CADTH and the Health Technology Inquiry Service

1
CADTH and the Health Technology Inquiry Service
Jeannette Smith Stakeholder Relations Officer

• August 2008

2
Presentation

• CADTH Overview
• Health Technology Inquiry Service
• Purpose
• Products
• Processes
• Examples
• Access

3
CADTH

• Founded in 1989 by the Canadian federal,
  provincial, and territorial Deputy Ministers of
  Health
• Private, not-for-profit organization
• Funded by Health Canada, the provinces and
  territories (except Quebec)
• Head office in Ottawa
• Second office in Edmonton
• Liaison presence in all provinces and territories
  (except Quebec)

4
CADTH

• Canadas national health technology agency
• Three programs
• 140 employees

5
The need for CADTH

• Drugs and health technologies are major drivers
  of health care costs
• Concerns about appropriate care
• Uncertainty regarding clinical benefit
• Quality problem overuse, underuse, misuse
• Affordability/sustainability issues
• Uncertainty regarding cost-effectiveness
• Practice or policy variation across parts of the
  system

6
CADTHs key clients and users

• Government policy makers
• Drug plan managers
• Regional health authorities, LHINs
• Hospitals and other health care facilities
• Health professionals

7
What decision makers need

• Independent, rigorously derived evidence- based
  information
• Relevant information answering specific
  questions
• Timeliness
• Messaging concise, understandable
• Context around decisions social, legal,
  ethical, political, patient, public
• Support to interpret and apply the information

8
CADTHs role

• Assessment of technologies from cradle to grave
• Advice and recommendations
• Assessment of utilisation of health technologies
  and drugs
• Focus on policy questions
• Directly linked to decision makers
• The right information to the right people
• Decision-maker support and education

9
CADTH Guiding Principles

• Impartial
• Independent of stakeholder influence on findings
• Rigorous processes rigorously applied
• Adaptable to change
• Pan-Canadian
• Focus on customer needs
• Support to customers for uptake of findings
• Collaborative

10
CADTHs Scientific Programs

• HTA (Health Technology Assessment)
• CDR (Common Drug Review)
• COMPUS (Canadian Optimal Medication Prescribing
  and Utilization Service)

CADTH
CDR
11
Common Drug Review

• Conducts objective, rigorous reviews of clinical
  and economic evidence for new drugs
• Provides formulary listing recommendations to the
  publicly funded drug plans in Canada
• Formulary decisions are based on CDR
  recommendations, as well as individual plan
  mandates, priorities, resources

12
Canadian Optimal Medication Prescribing and
Utilization Service (COMPUS)

• Identifies optimal therapies in drug prescribing
  and use
• Promotes their use to policy makers, educators,
  health care providers and consumers
• First pan-Canadian F/P/T initiative established
  to support optimal drug therapy amongst these
  stakeholders
• One of only a handful of programs of this nature
  in the world

13
COMPUS projects

• Proton Pump Inhibitors (PPIs)
• Diabetes Management

14
Health Technology Assessment

• CADTHs HTA program offers three services
• Health Technology Assessment (HTA)
• Horizon Scanning and Emerging Health Technologies
• Health Technology Inquiry Service (HTIS)

15
Health Technologies - definition

• Comprise
• Medical devices and equipment
• Medical and surgical procedures
• Drugs, vaccines, and blood products

• Health technologies
• Improve health
• Prevent, diagnose or treat disease
• Aid in rehabilitation or long-term care

16
Diverse products for diverse needs
17
HTA reports

• 301 reports and overviews in 2007-08
• 26 comprehensive peer-reviewed assessments
• 11 overviews
• 264 HTIS reports
• On-line searchable database

18
HTAs examples

• Emergency department overcrowding
• Re-use of single-use medical devices
• Long- vs. short-acting agents for ADHD (in
  progress)
• Technologies for aiding reduction of
• medication errors in hospitals (in progress)

19
HTA realities

• HTAs take time and resources
• CADTH HTA topics decided by national committees
• HTAs can address only a small fraction of health
  technologies in use

20
Health Technology Inquiry Service

• Purpose To make decision support available
• Across the full spectrum of publicly funded
  health care institutions in Canada including
  governments, RHAs, LHINs, long term care
• For the thousands of health technologies that may
  never be candidates for HTA
• To inform health technology decisions when
  evidence is required in a short timeframe

21
HTIS

• A research service that provides quick access to
  evidence to inform policies and decisions about
  the uptake, use and/or purchase of
• Medical devices
• Medical and surgical procedures
• Diagnostic tests
• Drugs

22
HTIS beyond the scope

• The HTIS mandate does not extend to
• Individual patient care issues
• IT
• Human Resources
• Records management
• Staff safety

23
HTIS users

• Health care decision makers in
• Federal and provincial ministries of health
• Provincial and territorial medical directors
• Regional health authorities, Local Health
  Integration Networks
• Hospitals and other publicly funded health
  care facilities

24
HTIS products

• Reports containing evidence about
• Clinical outcomes
• Risk, safety, mortality, morbidity
• Quality of life
• Cost-effectiveness, economic, or cost impacts

