The outcome of IHE initiatives is providing better information for developing health policy and best medical practices. IHE disseminates information in many ways. In addition to publications in peer-reviewed journals, IHE produces books and a variety of reports synthesizing information in a particular field.
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Healthcare systems and organizations, industry, and the public call for support in navigating digital health technologies (DHTs). The authors critically assessed the regulations for DHTs in the U.S., the U.K., and Canada and the DHT-specific health technology assessment (HTA) guidelines, frameworks, and toolkits to describe the current state of practice and propose considerations…
This commentary clarifies and reinforces recommendations provided in a recently published article on the second edition of the practical guide for evidence-informed deliberative processes (EDPs): “Evidence-Informed Deliberative Processes for Health Benefit Package Design – Part II: A Practical Guide”. While the practical guide draws on an extensive amount of information…
| Melanie McPhail, Christopher McCabe, Dean Regier, Tania Bubela
Regulatory and reimbursement decisions for drugs and vaccines are increasingly based on limited safety and efficacy evidence. In this environment, life-cycle approaches to evaluation are needed. A life-cycle approach grants market approval and/or positive reimbursement decisions based on an undertaking to conduct post-market clinical trials that address evidentiary uncertainties,…
| Erin Kirwin, Jeff Round, Ken Bond, Christopher McCabe
This paper presents a Life-Cycle Health Technology Assessment (HTA) framework designed to address three challenges faced by standard HTA: uncertainty, evolving evidence and health system sustainability. The LC-HTA framework is built around on-market evidence generation and risk-based pricing strategies. Where…
The Institute of Health Economics conducted an environmental scan to: describe available Alberta data assets to support the identification, surveillance, and management of high-risk patients with known cardiovascular disease; identify preliminary gaps in the available information; and formulate potential strategies to address the gaps identified. This environmental scan represents…
| Bing Guo, Carmen Moga, Charles Yan, Gareth Hopkin, Jeff Round, Jennifer Seida, Lisa Tjosvold, Michelle Pollock
This health evidence review assesses the clinical effectiveness and economic impact of various vascular risk reduction (VRR) initiatives that have been implemented in Alberta, and promising new initiatives, to inform priority-setting decisions regarding risk-reduction initiatives. The assessment also examines the clinical benefit that future projects would need to achieve for them…
| Susan Armijo-Olivo, Bing Guo, Nathan McClure, Carmen Moga, Negar Razavilar, Jeff Round, Lisa Tjosvold, Dat Tran, Charles Yan
This health evidence review assesses strategies for the delivery of high-quality and cost-effective stroke rehabilitation care in Alberta to inform decisions about how the province might increase care capacity for stroke rehabilitation services and maximize the benefits of effective treatment interventions. The review assesses two novel approaches to the delivery of high-quality…
Summary: Deliberative processes are a well-established part of health technology assessment (HTA) programs in a number of high- and middle-income countries, and serve to combine complex sets of evidence, perspectives, and values to support open, transparent, and accountable decision making. Nevertheless, there is little documentation and research to inform the development…
| Michelle Pollock, Ann Scott, Jennifer Seida, Paula Corabian, Andrew J. Sutton, Mike Paulden, Christopher McCabe, Lisa Tjosvold, Bing Guo
The clinical review and economic evaluation aimed to determine how Oncotype DX and Prosigna can be optimally used to determine which patients with early-stage breast cancer will benefit from adjuvant chemotherapy. This report addresses the following research question: For patients with early-stage (I–III), ER+, HER2?, node-negative or node-positive (one to three nodes) breast…
| Timothy Caulfield, Alessandro R Marcon, Blake Murdoch, Jasmine Brown, Sarah Tinker Perrault, Jonathan Jarry, Jeremy Snyder, Samantha J Anthony, Stephanie Brooks, Zubin Master, Christen Rachul, Ubaka Ogbogu, Joshua Greenberg, Amy Zarzeczny, Robyn Hyde-Lay
Abstract: Numerous social, economic and academic pressures can have a negative impact on representations of biomedical research. We review several of the forces playing an increasingly pernicious role in how health and science information is interpreted, shared and used, drawing discussions towards the role of narrative. In turn, we explore how aspects of narrative are used in…
| Paula Corabian, Bing Guo, Carmen Moga, Ann Scott
This article retrospectively examines the evolution of rapid assessments (RAs) produced by the Health Technology Assessment (HTA) Program at the Institute of Health Economics over its 25-year relationship with a single requester, the Alberta Health Ministry (AHM).
