Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-24T16:50:38.991Z Has data issue: false hasContentIssue false
  • English
  • Français

Establishing a comprehensive continuum from an evidentiary base to policy development for health technologies: The Ontario experience

Published online by Cambridge University Press:  19 June 2007

Leslie Levin ,
Ron Goeree ,
Nancy Sikich ,
Birthe Jorgensen ,
Melissa C. Brouwers ,
Tony Easty  and
Catherine Zahn
Leslie Levin
Affiliation:
Ministry of Health and Long-Term Care and University of Toronto
Ron Goeree
Affiliation:
McMaster University and St. Joseph's Healthcare Hamilton
Nancy Sikich
Affiliation:
Ministry of Health and Long-Term Care
Birthe Jorgensen
Affiliation:
Ministry of Health and Long-Term Care
Melissa C. Brouwers
Affiliation:
McMaster University and Cancer Care Ontario
Tony Easty
Affiliation:
University of Toronto and University Health Network
Catherine Zahn
Affiliation:
University Health Network
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: The aim of this study was to describe a comprehensive continuum that has developed in Ontario between government and key stakeholder groups, including hospitals, physicians, academic institutions, clinical epidemiologists, health economists, industry, and bioethicists to achieve evidence-based recommendations for policy development.

Methods: The various components of the comprehensive model that has evolved to develop an evidentiary platform for policy development are summarized, and the flow between these components is described.

Results: The development of the Ontario Health Technology Advisory Committee (OHTAC) and associated programs demonstrate the need to go beyond the traditional steps taken within most health technology assessment paradigms. These components include pragmatic postmarketing studies, human factors, and safety analyses, and formalized interactions with a broad spectrum of potential end-users of each technology, experts, and industry. These components, taken together with an expanded systematic review to include a range of economic analyses, and societal impacts augment the traditional systematic review processes. This approach has been found to be important in assisting decision making and has resulted in an 81 percent conversion from evidence to policy consideration for eighty-three technologies that had been assessed at the time this article was submitted.

Conclusions: The comprehensive model, centered around OHTAC, has added important new dimensions to health policy by improving its relevance to decision makers and providing an accountable and transparent basis for government to invest appropriately in health technologies. This study could also form a basis for further research into appropriate methodologies and outcome measurements as they relate to each component of this approach.

