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Vaccination has been a key part of Canada’s coronavirus disease 2019 (COVID-19) pandemic response. Although the clinical benefits of vaccination are clear, an understanding of the population-level benefits of vaccination relative to the programmatic costs is of value. The objective of this article is to quantify the economic impact of COVID-19 vaccination in the Canadian…

Many publicly funded health systems use a mix of privately and publicly operated providers of care to deliver elective surgical services. The aim of this systematic review was to assess the role of privately operated but publicly funded provision of surgical services for adult patients who had cataract or orthopedic surgery within publicly funded health systems in high-income countries.…

Sepsis is a leading cause of hospital mortality, particularly in the intensive care unit (ICU) , and the related financial costs to healthcare systems are substantial.  Antimicrobial use in ICUs is considerable; early, and effective antimicrobial therapy has been associated with improved sepsis outcomes. However, up to 50% of antimicrobials are sub-optimally prescribed,…

Emergency and urgent care systems in high-income countries face major challenges related to overcrowding, long wait times, and rising demand. Internationally, and across Canada, healthcare systems have experimented with various policies to promote access to health services for unplanned acute conditions while reducing avoidable visits to hospital emergency departments (EDs). This…

This report provides an overview of the policy levers and associated actions to support achievement of the principles outlined the Canadian Heart Failure Patient and Caregiver Charter. The authors hope the material will be useful to inform ongoing improvements in heart failure management in Canada and support evidence-informed policy and strategy development. The report gives specific…

Combination therapy is the use of two or more therapies with the intention of improving patient health which are increasingly becoming more prevalent in the health system. Combination therapies can be produced by a single manufacturer but often the various components of the combination are produced by different companies which creates complexities in terms of pricing and reimbursement…

Internationally and across Canada, governments have explored varied approaches to reforming the governance and financing of primary care with the aim of improving access, efficiency, effectiveness, and patient experiences in the health system. This rapid review prepared for the Institute of Health Economics by the North American Observatory on Health Systems and Policies presents…

Getting access to administrative health data for research purposes is a difficult and time-consuming process due to increasingly demanding privacy regulations. An alternative method for sharing administrative health data would be to share synthetic datasets where the records do not correspond to real individuals, but the patterns and relationships seen in the data are reproduced.…

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…

Appropriate management of chronic obstructive pulmonary disease (COPD) patients following acute exacerbations can reduce the risk of future exacerbations, improve health status, and lower care costs. While a transition care bundle (TCB) was associated with lower readmissions to hospitals than usual care (UC), it remains unclear whether the TCB was associated with cost savings.…

This report identifies extreme heat adaptation strategies that might be feasibly implemented before and during summer 2022, with a focus on vulnerable populations. Information for this report was collected through a rapid review of published and grey literature and summarizes the current evidence on strategy effectiveness and cost, as well as factors influencing implementation…

Self-administered subcutaneous immunoglobulin G (SCIg) reduces nursing time and eliminates the need for treatment at ambulatory care clinics, as compared with clinic-based intravenously administered IgG (IVIg), and are therapeutically equivalent. Using administrative health data in Alberta, this population-based cohort study examined the costs of IgG administration (SCIg versus…

Diagnostic testing has been pivotal in detecting SARS-CoV-2 infections and reducing transmission through the isolation of positive cases. This study quantified the value of implementing frequent, rapid antigen (RA) testing in the workplace to identify screening programs that are cost-effective. The findings provide important insights which can inform testing strategies. The modeling…

The Institute of Health Economics contributed as part of the team authoring the Canada Report for the Partnership for Health Sustainability and Resilience (PHSSR) initiative. https://www.phssr.org/findings  The report lead author was Dr. Sara Allin, the Director for the North American Observatory on Health Systems and Policies. https://www.dlsph.utoronto.ca/2022/11/15/strengthening-primary-care-key-to-rebuilding-canadas-crumbling-healthcare-system/…

Increasing demand for provision of care to stroke survivors creates challenges for health care planners. A key concern is the optimal alignment of health care resources between provision of acute care, rehabilitation, and among different segments of rehabilitation, including inpatient rehabilitation, early supported discharge (ESD), and outpatient rehabilitation (OPR). In this…