| Paula Corabian, Bing Guo, Carmen Moga, Ann Scott
The Health Technology Assessment Program at the Institute of Health Economics has conducted rapid assessments (RAs) since 1993. This information paper draws on this experience and describes the evolution of RA process and products over a 25-year relationship with a single requester to quantify the effects of this partnership on the RAs produced. The aim is to contribute to emergent…
Ce rapport fournit un résumé d’un atelier de sprint sur la conception de données probantes du monde réel (DPMR) qui a eu lieu le 21 octobre 2018 à Toronto, en Ontario. L’atelier a été conçu et offert dans le cadre d’un partenariat entre l’Agence canadienne des médicaments et des technologies…
This report provides a summary of a real-world evidence (RWE) design sprint workshop that took place on October 21, 2018 in Toronto, Ontario. The workshop was developed and delivered as a joint partnership between the Canadian Agency for Drugs and Technologies in Health (CADTH); Canadian Association for Population Therapeutics (CAPT), Health Canada, and the Institute of Health…
This study originated from discussions on how to translate research findings into conclusions regarding safety and effectiveness in systematic reviews responding to requests from a provincial mechanism for introducing and diffusing publicly funded healthcare technologies. Its objective is to identify prominent and reliable evidence grading systems used in health technology assessment…
| Charles Yan, Yufei Zheng, Michael D. Hill, Balraj Mann, Thomas Jeerakathil, Noreen Kamal, Shy Amlani, Anderson Chuck
Abstract: We present a conceptual approach to determine the optimal solution to delivering a health technology, consistent with the objective of maximizing patient outcomes subject to resources available to a publicly funded health system. The article addresses two key policy questions: 1) adding system values through appropriate planning of health services delivery and 2) considering…
This paper reviews implementation of enhanced recovery after surgery (ERAS) and its financial implications. Literature on clinical outcomes and financial implications were reviewed. Reports from many different surgery types shows that implementation of ERAS reduces complications and shortens hospital stay. These improvements have major impacts on reducing the cost of care even…
| Thanh Nguyen, Ilke Akpinar, Jennifer Gratrix, Sabrina Plitt, Petra Smyczek, Ron Read, Philip Jacobs, Tom Wong, Ameeta E Singh
Adding universal rectal screening to urogenital screening should positively impact rectal Chlamydia trachomatis (CT) incidence in affected populations. A dynamic Markov model was used to evaluate costs and outcomes of three rectal CT screening strategies among women attending sexually transmitted infection clinics in Alberta, Canada: universal urogenital-only screening (UG-only),…
This report provides a summary of recently published information (January 2015 to present) regarding the glucose monitoring technologies that are commercially available in North America, as well as those that are emerging within the next five years (up to 2021).