Keywords

Health technology policy analysisField evaluationHuman factors analysisOntario Health Technology Advisory CommitteeMedical advisory secretariat
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 23 , Issue 3 , July 2007 , pp. 299 - 309
Copyright
© 2007 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Atkins D, Best D, Briss PA, et al. 2004 Grading quality of evidence and strength of recommendations. BMJ. 328: 1490.Google Scholar
Bai SW, Sohn WH, Chung DJ, et al. 2005 Comparison of the efficacy of Burch colposuspension, pubovaginal sling, and tension-free vaginal tape for stress urinary incontinence. Int J Gynaecol Obstet. 91: 246– 251.Google Scholar
Bardy GH, Lee KL, Mark DB, et al. 2005 Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. [erratum appears in N Engl J Med. 2005;352:2146]. N Engl J Med. 352: 225– 237.Google Scholar
Bodenheimer T. 2005 High and rising health care costs. Part 2: Technologic innovation. Ann Intern Med. 142: 932– 937.Google Scholar
Bowen J, Hopkins R, He Y, et al. Systematic review and cost-effectiveness analysis of drug eluting stents compared to bare metal stents for percutaneous coronary interventions in Ontario. Interim report for the Ontario Ministry of Health and Long-Term Care. Hamilton, ON: Program for Assessment of Technology in Health (PATH); December 2005.
Brouwers MC, Browman GP. The promise of clinical practice guidelines. In: Sullivan T, Evans W, Angus H, Hudson A, eds. 2003. Strengthening the quality of cancer services in Ontario. Ottawa: CHA Press
Browman GP, Levine MN, Mohide EA, et al. 1995 The practice guidelines development cycle: A conceptual tool for practice guidelines development and implementation. J Clin Oncol. 13: 502– 512.Google Scholar
Canadian Institute for Health Information. 2005. Health care in Canada 2005. Ottawa, ON: CIHI;
El Barky E, El Shazly A, El Wahab OA, et al. 2005 Tension free vaginal tape versus Burch colposuspension for treatment of female stress urinary incontinence. Int Urol Nephrol. 37: 277– 281.Google Scholar
Goeree R, Levin L. 2006 Building bridges between academic research and policy formulation: The PRUFE framework - an integral part of Ontario's evidence-based HTPA process. Pharmacoeconomics. 24: 1143– 1156.Google Scholar
Guyatt G, Gutterman D, Baumann MH, et al. 2006 Grading strength of recommendations and quality of evidence in clinical guidelines: Report from an American College of Chest Physicians Task Force. Chest. 129: 174– 181.Google Scholar
Kadish A, Dyer A, Daubert JP, et al. 2004 Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med. 350: 2151– 2158.Google Scholar
Laarman GJ, Suttorp MJ, Dirksen MT, et al. 2006 Paclitaxel-eluting versus uncoated stents in primary percutaneous coronary intervention. N Engl J Med. 355: 1105– 1113.Google Scholar
Liapis A, Bakas P, Creatsas G. 2002 Burch colposuspension and tension-free vaginal tape in the management of stress urinary incontinence in women. Eur Urol. 41: 469– 473.Google Scholar
Medical Advisory Secretariat. Technologies in osteoarthritis of the knee: Integrated health technology policy assessment. Toronto: Ontario Ministry of Health and Long-Term Care; October 2005.
Morice MC, Serruys PW, Sousa JE, et al. 2002 A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med. 346: 1773– 1780.Google Scholar
Moses JW, Leon MB, Popma JJ, et al. 2003 Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med. 349: 1315– 1323.Google Scholar
Moss AJ, Cannom DS, Daubert JP, et al. 1999 Multicentre automatic defibrillator implantation trial II (MADIT II): Design and clinical protocol. Ann Noninvasive Electrocardiol. 4: 83– 91.Google Scholar
Moss AJ, Zareba W, Hall WJ, et al. 2002 Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 346: 877– 883.Google Scholar
National Institute for Health and clinical Excellence. 2006. Implantable cardioverter defibrillators for arrhythmias: Review of technology appraisal 11. Technology Appraisal 95. London, UK: NICE; January
Paraiso MF, Walters MD, Karram MM, et al. 2004 Laparoscopic Burch colposuspension versus tension-free vaginal tape: A randomized trial. Obstet Gynecol. 104: 1249– 1258.Google Scholar
Phurrough S, Farrell J, Chin J. National coverage determination (NCD) on implantable defibrillators: Decision memorandum. Baltimore, MD: Centers for Medicare and Medicaid Services; June 2003.
Spaulding C, Henry P, Teiger E, et al. 2006 Sirolimus-eluting versus uncoated stents in acute myocardial infarction. N Engl J Med. 355: 1093– 1104.Google Scholar
Ustun Y, Engin-Ustun Y, Gungor M, et al. 2003 Tension-free vaginal tape compared with laparoscopic Burch urethropexy. [erratum appears in J Am Assoc Gynecol Laparosc. J Am Assoc Gynecol Laparosc. 2003; 10: 581.Google Scholar
Valpas A, Kivela A, Penttinen J, et al. 2003 Tension-free vaginal tape and laparoscopic mesh colposuspension in the treatment of stress urinary incontinence: Immediate outcome and complications–a randomized clinical trial. Acta Obstet Gynecol Scand. 82: 665– 671.Google Scholar
Valpas A, Kivela A, Penttinen J, et al. 2004 Tension-free vaginal tape and laparoscopic mesh colposuspension for stress urinary incontinence. Obstet Gynecol. 104: 42– 49.Google Scholar
Ward K, Hilton P, United Kingdom and Ireland Tension-free Vaginal Tape Trial Group. 2002 Prospective multicentre randomised trial of tension-free vaginal tape and colposuspension as primary treatment for stress incontinence. BMJ. 325: 67.Google Scholar
Ward KL, Hilton P; UK and Ireland TVT Trial Group. 2004 A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: Two-year follow-up. Am J Obstet Gynecol. 190: 324– 331.Google Scholar