Pustular psoriasis is a rare form of psoriasis and a chronic disease, with patients experiencing diminished quality of life, reduced productivity, stigma, and shortened life expectancy from disease. Optimal management of pustular psoriasis requires access to healthcare providers with highly specialized knowledge. The rarity of the condition means some patients may receive inappropriate…

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…

Using the example of frailty care in Canada, this discussion paper was completed in 2021 and presents an adaptation of the WHO Best Buys principles as a tool to support higher-level decision making and priority setting for high-value healthcare investment. Our goal is to support decision-makers to reduce the preventable and avoidable burden of morbidity, mortality and disability…

This report is the result of a national consultation and roundtable deliberations conducted by the Institute of Health Economics to support the development of a National Strategy for Heart Valve Disease in Canada. Two virtual policy engagements with clinical leaders, patients and health system managers were conducted in November 2021. These workshops identified 9 thematic areas…

The diagonal approach is a health system funding concept wherein vertical approaches targeting specific diseases are combined with horizontal approaches intended to strengthen health systems broadly.  This paper aims to develop a theoretical framework for the diagonal approach. It allows concurrent evaluation of three different types of horizontal interventions, those: (i)…

This study defines a core data set to facilitate economic evaluations of precision oncology. Precision oncology is generating vast amounts of multiomic data to improve human health and accelerate research. Existing clinical study designs and attendant data are unable to provide comparative evidence for economic evaluations. This lack of evidence can cause inconsistent and inappropriate…

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,…

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…

Long COVID has no commonly accepted case definition, but is characterized generally as the persistence of any COVID-19 symptoms past the typical convalescence period. Initial reports are emerging of significant ongoing symptom burden for some COVID-19 cases, but the prevalence and profile of these long-term cases, and the potential need for or utilization of community-based supports…

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…

Previous reports have examined predictors for inpatient stroke rehabilitation length of stay (LOS) and home discharge. However, none of them has provided a validation benchmark for predictability of identified risk factors. Accordingly, we examined temporal trends, geographic variations, and predicted inpatient rehabilitation LOS and home discharge for stroke patients in Alberta…

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…

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…

The impact of universal varicella vaccination on herpes zoster (HZ) risk in unvaccinated and vaccinated children, and its long-term influence on HZ epidemiology, remains unknown. This retrospective cohort study used population-based administrative health data for children born between 1993 and 2018. A universal varicella vaccination programme implementation corresponded to decreased…

The objective of this study was to implement a model-based approach to identify the optimal allocation of a coronavirus disease 2019 (COVID-19) vaccine in the province of Alberta Canada. The results have three important policy implications: (i) optimal vaccine allocation will depend on the public health policies in place at the time of allocation and the impact of those policies…

The COVID Strategic Choices Group is an interdisciplinary taskforce with experience across different domains of expertise (including epidemiology, public health, public policy, economics and business) and regions of Canada. IHE CEO, Dr. Christopher McCabe is a member of the COVID Strategic Choices Group. Members serve in their individual capacity and not as representatives of any…

This special supplement of Clinical Laboratory News showcases the winning teams from the UNIVANTS Healthcare Excellence Awards. It features innovative programs in Laboratory Medicine. The Institute of Health Economics is pleased to be one of the partners and judges in this prestigious program. Approximately 180 applications were initiated and three top-performing teams were selected…

The purpose of this report is to provide a summary of current information and stakeholder perspectives regarding the current and future state of regenerative medicine (with a focus on stem cell-based research) in Canada and globally. Specifically, it assesses the strengths, potential areas for improvement, and opportunities for growth in the Canadian sector to ensure the future…

Little is currently known about the overall health service utilization and cost burden in patients with high risk for cardiovascular disease (HRCVD) who are recommended to start a statin to control dyslipidemia to prevent CVD events and mortality in short- and long-term care. We assessed the resource use and healthcare cost burden in this HRCVD patient population in Alberta, Canada,…

The Institute for Health Economics (IHE) conducted a roundtable on PF-ILD, in November 2021 and policy recommendations from the diverse stakeholder group provided some guidance on areas to focus on to improve the lives of those living with progressive fibrosing interstitial lung disease. Key actions identified at the roundtable included: increased surveillance for early identification…