| Anderson Chuck, Thanh Nguyen, James Wesenberg, Rhada Chari, Robert Wilson, Selikke Janes-Kelley
Objectives: In 2006, the Alberta Ministry of Health issued a policy to implement fetal fibronectin (fFN) testing as a publicly funded service for pregnant women. The goals were to reduce maternity health care utilization and unnecessary treatment, which would result in cost-savings for the health system by more accurately diagnosing false preterm labour. We conducted a post-policy…
This guide has been developed by the information specialists at the Institute of Health Economics in Edmonton Alberta and is intended to facilitate searching for health technology assessments (HTAs) or systematic reviews by providing the list of current and reliable internet-based resources that we regularly use in our work. We have tried as much as possible to match this guide…
Alberta STE Report written under contract with the Alberta Health Technologies Decision Process (AHTDP). This STE report examines the safety, screening accuracy, therapeutic efficacy/effectiveness, cost-effectiveness, budget impact, and health system readiness of newborn screening for seven conditions (galactosemia, tyrosinemia type I, homocystinuria, sickle cell anemia, sickle…
| Angus Thompson, Maria Ospina, Liz Dennett, Arianna Waye, Philip Jacobs
Presenteeism, reduced productivity while working, has come into consideration as a major occupational health problem in many countries with serious consequences for both organizations and employees. Increasing evidence shows that presenteeism represents a significant source of productivity losses that can cost organizations much more than does absenteeism, and it can lead to an…
| Bing Guo, Carmen Moga, Christa Harstall, Don Schopflocher
Objective: Because of a lack of a control group, a case-series study is considered one of the weaker study designs from which to obtain evidence on treatment effectiveness. Under certain circumstances, however, this is the only available evidence to inform health-care decisions. This study's intent was to develop and validate a quality appraisal checklist specifically for…
Written under contract with the Alberta Health Technologies Decision Process (AHTDP). This report provides an assessment of how the adoption of fFN testing in Alberta impacted the clinical management of preterm labour and healty system resources. This was also an opportunity to retroactively use the Post Policy Implementation Framework to evaluate a specific policy developed within…
| Julie Polisena, John Lavis, Don Juzwishin, Pam McLean-Veysey, Ian Graham, Christa Harstall, Janet Martin
A perceived gap exists in how well Canadian health technology assessment (HTA) producers are supporting the use of their HTAs by decision-makers. The authors propose that the newly released HTA Database Canadian search interface incorporate structured decision-relevant summaries of HTAs that would be developed by participating Canadian HTA organizations. The registry would…
| Ann Scott, Dion Pasichnyk, Christa Harstall, Dagmara Chojecki
This Information Paper is an inventory and broad summary of factors affecting the adoption and diffusion of health technologies and of available models, strategies, tools, and processes for optimizing health technology diffusion.
| Maria Ospina, Liz Dennett, Arianna Waye, Philip Jacobs, Angus Thompson
Objectives: To assess and compare the measurement properties (ie, validity, reliability, responsiveness) and the quality of the evidence of presenteeism instruments.
Alberta STE Report written under contract with the Alberta Health Technologies Decision Process (AHTDP). This report examines the safety, screening accuracy, therapeutic efficacy, patient outcomes and cost effectiveness of first trimester Quad (1T-Quad) +/- NT and NIPT screening for fetal trisomies. Section Authors: Section One – Technology Effectiveness and Safety: Ken Bond,…
Summary of Systematic Reviews, Primary Studies, and Evidence-based Guidelines. The following research questions were addressed in this review: What are the clinical effects of a universal screening strategy for ARO carriage when compared with no screening? What are the clinical effects of a universal screening strategy for ARO carriage when compared with targeted screening (screening…
Antibiotic-Resistant Organisms (AROs) are a serious health problem, though they are more prevalent in some settings than others. We were asked to make findings and develop recommendations on how to address surveillance of and screening for AROs in acute care hospitals. This consensus statement addresses these requests. However, confining the discussion and recommendations to hospitals…
Alberta STE Report written under contract with the Alberta Health Technologies Decision Process (AHTDP). This report examines the potential role of low dose computed tomography (LDCT) in screening for lung cancer in adults aged 50 years or older in Alberta. Section Authors: Section One – Social and System Demographics Analysis: Bing Guo, Dagmara Chojecki Section Two –…
OBJECTIVES: The objective of this study was to explore the degree to which databases otherthan MEDLINE contribute studies relevant for inclusion in rapid health technology assessments (HTA).
