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  • Cambridge University Press (CUP)  (3)
  • Blackhouse, Gord  (3)
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  • Cambridge University Press (CUP)  (3)
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  • 1
    Online Resource
    Online Resource
    In search of the evidentiary foundation of published Canadian economic evaluations (2001–06)
    Cambridge University Press (CUP) ; 2009
    In:  International Journal of Technology Assessment in Health Care Vol. 25, No. 02 ( 2009-4), p. 214-221
    Details
    In: International Journal of Technology Assessment in Health Care, Cambridge University Press (CUP), Vol. 25, No. 02 ( 2009-4), p. 214-221
    Abstract: Objectives: The aim of this study was to present a review of economic evaluations conducted from a Canadian perspective and to characterize sources of evidence and statistical methods to analyze effectiveness measures, resource utilization, and uncertainty. Methods: A search strategy was developed to identify Canadian economic evaluations published between January 2001 and June 2006. A standardized abstraction form was used to extract key data (e.g., study design, data sources, statistical methods). Results: A total of 153 unique studies were included for review, of which 75 were evaluations of drug therapies and less than half were funded by industry. Cost-effectiveness analysis was the most common type of economic evaluation and 80 percent of the studies used modeling techniques. A single source of evidence for effectiveness measures was used in half of the studies. Statistical methods were commonly reported to compare effectiveness measures when the economic evaluation was conducted alongside a clinical trial but less commonly when determining effectiveness input parameters in model-based economic evaluations, or to analyze resource utilization data. Authors relied mostly on univariate sensitivity analyses to explore uncertainty. Conclusions: This review identifies the need to improve the conduct and reporting of statistical methods for economic evaluations to improve confidence in the results.
    Type of Medium: Online Resource
    ISSN: 0266-4623 , 1471-6348
    URL: Article
    DOI: 10.1017/S0266462309090278
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2009
    detail.hit.zdb_id: 2020486-3
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  • 2
    Online Resource
    Online Resource
    Economic evaluation of drug-eluting stents compared to bare metal stents using a large prospective study in Ontario
    Cambridge University Press (CUP) ; 2009
    In:  International Journal of Technology Assessment in Health Care Vol. 25, No. 02 ( 2009-4), p. 196-207
    Details
    In: International Journal of Technology Assessment in Health Care, Cambridge University Press (CUP), Vol. 25, No. 02 ( 2009-4), p. 196-207
    Abstract: Objectives: To determine the cost-effectiveness (CE) and cost-utility (CU) of drug-eluting stents (DES) compared to bare metal stents (BMS) in Ontario using a large prospective “real-world” cohort study and determine the extent to which results vary by patient risk subgroups. Methods: A field evaluation was conducted based on all stent procedures in the province of Ontario between December 1, 2003, and March 31, 2005, with a minimum subject follow-up of 1 year. Effectiveness data from the study using a propensity-score matched cohort were combined with resource utilization and cost data and quality of life (QOL) data from the published literature in a decision analytic modeling framework to determine 2-year cost-effectiveness (cost per revascularization avoided) and cost-utility (cost per quality-adjusted life-year ([QALY] gained). Stochastic model parameter uncertainty was expressed using probability distributions and analyzed using a probabilistic model. Modeling assumptions were assessed using traditional deterministic sensitivity analysis. Results: Significant differences in revascularization rates were found for patients with two or more high risk factors. Despite these differences, the CE and CU of DES remained high (e.g., $419,000 per QALY gained in the most favorable patient risk subgroup). In sensitivity analysis, the difference in cost between DES and BMS had an impact on the CE and CU results. For example, at a price differential of $500, the CU of DES was $20,000/QALY for one patient subgroup and DES was dominant (i.e., less costly and more effective) in another. Conclusions: At current prices, the CE/CU of DES compared with BMS is high even in patient high risk subgroups. As the relative price of DES decrease, the value for money attractiveness of DES increases, especially for selected high risk patients.
    Type of Medium: Online Resource
    ISSN: 0266-4623 , 1471-6348
    URL: Article
    DOI: 10.1017/S0266462309090254
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2009
    detail.hit.zdb_id: 2020486-3
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  • 3
    Online Resource
    Online Resource
    Economic evaluations conducted by Canadian health technology assessment agencies: Where do we stand?
    Cambridge University Press (CUP) ; 2008
    In:  International Journal of Technology Assessment in Health Care Vol. 24, No. 04 ( 2008-10), p. 437-444
    Details
    In: International Journal of Technology Assessment in Health Care, Cambridge University Press (CUP), Vol. 24, No. 04 ( 2008-10), p. 437-444
    Abstract: Objectives: 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.
    Type of Medium: Online Resource
    ISSN: 0266-4623 , 1471-6348
    URL: Article
    DOI: 10.1017/S0266462308080574
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2008
    detail.hit.zdb_id: 2020486-3
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    Online Resource
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