The Royal Society of Canada Task Force on COVID-19 was established early in 2020 to equip Canadians with accurate information about Canadian response and recovery. A number of Working Groups were established included one on COVID-19 and Economic Recovery which is chaired by the Institute of Health Economics’ CEO, Dr. Chris McCabe. Their report, "Renewing the Social Contract:…

This Rapid Review assesses the evidence on the rate of COVID-19 transmission from children to children or adults compared with the rate of transmission from adults to others, and the rate of COVID-19 infection in children compared with the rate in adults, to support return-to-school decision making. Twenty-two articles were included in the review. Based on a rapid assessment of…

Face mask use within schools has been suggested as a COVID-19 risk mitigation strategy, but the effectiveness of mask use as protection against COVID-19 transmission and infection in a school setting is currently unknown. This Rapid Review assesses the evidence on the impact of community mask use on the susceptibility to and transmission of COVID-19, and how mask use compliance…

The Institute of Health Economics is proud to be a founding partner of the international Univants of Healthcare Excellence Program https://www.univantshce.com/int/en/program along with 7 other health care organizations. The following article from the September 2020 Journal of Applied Laboratory Medicine outlines twelve diverse best practices which were recognized by the program…

Delay in transfer from intensive care unit (ICU) may contribute to strained capacity. Using a population-based patient cohort in 17 ICUs in Alberta between 2012 and 2016, this paper describes the epidemiologic features and healthcare costs attributable to potentially avoidable delays in ICU discharge. Potentially avoidable discharge delay occurred in approximately 70% of ICU patients…

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…

Primary care services after hours in Alberta are limited, and, as a result, emergency departments have long wait times and overcrowding as they accommodate a greater number of low-acuity conditions. In recent decades, various urgent care models have been established to fill the gap between emergency and primary care, with the aim of providing unscheduled services for urgent but…

This study examined the temporal trends of healthcare service and medicine utilization and explored the care quality of patients with chronic low back pain (CLBP) by assessing inappropriate use of medicine, using Alberta's administrative health data from 1 April 2011 to 31 March 2018. The prevalence of CLBP in Alberta increased from 1.8% FY 2011/12 to 3.0% in FY 2017/18, and the…

There have been few epidemiological studies of dysphagia and associated outcomes using administrative datasets. In this study we estimate the proportion of patients with either stroke or head and neck cancer who are additionally diagnosed with dysphagia or aspiration pneumonia, or that have a feeding tube placed. Our analysis is based on a cohort of patients identified in administrative…

Summary: We examined the association between optimal control of dyslipidemia and mortality and healthcare costs in patients with high risk for cardiovascular disease (HRCVD) between 2012-2016 in Alberta, Canada. HRCVD patients who were optimally controlled had lower mortality and incurred modestly higher costs, compared to those who were not. Secondary prevention patients with…

The objective of this study, published in the International Journal of Chronic Obstructive Pulmonary Disease, was to describe the trends in pharmacologic treatment for patients newly diagnosed with chronic obstructive pulmonary disease (COPD) in Alberta, Canada.

This analysis, published in BMC Psychiatry, aimed to determine cost-effectiveness of a stepped-care pathway for depression in adults in primary care versus standard care (SC), treatment-as-usual (TAU), and online cognitive behavioural therapy (CBT).

The aim of this study, published in PharmacoEconomics – Open, was to conduct an early economic analysis of a hypothetical rapid test for typhoid fever diagnosis in Ghana and identify the necessary characteristics of the test for it to be cost effective in Ghana.

This study, published in PharmacoEconomics – Open, reports exploratory analysis of the provincial and nationwide costs of industry-sponsored drug clinical trials (CTs) in Canada. The costs of industry-sponsored drug CTs completed in 2016 were Can$2.1 billion. In addition to the creation of knowledge, these trials play an important role in alleviating the healthcare cost burden…

OBJECTIVES: To examine the resource use and healthcare costs for chronic obstructive pulmonary disease (COPD) in Alberta, Canada between 2008 and 2016 and model the future costs to 2030.