This report has been produced in response to a request from Alberta Health (AH). The objective was to perform a review of practices of engaging committees composed of lay people or members of the general public at international, national, provincial, and regional levels. The review attempts to address the following questions: What scientific evidence is available about committees…
Transcutaneous Bilirubinometry for the Screening of Hyperbilirubinemia in Neonates ≥35 Weeks’ Gestation This report was prepared for Alberta Health Services (AHS) and focuses on the published evidence about the safety, test accuracy, and clinical impact of the use of transcutaneous bilirubin (TcB) test for the screening of significant hyperbilirubinemia in term or late…
| Ian Colman, Yasmin Garad, Yiye Zeng, Kiyuri Naicker, Murray Weeks, Scott Patten, Peter Jones, Angus Thompson, T. Cameron Wild
Purpose: Studies suggest that childhood trauma is linked to both depression and heavy drinking in adulthood, and may create a lifelong vulnerability to stress. Few studies have explored the effects of stress sensitization on the development of depression or heavy drinking among those who have experienced traumatic childhood events. This study aimed to determine the effect…
Alberta STE Report written under contract with the Alberta Health Technologies Decision Process (AHTDP). This report performs an evaluation of the scientific evidence on the safety, performance, and effectiveness of universal and targeted preschool hearing screening (PHS) to inform the Infant and Preschool Screening Framework being developed by the Community and Public Health (CPH)…
Alberta STE Report written under contract with the Alberta Health Technologies Decision Process (AHTDP). This review focused on the best evidence available on the use of PSVS to detect vision conditions in asymptomatic preschool children (aged from birth to 6 years; not necessarily considered at risk for developing visual impairment) to determine the safety and efficacy/effectiveness…
Alberta STE Report written under contract with the Alberta Health Technologies Decision Process (AHTDP). This report is an update of a 2007 report. Permanent congenital hearing impairment/loss (PCHI/PCHL) is one of the most common congenital anomalies found at birth which can lead to delays and deficits in the development of speech, language, cognition, and learning, as well as…
This project is concerned with describing a comprehensive set of HTA products, not the methods used to produce them. The report describes various products produced by HTA agencies and provides a summary of the basic elements of these products, but an in-depth analysis of, or comparison between, the various products in terms of their methodology is beyond its scope. Information…
Alberta STE Report written under contract with the Alberta Health Technologies Decision Process (AHTDP). This report provides an epidemiological profile of fetal aneuploidy and open neural tube defects (ONTD); describes the patterns of care, utilization trends, and factors affecting the provision of first and second trimester screening (FASTs) services for fetal aneuploidy and…
| Paula Corabian, Dagmara Chojecki, Christa Harstall
This exploratory report provides a summary of some of the published information on the current status of research in and potential future sphere of activity of nanomedicine (Part I) and an inventory of resources on nanotechnology and nanomedicine (Part II). Over the next 5 to 10 years it is expected that the overall impact of nanomedicine will be multifaceted, with significant…
| Carmen Moga, Bing Guo, Don Schopflocher, Christa Harstall
This Methodology Paper summarizes the process, a modified Delphi approach, used to develop a specific checklist for the quality appraisal of case series studies. This work was supplemented with a review of other published checklists and an initial pilot test of the newly developed quality appraisal checklist. Researchers at the Institute of Health Economics with researchers from…
| Anne-Marie Boström, Susan E Slaughter, Dagmara Chojecki, Carole Estabrooks
OBJECTIVES: The recent emphasis on knowledge translation (KT) in health care is based on the premise that quality of care improves when research findings are translated into practice. This study aimed to identify the extent, nature, and settings of KT research pertaining to the care of older adults.
This report describes a framework for evaluating policies developed within the Alberta Health Technologies Decision Process (AHTDP) to strengthen the link between policy development and evidence. The framework was designed as a foundation upon which to build a more detailed and contextualized evaluative process in consultation with all stakeholders who are likely to be affected…
| Carissa Escober-Doran, Philip Jacobs, Carolyn Dewa
Objective: In Canada charitable or nonprofit organizations provide government-contracted mental health and addictions services, and they augment government funding by raising charitable revenues. This study estimated by source the revenues of nonprofit mental health and addictions organizations in Canada.
