Author(s)
Ana Johnson, PHD, Assistant Professor1, Nancy Sikich, MSc, Clinical Epidemiologist2, Gerald Evans, MD, FRCPC, Associate Professor of Medicine1, William Evans, MD, President3, Mita Giacomini, PhD, Professor of Clinical Epidemiology & Biostatistics4, Murray Glendining, BSc, Executive Vice President5, Murray D. Krahn, MD, MSc, FRCP(C), F. Norman Hughes Chair in Pharmacoeconomics6, Les Levin, MD, Senior Medical Advisor7, Paul I. Oh, MD, FRCPC, Medical Director8, Charmaine Perera, BSc, Health Policy Analyst21Queen's University, Kingston, ON, Canada; 2 Ministry of Health and Long Term Care, Toronto, ON, Canada; 3 Juravinski Cancer Centre, Hamilton, ON, Canada; 4 McMaster University, Hamilton, ON, Canada; 5 Hamilton Health Sciences, Hamilton, ON, Canada; 6 University Health Network, Toronto, ON, Canada; 7 Ontario Ministry of Health and LongTerm Care, Toronto, ON, Canada; 8 Toronto Rehabilitation Institute, North York, ON, Canada
OBJECTIVES This work describes the development of a framework for health technology decisions for Ontario Health Technology Advisory Committee (OHTAC) in Ontario, Canada. The focus of the work is on the development of an explicit framework for the recommendation of adoption of new health technologies. METHODS OHTAC convened a “Decision Determinants Sub-Committee” in January 2007 which undertook a systematic literature review and conducted key informant interviews to develop an explicit decision making framework. The purpose of the literature review and key informant interviews was to examine methods and models relevant in our setting. The main research questions were the following: a) what criteria are used to make health technology recommendations?; b) what methods are used to evaluate health technologies using these criteria (e.g., assigned weights, ranking, rating)?; and c) what methodology is used to synthesize these criteria (e.g., process/rules/frameworks). RESULTS Given the literature review and views provided by key informants, the “Decision Determinants Sub-Committee” offered recommendations about decision criteria, and the process by which decisions are made. Decision criteria include 1) overall clinical benefit; 2) consistency with societal and ethical values; 3) value for money; and 4) feasibility of adoption into the health system. The sub-committee drew on several key ideas: evidence based medicine to reflect the primacy of scientific evidence, cost-effectiveness analysis to reflect the importance of using society's resources wisely, and “Accountability for Reasonableness” to describe the elements of a fair decision-making process, and a deliberative process to describe how separate attributes of health technology ought to be evaluated and weighed. CONCLUSIONS 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. The transparency of the process should enable one to have a clear understanding of how OHTAC arrives at its recommendations regarding specific technologies.
Conference/Value in Health Info
2009-05, ISPOR 2009, Orlando, FL, USA
Value in Health, Vol. 12, No. 3 (May 2009)
Code
HT2
Topic
Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes
Disease
Multiple Diseases