Clinical research is funded by industry, governments, charities, and hospitals. It is important to know the economic commitment of the various funding bodies, but until now there has been no national source available which provides these data. We surveyed the major funders to provide such a measure. There is evidence that government and charity funding of medical research is a…

Adjuvant trastuzumab significantly improves outcomes for patients with HER2-positive early breast cancer. The standard treatment duration is 12 months but shorter treatment could provide similar efficacy while reducing toxicities and cost. We aimed to investigate whether 6-month adjuvant trastuzumab treatment is non-inferior to the standard 12-month treatment regarding disease-free…

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…

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…

This study, published in the Journal of Critical Care, explores the association between strained ICU capacity and healthcare costs, and demonstrates the admissions to ICUs experiencing strain incur incremental costs, attributed to longer hospitalization and physician services.

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).

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…

Alberta Health initiated the Nurse Practitioner Demonstration Project(s) (NPDP) in 2016 to support access to and further integration of Nurse Practitioners (NPs) into Alberta’s primary health care system. Funding was provided (based on diverse program plans) to the Boyle McCauley Health Centre (BMHC), The Alex Community Health Centre (The Alex), the Calgary Urban Project…

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…

Little is known about the resource use and cost burden of acute myocardial infarction (AMI) beyond the index event. We examined resource use and care costs during the first and each subsequent year, among patients with incident AMI.

This environmental scan describes existing initiatives that aim to accelerate the diagnostic phase of cancer care in Alberta, Canada, and internationally. Specifically, it describes their development and implementation, structure and functioning, intended outcomes and effectiveness, costs and cost savings, and enablers and barriers.

OBJECTIVE: To measure the provincial government cost of mental health-related activities for youth ages 12 to 17 in Alberta in 2014 to 2015.

The Institute of Health Economics has contributed to a study published in the Journal Gynecologic Oncology. The study described the effects of Enhanced Recovery After Surgery (ERAS) guideline implementation in gynecologic oncology on length of stay, patient outcomes, and economic impact in Alberta. The study compared pre-and post-guideline implementation outcomes at two centers…

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…

Objective: Fetal alcohol spectrum disorder (FASD) is a medical term used to describe a range of mental and physical disabilities caused by maternal alcohol consumption. The role of alcohol as a teratogen and its effects on the cellular growth of the embryo and the fetus were not determined on scientific grounds until the late 1960s. However, the link between alcohol use during…

Objective: Fetal Alcohol Spectrum Disorder (FASD) is a preventable disorder caused by maternal alcohol consumption and marked by a range of physical and mental disabilities. Although recognized by the scientific and medical community as a clinical disorder, no internationally standardized diagnostic tool yet exists for FASD. Methods and Results: This review seeks to analyse the…

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…

As the Federal Government contemplates introducing an element of value-based pricing to the pharmaceutical industry regulatory framework, this report provides an overview of key theoretical and empirical material, to support informed engagement by all stakeholders in this important debate.

The Institute of Health Economics (IHE) was commissioned by the Canadian Cardiovascular Society to provide a rapid update of the literature, to compare the impacts of public reporting and external benchmarking on selected outcomes, and to evaluate and describe the applicability of this body of research to non- competitive health systems, emphasizing perspectives and considerations…

Objective: The aim of this study was to analyze the health care costs and savings associated with quality improvement (QI) interventions initiated and implemented utilizing the National Surgical Quality Improvement Program (NSQIP). Background: Five acute care facilities of Alberta Health Services (AHS) adopted NSQIP in 2015 for a pilot project. Methods: The cost-savings of NSQIP…

This report provides a summary of the proceedings from the IHE roundtable on diabetes care and management in Indigenous populations in Canada, held on November 1, 2017. The roundtable aimed to: discuss and share learnings and promising practices from successful community-led diabetes programs, highlighting approaches to effectively engage communities to co-develop prevention and…

Since 2000, 5 studies have been published that each purported to estimate aggregate national mental health costs in Canada. Each of these studies used a different method. Our aim was to compare the studies, and we created a framework for the different elements used to assess mental health costs (direct costs, indirect costs, transfer payments, and “human” costs). In…

This report provides a summary of the IHE/CAPT Precision Health workshop that took place on October 22, 2017 in Toronto, Ontario. The intent of the workshop was to identify gaps and opportunities in implementing precision health technologies into the Canadian health system. The workshop was supported by unrestricted grants from Merck Canada and Hoffmann-La Roche Limited.The views…

Presenteeism (reduced productivity at work) is thought to be responsible for large economic costs. Nevertheless, much of the research supporting this is based on self-report questionnaires that have not been adequately evaluated.

