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

Johnson, Ana; Sikich, Nancy; Evans, Gerald A.; Evans, William K.; Giacomini, Mita; Glendining, Murray; Krahn, Murray; Levin, Leslie; Oh, Paul; Perera, C

doi:10.1017/s0266462309090199

Cited by 60 publications

(74 citation statements)

References 19 publications

(22 reference statements)

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“…18 Demographic and geographic balance was sought in creating the 14-person panel to ensure a reasonable range of perspectives on the issues being deliberated. The recruitment strategy and the panel's demographics are described in detail elsewhere.…”

Section: Citizens' Reference Panel On Health Technologiesmentioning

confidence: 99%

Citizens' perspectives on personalized medicine: a qualitative public deliberation study

et al. 2013

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Our objective was to explore citizens' informed and reasoned values and expectations of personalized medicine, a timely yet novel genomics policy issue. A qualitative, public deliberation study was undertaken using a citizens' reference panel on health technologies, established to provide input to the health technology assessment process in Ontario, Canada. The citizens' panel consisted of five women and nine men, aged 18-71 years, with one member selected from each health authority region. There were shared expectations among the citizens' panel members for the potential of personalized medicine technologies to improve care, provided they are deemed clinically valid and effective. These expectations were tempered by concerns about value for money and the possibility that access to treatment may be limited by personalized medicine tests used to stratify patients. Although they questioned the presumed technological imperative presented by personalized medicine technologies, they called for increased efforts to prepare the health-care system to effectively integrate these technologies. This study represents an early but important effort to explore public values toward personalized medicine. This study also provides evidence of the public's ability to form coherent judgments about a new policy issue. Concerned that personalized tests might be used to ration care, they suggested that treatment should be made available if patients wanted it, irrespective of tests that indicate little benefit. This issue raises clinical and policy challenges that may undermine the value of personalized medicine. Further efforts to deliberate with the public are warranted to inform effective, efficient and equitable translation of personalized medicine.

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Section: Citizens' Reference Panel On Health Technologiesmentioning

confidence: 99%

Citizens' perspectives on personalized medicine: a qualitative public deliberation study

et al. 2013

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“…*3 Dionne et al, 2015Dolan, 2010;Duthie et al, 1999;Le Gales & Moatti, 1990;Gibson et al, 2006;Gurtner, 2014;Hilgerink et al, 2011;Johnson et al, 2009;Lasry et al, 2011;Mullen, 2004;Ritrovato et al, 2015;Tannahill, 2008;Wilson et al, 2006;Wilson et al, 2007;Youngkong et al, 2012a;Youngkong et al, 2012b. *4 de Greef-van der Sandt et al, 2016;Vuorenkoski et al, 2008;Youngkong et al, 2009. *5 Diaby & Goeree , 2014Goetghebeur et al, 2008;Goetghebeur et al, 2010;Goetghebeur et al, 2012;Golan & Hansen, 2010;Hailey, 2009;Menon et al, 2010;Miot et al, 2012;Mullen, 2004;Tony et al, 2011;University of York, 2002;Wilson et al, 2007. *6 Golan & Hansen, 2010;Johnson et al, 2009;Martin et al, 2001;Meagher, 2010;Noorani et al, 2007;Simoens, 2014;Vuorenkoski et al, 2008. *7 Bots & Hulshof, 2000Koopmanschap et al, 2010;Mullen, 2004.…”

Section: (("Decision Making"[mesh] Not Shar*[tiab]) or ("Decision Supunclassified

“…*8 Broekhuizen et al, 2015Mitton et al, 2006. *9 Broekhuizen et al, 2015Dionne et al, 2015;Dolan, 2010;Duthie et al, 1999;Johnson et al, 2009;Lehoux & Williams-Jones, 2007;Lopert, 2009;Mühlbacher & Kaczynski, 2015;Vuorenkoski et al, 2008. *10 Hailey, 2009Johnson et al, 2009;Martin et al, 2001.…”

Section: (("Decision Making"[mesh] Not Shar*[tiab]) or ("Decision Supunclassified

Análise de Decisão Multicritérios (MCDA): uma revisão rápida sobre os critérios utilizados na Avaliação de Tecnologias em Saúde