Abstract: The article presents information on the Health Technology Assessment. Guidance for health care practices in Sweden were documented when Medical Collegium was established in 1663 to distinguish quackery from medicine and control the poisonous drugs. In early 1980s, Sweden established the Swedish Council on Technology Assessment in Healthcare to assess major diseases…
| Amanda Burls, Lorraine Caron, Ghislaine Cleret de Langavant, Wybo Dondorp, Christa Harstall, Ela Pathak-Sen, Bjørn Hofmann
OBJECTIVES: Values are intrinsic to the use of health technology assessments (HTAs) inhealth policy, but neglecting value assumptions in HTA makes their results appear more robust or normatively neutral than may be the case. Results of a 2003 survey by the International Network of Agencies for Health Technology Assessment (INAHTA) revealed the existence of disparate methods…
| Susan E Brien, Diane Lorenzetti, Steven Lewis, James Kennedy, William A Ghali
BACKGROUND: There is an extensive body of literature on health system quality reporting that has yet to be characterized. Scoping is a novel methodology for systematically assessing the breadth of a body of literature in a particular research area. Our objectives were to showcase the scoping review methodology in the review of health system quality reporting, and to reporton…
Rationale, aims and objectives: The Appraisal of Guidelines Research and Evaluation (AGREE) instrument is a generic tool for assessing guideline quality. This feasibility study aimed to reduce the ambiguity and subjectivity associated with AGREE item scoring, and to augment the tool's capacity to differentiate between good- and poor-quality guidelines. Note: This is an Alberta…
The objective of this report is to assess research evidence on the safety and prognostic value of exercise testing (including electrocardiogram exercise testing and cardiopulmonary exercise testing) for the prediction of cardiac events in patients with chronic diseases including diabetes, chronic obstructive pulmonary disease (COPD), and arthritis. Information Specialist: Trish…
Alberta STE Report written under contract with the Alberta Health Technologies Decision Process (AHTDP). This report is about testing for Human Papillomavirus (HPV). HPV is one of the most common sexually transmitted infections and can also cause cervical cancer. Cervical screening aims to reduce cervical cancer incidence and mortality by detecting precancerous lesions early. Until…
The use of the term “comparative effectiveness” (CE) has attracted considerable attention, particularly in the United States. This booklet examines the concept of CE and its relationship to other assessment frameworks.
| David Hailey, Jeremy Grimshaw, Martin Eccles, Craig Mitton, Carol E. Adair, Emily McKenzie, Scott Patten, Brenda Waye-Perry, Leif Rentzhog, Paul Taenzer, Christa Harstall, Saifee Rashiq, Pamela Barton, Don Schopflocher, Lynda Jobin
Effective Dissemination of Findings from Research contains essays resulting from a workshop on effective dissemination of findings from research organized by the Institute of Health Economics. The publication is intended as one of the many available resources on dissemination of research findings for those interested in the subject. Chapter 3 of this report originally appeared…
| Ann Scott, Carmen Moga, Christa Harstall, Jacques Magnan
Abstract: Health technology assessments (HTAs) are an as yet unexploited source of comprehensive, systematically generated information that could be used by research funding agencies to formulate researchable questions that are relevant to decision-makers. We describe a process that was developed for distilling evidence gaps identified in HTAs into researchable questions…
Risk assessment tools for predicting recidivism of spousal violence. The objective of this report is to assess the research evidence on the inter-rater reliability and predictive validity of various risk assessment instruments in predicting male-to-female spousal violence recidivism and lethality in those males who had contact with the police system. Information Specialist: Liz…
| Ann Scott, Carmen Moga, Pamela Barton, Saifee Rashiq, Don Schopflocher, Paul Taenzer, Christa Harstall
Rationale and objective: A research translation strategy for chronic pain was developed that has significant potential to advance the usefulness of systematic reviews (SRs) in clinical practice.
Note: This is an Alberta Ambassador Guideline Adaptation Program related publication.