Purpose: In pharmaceutical clinical trials, industrial sponsors pay for study drugs and related healthcare services. We conducted a study to determine industry’s economic contribution of these trials to the Alberta healthcare system. Authors and Affiliations: Dat T. Tran1,2; Ilke Akpinar2 ; Richard N. Fedorak3 ; Egon Jonsson2 ; John R. Mackey4 ; Lawrence Richer5 ; Philip…

This evidence-based report examines expanding the role of paramedics in the community. It summarizes the various types of community paramedicine programs (characteristics, implementation, and funding sources in other jurisdictions) as well as the safety, effectiveness, and economic outcomes of these paramedic programs towards providing patients with alternate, non-emergency health…

L’IHE dans votre poche 2017 – Guide de statistiques sur l’économie de la santé présente et divise les données les plus récentes en sections portant sur le fardeau économique de la maladie, les ressources en soins de santé, les comportements liés à la santé, l'état de santé, les…

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…

Alberta STE Report written under contract with the Alberta Health Technologies Decision Process (AHTDP). This STE report examines the social and system demographics, technological safety and therapeutic efficacy/effectiveness, cost-effectiveness, and budget impact of endovascular therapy for acute ischemic stroke, contextualized to the Alberta setting. Section Authors: Section…

This report provides a summary of the IHE Real-World Evidence Roundtable, which took place on December 12, 2016. The intent of the roundtable was to capture initial thinking regarding preferences and perceptions of the use of real-world evidence for pricing and reimbursement of new medicines in Canada and what more may be needed.

This report provides a summary of the IHE Biosimilars Forum engagement exercise that took place on April 23, 2017 in Ottawa, Ontario. The intent of the forum was to identify: options to categorize and consider biosimilars; a process to engage stakeholders to identify place in therapy and further evidence development that may be required; and an approach to knowledge exchange that…

IHE In Your Pocket 2017 – A Handbook of Health Economic Statistics includes the most currently available data, presented in separate sections on the economic burden of illness, health care resources, health behaviours, health status and demographics, and health system performance. IHE In Your Pocket was designed to provide a compact, comprehensive, and comparative overview…

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),…

Alberta Health Services (AHS) has established a number of Strategic Clinical Networks (SCNs) in the province around specific health care topics (e.g., Cardiovascular Health & Stroke) and within areas where care is delivered (e.g., Surgery). The SCNs are the engines of innovation in the health system and have a mandate to find new and innovative ways of delivering care to provide…

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).

The Liberal government committed to making mental health services more accessible. Housing funding was increased in the last budget, but now commitment to comprehensive home care for the severely mentally ill and access to primary care treatments for common mental disorders are needed.

Objective: Public health decision makers not only consider health benefits but also economic implications when articulating and issuing lifestyle recommendations. Whereas various estimates exist for the economic burden of physical inactivity, excess body weight and smoking, estimates of the economic burden associated with our diet are rare. In the present study, we estimated the…

This overview report provides a summary of the published information on the oxygen therapy issues studied in the past 10 years in the acute care settings. The report includes a summary of audit studies that aimed to address appropriate/inappropriate use of oxygen, and explores the safety and quality issues identified in the literature about oxygen prescription, administration,…

This report provides a summary of the IHE Biosimilars Forum engagement exercise that took place on October 6, 2016 in Edmonton. The intent of the forum was to inform Alberta biosimilar reimbursement policy by sharing international experiences in this area, and the perspectives of key stakeholders.

This rapid report provides a summary of current evidence on the application of gainsharing shared savings strategies in healthcare systems and the barriers and facilitators related to their implementation.

Economic evaluation helps policy makers and healthcare payers make decisions on drug listing, coverage, and reimbursement. When economic evaluations are conducted before a product launch, the prices of the pharmaceuticals have to be forecast.

