Economic evaluations conducted by Canadian health technology assessment agencies: where do we stand?
OBJECTIVE
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.
Tarride
Jean-Eric
JE
Department of Clinical Epidemiology and Biostatistics, McMaster University/St. Joseph's Healthcare Hamilton, 25 Main Street West, Hamilton, Ontario, Canada. tarride@mcmaster.ca
McCarron
Catherine Elizabeth
CE
Lim
Morgan
M
Bowen
James M
JM
Blackhouse
Gord
G
Hopkins
Robert
R
O'Reilly
Daria
D
Xie
Feng
F
Goeree
Ron
R
D002170:Canada; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D006801:Humans; D033181:Information Dissemination; D012107:Research Design; D013673:Technology Assessment, Biomedical / Q000379:methods*