A successful screening program for cystic fibrosis (CF) refers to the ability of the program to appropriately identify and refer for care those with CF, while meeting the needs of those who do not have CF, particularly those infants identified by the screening program as carriers (individuals unaffected by CF but have a mutation in one of their CFTR genes). Some measures of success…
The use of the automated auditory brainstem response and otoacoustic emissions tests for newborn hearing screening. Permanent congenital hearing impairment/loss (PCHI) is one of the most common congenital anomalies found at birth which can be expected to lead to delays and deficits in the development of speech, language, cognition and learning, as well as secondary effects on the…
Alberta Heritage Foundation for Medical Research (AHFMR) HTA Initiative #24. Health technology assessments (HTAs) routinely identify questions or research ‘gaps’ that are not adequately addressed by the primary research. The unique situation of having an HTA unit housed within a provincial research funding organization provided an ideal setting for linking research…
Institute of Health Economics Working Paper WP 06-02. The purpose of this report is to examine the economic implications for the province if a supplement to the fee schedule were allowed for vacuum-assisted biopsies. NOTE: In 2006 the Alberta Heritage Foundation for Medical Research HTA unit moved to IHE. Documents produced in and prior to 2006 have different formats; the format…
Alberta Heritage Foundation for Medical Research (AHFMR) HTA Initiative #20. Health Technology Assessment (HTA) is the systematic evaluation of properties, effects and/or other impacts of health care technology. Its primary purpose is to provide objective information to support health care decisions and policy making at the local, regional, national and international levels. NOTE:…
| Saifee Rashiq, Pamela Barton, Christa Harstall, Don Schopflocher, Paul Taenzer
Background: The purpose of Health Technology Assessment (HTA) is to make the best possible summary of the evidence regarding specific health interventions in order to influence health care and policy decisions. The need for decision makers to find relevant HTA data when it is needed is a barrier to its usefulness. These barriers are highest in rural areas and amongst isolated…
| Margaret Wanke, Don Juzwishin, Richard Thornley, Liza Chan
Alberta Heritage Foundation for Medical Research (AHFMR) HTA Initiative #16. The objectives of this review were: To propose a generic evaluation framework for HTA agencies to strengthen their evaluation capacity. To conduct a review of HTA agencies to understand what aspects of HTA agencies have been evaluated, approaches/methods used, outcomes of hte evaluations and to understand…
Alberta Heritage Foundation for Medical Research (AHFMR) HTA Initiative #21. Much of the activity and purpose of HTA is related to interaction with organizations and individuals with interests in the technologies that are being considered. The focus is often stakeholders with major financial or operational responsbilities for health technologies, including government authorities,…
Alberta Heritage Foundation for Medical Research (AHFMR) HTA Initiative #18. This paper has two specific objectives: to describe some of the challenges of using research evidence to inform healthcare policy making; and to provide policy makers and researchers with a framework or tool that would identify and facilitate the use of research evidence and other information in healthcare…
Alberta Heritage Foundation for Medical Research (AHFMR) HTA Initiative #19. The intent is to develop an overview as a guide to HTA managers; this paper should be regarded as a vehicle for further discussion on these issues. NOTE: In 2006 the Alberta Heritage Foundation for Medical Research HTA unit moved to IHE. Documents produced in and prior to 2006 have different formats; the…
Alberta Heritage Foundation for Medical Research (AHFMR) Information Paper #23. The activities of the HTA Unit in 2002–2003, as reflected in various types of reports it had produced and related dissemination activities, were reviewed in a paper published in 2004. The paper provided an overview of the effectiveness of the Unit as an aid to its future management, drawing on…
| Robert Lee, Karie-Lynn Kelly, Chris Newcomb, David Cooke, Edidiong Ekaette, Peter Craighead, Peter Dunscombe
Alberta Heritage Foundation for Medical Research (AHFMR) HTA Initiative #15. This paper summarizes the first steps in a research program designed to inform technology assessment and decision-making associated with radiotherapy (treatment of cancer with ionizing radiation) at the Tom Baker Cancer Centre (TBCC) in Calgary, Alberta. NOTE: In 2006 the Alberta Heritage Foundation for…
Alberta Heritage Foundation for Medical Research (AHFMR) HTA Initiative #13. Appraising the quality of evidence is an important, yet difficult task, complicated by the consideration of disparate evidence. Quality checklists for assessing RCTs abound, yet it is acknowledged that even within this single study the reliability, validity, feasibility and utility of the various tools…
Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #25. This report is a systematic review of the literature on the use of computerized electrocardiogram (ECG) interpretation for detecting heart conditions as a part of routine medical examinations in healthy adults. The aim of this report is to inform practitioners and other interested parties on the available…
Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #21. The three objectives of this assessment are to determine the available scientific evidence on: the effective time interval for mammography screening in asymptomatic women aged 50 to 69 years; the effective screening interval in asymptomatic women between the ages of 40 and 49 years; and the mortality rate…