The Institute of Health Economics (IHE), in partnership with the Canadian Pulmonary Fibrosis Foundation (CPFF), held a forum on April 25th, 2016 in Toronto, Ontario, entitled Optimizing access to care for patients with idiopathic pulmonary fibrosis: A multi-stakeholder national forum, to discuss the need for patient-led policy recommendations and a patient charter for idiopathic…

  BACKGROUND: In February 2013, Alberta Health Services established an Enhanced Recovery After Surgery (ERAS) implementation program for adopting the ERAS Society colorectal guidelines into 6 sites (initial phase) that perform more than 75% of all colorectal surgeries in the province. We conducted an economic evaluation of this initiative to not only determine its cost-effectiveness,…

This white paper follows on from the 2016 IHE report, Economic surveillance for chronic obstructive pulmonary disease (COPD) in Alberta. It provides a summary of main gaps in COPD care across Canada and, in the context of a broad economic framework, it surveys important examples of programs and policies designed to address these gaps.

  OBJECTIVES: This study aimed to evaluate the trends and regional variation of stroke hospital care in 30-day in-hospital mortality, hospital length of stay (LOS), and 1-year total hospitalization cost after implementation of the Alberta Provincial Stroke Strategy.

  BACKGROUND: Eplerenone has been demonstrated as being cost effective for the treatment of patients with systolic heart failure (HF) and mild symptoms in several jurisdictions; however, its cost effectiveness is unknown in the context of Alberta, Canada.

  Objective: The objective of this paper is to estimate the additional mental health service costs incurred within the criminal justice system that are incurred because of people with mental illnesses who go through the system. Our focus is on costs in Alberta.

The Institute of Health Economics (IHE) together with the O’Brien Institute for Public Health (O’Brien Institute) held a policy forum on February 8th, 2016, entitled Physicians as Stewards of Resources: Roles, Responsibilities, and Remuneration to inform decision-making regarding the fiscal sustainability of theprovincial healthcare system, with a specific…

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…

This report provides the results of an economic surveillance analysis on the components of the Alberta healthcare system that are devoted to COPD prevention and treatment. It focuses on epidemiology (prevalence and incidence), service use, and cost indicators, and identifies gaps in the system that presumably add to the overall economic burden of COPD. PDF of the above image:  IHE…

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…

  Objectives: To estimate the life expectancy and specify the causes of death among people with fetal alcohol syndrome (FAS). Methods: Included were all patients recorded in Alberta provincial databases of inpatients, outpatients, or practitioner claims from 2003 to 2012. People with FAS were identified by ICD-9 code 760.71 and ICD-10 codes Q86.0 and P04.3, and were linked…

Alberta STE Report written under contract with the Alberta Health Technologies Decision Process (AHTDP). This rapid report has been produced in response to a request from Alberta Health to provide an update on the new published research evidence on the efficacy/effectiveness, efficiency, and safety of hysteroscopic tubal sterilization (HTS) using the Essure® system for permanent…

Alberta STE Report written under contract with the Alberta Health Technologies Decision Process (AHTDP). This report is an update of the “Technological efficacy/effectiveness analysis” (T) section of the 2014 Alberta STE report, which was an evidence assessment of the clinical effectiveness and safety of endovenous ablation interventions for symptomatic varicose veins…

  Abstract: Canada having a universal health insurance plan that provides hospital and physician benefits offers a natural experiment of whether continuity ofcare actually provides lower or higher utilization of services. The question we are evaluating is whether Canadians, who have a regular physician, use more health resources than those who do not have one? Using two statistical…

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…

This report is from an Alberta Strategic Clinical Networks (SCN) exchange meeting with Mr. Neil Fraser. This event brought together SCNs and related health system stakeholders, and a leader in the Canadian medical technology industry, and recent member of a Federal Advisory Panel on Healthcare Innovation. The meeting had the objectives to help the SCNs to understand the Advisory…

  Background: Significant gaps in the evidence base on costs in rural communities in Canada and elsewhere are reported in the literature, particularly regarding costs to families. However, it remains unclear whether the costs related to all resources used by palliative care patients in rural areas differ to those resources used in urban areas.

