Author
Mayvis Rebeira, Ph.D.
Introduction
Health technology assessments (HTAs) are increasingly used to inform decisions by public and private payers regarding funding for new health technologies that includes drugs and medical devices. HTAs involve reviews of clinical evidence on the effectiveness of the health technologies and economic evidence on the value-for-money. It may also include other considerations such as severity of disease, unmet need, patient values, implementation and ethical considerations. The economic methods and concepts used to conduct HTAs have evolved significantly at the global level creating some divergence with Canadian approaches.
Objective
To provide an overview of economic evaluation and identify some key limitations of current economic evaluation methods used in HTAs in Canada, to generate discussions on these issues and to propose options to improve economic evaluations methods of health technologies.
Results
Several issues have been identified with current economic evaluation methods. These include the choice of comparator, data demands, handling uncertainty, measurement issues regarding health effects, discount rates, types of evaluations to be used, cost-effectiveness thresholds, as well as the scope of costs to include or exclude when assessing a new technology. Issues around economic evaluations may result in suboptimal recommendations or decisions regarding the funding of new health technologies.
Conclusions
The need to address these limitations is important for several reasons – it ensures that a more accurate and empirically-supported cost-effectiveness threshold is used to measure value for money for health technology funding decisions or recommendations; it facilitates the efficient use of resources in the health system; and it enables the adoption of innovative health technologies that can improve patients’ lives. Based on the limitations identified in this paper, 3 options are identified that can lead to better and more accurate economic assessments in Canada: (1) current guidelines on economic evaluations in Canada are currently being updated to further incorporate methodological research advances that have been made in the global field of HTA over the past decade; (2) the determination of the cost-effectiveness threshold in Canada should be established through sound empirical research grounded in economic theory; and (3) the budget impact analysis, should be applied from the perspective of the entire healthcare system budget rather than just the health technology budget in order to harvest cost efficiencies throughout the healthcare system.