25
HTIS products
26
Staff

• LIS staff -16 information specialists and library
  technicians
• Authors and reviewers highly trained
  specialists experienced in conducting critical
  appraisals of evidence
• In-house and contract

27
Report levels, content, timelines

• Five levels of reports available
• Level 1 Reference list 24-72 hours
• Level 1.5 Summary of abstracts up to 10
  business days
• Level 2 Summary of evidence with critical
  appraisal up to 30 business days
• Level 3 Peer-reviewed summary with critical
  appraisal up to 60 business days
• Level 4 Peer-reviewed rapid review 16 weeks

28
Content

• Bibliography of best evidence listing quality
  evidence papers and other resources
• List of abstracts from quality documents
• Additional sources of potentially useful
  information
• Contact information for people who are experts in
  or users of particular technologies
• Summary of evidence with critical appraisal
• Peer review

29
HTIS request process

• Step 1
• Complete a one-page request form
• Requests can be made through
• Member of CADTHs Liaison Team
• E-mail htis_at_cadth.ca
• Telephone [phone]
• Fax [phone]

30
HTIS request process

• Step 2
• A 5- to 10-minute phone call from a CADTH
  research officer to
• Refine/verify the question(s) - PICO
• Discuss level of report required
• Discuss timeframe for delivery of report

31
Search process

• Two working days allotted for a basic search
• Sources can include
• PubMed
• OVID MEDLINE
• EMBASE
• BIOSIS
• CINAHL
• Cochrane Library
• University of York Centre for Reviews and
  Dissemination databases
• ECRI
• EuroScan
• International HTA agencies
• Internet (focused search)

32
Search process

• English language articles only
• All pertinent literature pro, con or neutral
  included in bibliography
• Defined timeframe for example, articles
  published since 2001

33
Review process

• All reports reviewed by
• CADTH research assistant
• HTIS Manager

34
Recent requests

• Pneumatic anti-shock garments for acute shock
• Needle gauge for administration of red blood
  cells
• Disposable stapler use in bowel surgery
• Cost-effectiveness of bariatric surgery for
  morbidly obese patients
• Huber safety needles for intravascular access
  devices in adult oncology patients

35
Recent requests (cont.)

• Temporal temperature measurement during minor
  surgery
• Interventions for the management of obesity in
  patients with diabetes clinical and
  cost-effectiveness
• Mattresses for decubitus ulcer prevention
• Vacuum assisted wound closure
• Medication administration via enteral feeding
  tubes

36
Monthly summary

• Published around the 10th of each month
• Lists all HTIS reports completed the previous
  month
• Distributed by CADTH Liaison Team members
• Freely available to anyone who requests it
• People can request copies of any (or all) of the
  existing reports from their CADTH Liaison or from
  HTIS

37
HTIS in practice example 1

• From an Ontario hospital
• What is the evidence that the use of NSAIDS for
  analgesia will delay healing or increase the
  incidence of non-union in patients with
  fractures?
• 2. Is there any evidence that multiple doses of
  an NSAID versus a single dose of an NSAID have an
  effect on healing time or incidence of non-union
  in patients with fractures?

38
Response

• Thank you for providing the report on the use of
  NSAIDs in patients with fracturesIt gave me the
  evidence required to influence members of our
  Medical Advisory Committee to advance a new
  Medical Directive for Pain in our ER. The
  orthopedics surgeons remained unconvinced but
  those in the audience that practice evidence
  based medicine were convinced and voted in
  favour.
• Medical Director Emergency Program

39
HTIS in practice example 2

• From a small Northern Ontario hospital
• 1. What is the cost-effectiveness of VAC
  dressings compared to other types of wound care
  for wound healing?
• 2. Is there any evidence that VAC dressings
  decrease hospital length of stay compared to
  other types of wound care?
• 3. Is there a specific patient population that
  VAC dressings should be used for?

40
Response

• All I can say is that this is an absolutely
  super servicewithin two weeks I have been
  supplied with a veritable plethora of info that
  will help us to make a very informed decision.
• I was also put on to McGill and the University of
  Köln, Germany where I have had personal
  communication with experts in the Field of
  Medical Technology Evaluation. That is pretty
  good for a small community hospital in Northern
  Ontario.
• Assistant Executive Director/Patient Care Services

41
Key points

• HTIS is Canadian
• HTIS is free to any decision maker in Canadas
  publicly funded health care systems
• HTIS is quick
• HTIS responds to specific needs/questions
• HTIS is unbiased
• HTIS is confidential

42
HTIS and Hospital Medical Libraries

• Not duplicate services
• HTIS - an additional research-based resource that
  can provide impartial evidence specifically to
  inform decisions about health-technology-related
  policy, purchasing or patient care practices

43
Liaison Officers

• Liaison Officers on the ground in each
  jurisdiction
• Hired locally, work locally
• Strengthen links between CADTH and its
  stakeholders
• Ensure stakeholders needs are known. i.e. topic
  requests, policy decision needs
• Deliver information to stakeholders
• Help with uptake and utilization of advice

44
Accessing HTIS in Ontario

• New requests
• Existing reports
• Monthly summaries of reports
• Information
• Jeannette Smith, Stakeholder Relations Officer
• jeannettes_at_cadth.ca

45
www.cadth.ca