The Institute of Health Economics held a roundtable on June 4, 2015, entitled Innovative Funding Models: Kidney Care Policy Options for the Future, to identify and discuss key issues in kidney care policy options. Prior to the roundtable, an Innovative Funding Models: Kidney Care Policy Options for the Future Steering Committee teleconference refined project objectives, and the…

The Institute of Health Economics (IHE), in partnership with Boehringer Ingelheim (Canada) Ltd./Ltée held an invitational forum on October 3, 2015, in Edmonton, Alberta. The purpose of this discussion was to bring together multiple stakeholders from across Canada to investigate the current state of evidence and information regarding idiopathic pulmonary fibrosis (IPF) and…

Objective: In this study, we estimate the impact of the new PCV13 immunization program on the burden of disease and related healthcare costs in Alberta.

  OBJECTIVES: To examine differences in health services utilization (HSU) costs in the first year of life between low birth weight (LBW) and normal birth weight (NBW) infants, identify maternal and child characteristics associated with HSU costs, and estimate annual HSU cost of LBW infants for the province of Alberta, Canada.

  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…

  Objective: To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care. Note: This is an Alberta Ambassador Guideline Adaptation Program related publication.

Alberta Health Services (AHS) has recently established a number of Strategic Clinical Networks (SCNs) in the province around specific health care topics (e.g., Cardiovascular Health & Stroke) and within areas where care is delivered (e.g., Surgery). The SCNs are the engines of innovation in the health system and have a mandate to find new and innovative ways of delivering care…

This document describes the entry of new medical devices into the Canadian health system. It is intended to provide an accurate description of new medical device entry in Canada, and is intended to give patients, the public, private and public sector health system researchers, medical device companies, and private and public coverage bodies a general understanding of what regulatory,…

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…

  We reviewed literature to estimate the costs of Fetal Alcohol Spectrum Disorder (FASD) in the Canadian Criminal Justice System (CJS), and to update the total costs of FASD in Canada. The results suggest FASD is costlier than previous estimates. The costs of FASD associated with the CJS are estimated at $3.9 billion a year, with $1.2 billion for police, $0.4 billion for court,…

  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…

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.

This work, conducted by the Institute for Health Economics (IHE) and the University of Calgary (Health Economics group), was performed to better understand the unmet educational needs and health economics products that could support people in the province, and to determine the current capacity for conducting health economics in Alberta. This paper seeks to understand the needs…

  Objectives: Economic evaluations, although not formally used in purchasing decisions for medical devices in Canada, are still being conducted and published. The aim of this study was to examine the way that prices have been included in Canadian economic evaluations of medical devices.

Economic surveillance and economic assessments are important sources of information to help administrators and policy makers to track current trends and evaluate policies and care patterns. The Institute of Health Economics, in partnership with Alberta Health, held a two-day Costing Methods Workshop which helped to review costing practices by bringing together economists and other…

This White Paper discusses the concept of developing a comprehensive rheumatoid arthritis registry in Alberta, and the important health, social, and economic gains such a resource would generate for Alberta.

The Federal Minister of Health, the Honourable Rona Ambrose, announced the creation of the Advisory Panel on Healthcare Innovation (Panel) on June 24, 2014, to examine innovative health care ideas and approaches that exist in Canada and internationally. The Panel’s mandate is to identify promising innovations, here and internationally, which could help Canada reduce growth…

This book includes the plenary presentations made at the first international conference on prevention of FASD, which was attended by about 700 people from 35 countries around the globe. The issues addressed are FASD as a priority in health policy making; its prevalence and incidence; strategies for prevention; current applied and basic research in the field; the role of the medical…

Fetal alcohol spectrum disorder (FASD) is of growing concern around the world. A range of disabilities caused by prenatal exposure to alcohol, FASD is estimated to affect 2% to 5% of all newborns in the industrialized countries of Europe and North America, and the rates may be significantly higher in some developing countries and certain defined populations. Epidemiological studies…

  Objectives: To assess and compare the measurement properties (ie, validity, reliability, responsiveness) and the quality of the evidence of presenteeism instruments.