Souza¹,

Santos²,

Cintra³

2018

JBES

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RESUMOObjetivo: Identificar os vários critérios utilizados por agências e órgãos governamentais internacionais na Avaliação de Tecnologias em Saúde (ATS). Métodos: Foi realizada uma revisão rápida com busca estruturada na base de dados Medline (via PubMed) e Lilacs complementada por busca na literatura cinzenta, sem restrição de idioma. Incluíram-se estudos da área de saúde que descreviam critérios e que utilizaram o método MCDA (Análise de Decisão Multicritérios) na ATS. Excluíram-se estudos que avaliaram apenas uma tecnologia específica ou contexto restrito. Os critérios foram agregados e sumarizados conforme opinião de especialistas em ATS. Resultados: Foram identificadas 3.746 publicações, sendo 27 selecionadas. Os critérios extraídos foram categorizados e seus respectivos atributos foram listados. Dez categorias foram apresentadas: benefício e risco da intervenção (4 critérios); impacto da doença (4 critérios); impacto econômico (5 critérios); contexto terapêutico da intervenção (4 critérios); qualidade e incerteza da evidência (4 critérios); implementação da intervenção (5 critérios); benefícios para a sociedade (5 critérios); benefícios para o sistema de saúde público (5 critérios); benefícios para a indústria (1 critério); e outros (3 critérios). Os atributos mais prevalentes foram: custo-efetividade; segurança e tolerabilidade; impacto orçamentário para o sistema/plano de saúde; gravidade da doença; equidade; efetividade; custo. Conclusões: Os órgãos decisores utilizam grande variedade de critérios para o MCDA, refletindo visões e valores diferentes entre as culturas. O estudo fornece informação para discussão no contexto brasileiro de uma lista mais ampla e possível padronização de critérios a serem utilizados na tomada de decisão pública ou privada sobre a incorporação de novas tecnologias. ABSTRACTObjective: To identify the various criteria used by international government agencies and bodies in Health Technology Assessment (HTA). Methods: A rapid review was conducted with a structured search in the Medline database (via PubMed) and Lilacs supplemented by a search in the gray literature, without a restriction of language. Inclusion criteria were studies in health context, describing the criteria and using the MCDA (Multicriteria Decision Analysis) method in HTA. We excluded studies that assessed only one specific technology or restricted context. The criteria were aggregated and summarized according to the opinion of HTA experts. Results: A total of 3,746 publications were identified, of which 27 were selected. The extracted criteria were categorized, and their respective

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“…In Sweden, HTAs are undertaken by the Pharmaceutical Benefits Board to guide the reimbursement of drugs. 13 In Canada, economic evaluations have been included in HTA (excluding drugs) by the 14 Economic evaluations, especially with regard to chronic pain, should take into account a wide range of evidence and outcomes, including direct and indirect medical costs and productivity effects. Interested institutions, for example, hospitals, company employers, and health insurance providers, may differentially appreciate the economic benefits of any given treatment, that is, reduced cost, reduced future healthcare utilization, and reduced sick leave.…”

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confidence: 99%

“…qc.ca/site/home.phtml). 14 Les évaluations d'impact financier, particulièrement pour la douleur chronique, devraient tenir compte d'une vaste gamme de données probantes et de résultats, y compris les coûts médicaux directs et indirects et les effets sur la productivité. Les institutions intéressées, soit les hôpitaux, les employeurs et les fournisseurs d'assurance de santé, pourraient tous bénéficier, chacun à sa façon, des avantages économiques d'un traitement donné, par ex.…”

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L’impact financier de la douleur chronique, ou comment la science peut guider les politiques de santé

Gilron

Johnson

2010

Can J Anesth/J Can Anesth

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Prevalence estimates between 15-40% of the general population have been reported in epidemiologic studies of chronic noncancer pain 1 which includes headache, arthritis, fibromyalgia, low back and neck, post-traumatic, neuropathic, visceral and other causes of pain. Recognizing the biopsychosocial complexity of chronic pain and the fact that diagnosis and/or cure of underlying conditions is often unsuccessful, John Bonica et al. pioneered the concept of multidisciplinary pain clinics over 50 years ago to manage these devastating conditions. 2 Although chronic pain generally presents first to primary care practitioners, pain clinic referrals are made often for resistance to first-line treatments, severe unremitting pain and/or complex psychosocial situations. A wide variety of chronic pain treatment interventions are aimed at reducing pain, improving mood, promoting better physical, occupational, and social function, and teaching individual and family coping skills. A longstanding recognition of the value of pain clinics together with an increasing prevalence of chronic pain have led to growth in demand, waiting list size, and international concerns over limited pain treatment resources. 3,4 In Canada, a task force was recently established to study pain treatment waiting times. 4 In this issue of the Journal, STOP-PAIN Research Group investigators report on the biopsychosocial 5 and economic 6 burden of pain in individuals waiting to consult with a pain specialist.In STOP-PAIN-1, 728 of the 3,343 invitees from a waiting list to be seen at any of eight Canadian universitybased pain clinics completed several validated questionnaires regarding demographics, pain, sleep, and physical and emotional functioning. 5 To evaluate changes over time, 271 of the 512 randomly selected respondents repeated the questionnaires three months afterwards. In the linked STOP-PAIN-2 study, a subgroup of 272 of the 512 randomly selected respondents completed daily questionnaires about publicly and privately funded healthcarerelated costs (direct and indirect) over a three-month period. 6 STOP-PAIN-1 results indicated a shockingly high level of pain burden with ratings of severe pain, sleep disturbance, and interference with normal activities in approximately 66% of respondents, moderate or severe depression in 50% of respondents, and suicidal ideation in 35% of respondents. Compared with the general population, the results of the SF-36 questionnaire suggested profound quality of life impairments of 40-70% of respondents. Despite some small statistical differences, changes over the three-month follow up were unremarkable. STOP-PAIN-2 results indicated median participant care costs of $1,462 (CDN)/month or an overwhelming $17,544/year, the vast majority of which was indirect, e.g., lost labour time, and privately funded. As with other surveys, these investigations need to be considered in the context of some important methodological limitations, including likely heterogeneity of the study population, limited generalization to broader trea...

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

Abstract: 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.

Cited by 60 publications

References 19 publications

Citizens' perspectives on personalized medicine: a qualitative public deliberation study

Citizens' perspectives on personalized medicine: a qualitative public deliberation study

Análise de Decisão Multicritérios (MCDA): uma revisão rápida sobre os critérios utilizados na Avaliação de Tecnologias em Saúde

L’impact financier de la douleur chronique, ou comment la science peut guider les politiques de santé

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