas that need consideration when determining the effectiveness of a new technology. These include the use of real-world data (such as the big data found in provincial administrative health databases), network meta-analysis (which uses existing studies to bring together a comparison of multiple technologies that haven’t been compared as a group in a clinical study), and new forms of clinical trials (such as adaptive clinical trials).
Led by Karen Lee, the fourth edition of the guidelines was authored by a working group of leading Canadian health economists: Stirling Bryan (School of Population and Public Health, University of British Columbia), Doug Coyle (School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa), Murray Krahn (Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto), Christopher McCabe (Capital Health Endowed Research Chair, University of Alberta), and C. Elizabeth McCarron (CADTH).
In addition, CADTH consulted with patient groups and industry in the preparation of these guidelines, as well as commissioning research to inform approaches to some key topic areas and emerging issues.
Guidelines for the Economic Evaluation of Health Technologies: Canada — 4th Edition is available online.
CADTH is an independent, not-for-profit organization responsible for providing Canada’s health care decision-makers with objective evidence to help make informed decisions about the optimal use of drugs and medical devices in our health care system. CADTH receives funding from Canada’s federal, provincial, and territorial governments, with the exception of Quebec. The views expressed in CADTH’s publications are those of CADTH and do not necessarily reflect the views of our funders.