    Abstract: Parent-Child Assistance Program (P-CAP) is a 3-year home visitation/harm reduction intervention to prevent alcohol exposed births, thereby births with fetal alcohol spectrum disorder, among high-risk women. This article used a decision analytic modelling technique to estimate the incremental cost-effectiveness ratio and the net monetary benefit of the P-CAP…

  Abstract: Alberta's Primary Care Networks (PCNs) bring together family physicians and other health professionals to provide local, comprehensive, and readily accessible primary care services to patients. The Edmonton North PCN, one of the largest in the province, piloted the Resource in Clinic (RIC) Program with objectives to increase efficiencies in the use of physician…

À titre de président du jury, le Dr Alain Lesage, M.D., FRCPC, M.Phil., DFAPA, professeur au département de psychiatrie de l'Université de Montréal et clinicien à l’Institut universitaire en santé mentale de Montréal, Québec, a dirigé un comité spécial dont le mandat était d'élaborer…

This consensus development conference was commissioned by the Government of Alberta to improve the transition of its system of care for people with severe and persistent mental illness (SPMI) toward the community. The system, previously hospital- and institution-centred, is moving towards becoming a community-centred, patient- and family-led one. The development and deployment…

  INTRODUCTION: The objective of this study was to determine the short-term cost impact thatmedical tourism for bariatric surgery has on a public healthcare system. Due to long wait times for bariatric surgery services, Canadians are venturing to private clinics in other provinces/countries. Postoperative care in this population not only burdens the provincial health system…

In November 2014, the Institute of Health Economics partnered with Eli Lilly Canada Inc. and the Canadian Institutes of Health Research’s Institute for Health Services and Policy Research to hold a roundtable to discuss the federal role in healthcare innovation. The roundtable aimed to examine the existing state of healthcare innovation, its strengths and weaknesses (or gaps),…

  Objectives: To estimate the annual health services utilization (HSU) cost per person with FASD by sex and age; the lifetime HSU cost per person with FASD by sex, and the annual HSU cost of FASD for Alberta by sex.

  BACKGROUND & AIMS: Infliximab is effective for induction and maintenance of response in patients with moderate to moderately severe ulcerative colitis. Previous cost analyses of infliximab treatment for ulcerative colitis used models of colectomy vs infliximab and response rates derived from early clinical trials. In real life, therapeutic options are more complex; patients…

Real World Evidence: System Readiness – Are we ready to use routinely collected data to improve health system performance? Summary Report Real World Evidence: Priority Setting for Action was an invitational roundtable discussion organized by the Institute of Health Economics (IHE) and supported by and developed in partnership with Strategy for Patient Oriented Research Support…

  Objectives: To estimate incidence and prevalence of FASD by sex and age in Alberta, Canada.

  Abstract: Canadian and US health systems have often been characterized as having vastly different approaches to the financing and delivery of healthcare, with Canada portrayed as more reliant on rationing based on costs. In this article, we examine the similarities and differences between the two countries, the evolution and current role of health economic evaluation, and…

Alberta STE Report written under contract with the Alberta Health Technologies Decision Process (AHTDP). This report is an evidence assessment of the clinical effectiveness and safety of hysteroscopic tubal sterilization, and the value for money associated with adopting hysteroscopic tubal sterilization in Alberta. Section Authors: Section One – Background and Context: Carmen…

Alberta STE Report written under contract with the Alberta Health Technologies Decision Process (AHTDP). This report is an evidence assessment of the best available research evidence on the safety and effectiveness, cost effectiveness and budget impact of using Endovenous Laser Ablation (EVLA) or Endovenous Radiofrequency Ablation (RFA) in the management of symptomatic varicose…

  OBJECTIVE: To provide Canadian estimates of health care utilization costs associated withrheumatoid arthritis (RA)-related and non-RA-related care within 4 treatment strategies and in different physical functioning categories.

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,…

  OBJECTIVE: Sustained remission in rheumatoid arthritis (RA) results in healthcare utilizationcost savings. We evaluated the variation in estimates of savings when different definitions ofremission [2011 American College of Rheumatology/European League Against Rheumatism Boolean Definition, Simplified Disease Activity Index (SDAI) ≤ 3.3, Clinical Disease Activity Index…

  BACKGROUND: Interest in the well-being of physicians has increased because of their contributions to the healthcare system quality. There is growing recognition that physicians are exposed to workplace factors that increase the risk of work stress. Long-term exposure to high work stress can result in burnout. Reports from around the world suggest that about one-third to…

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…

This discussion paper has been produced in response to a request from CIHR Institute of Health Services and Policy Research (CIHR IHSPR). The discussion paper will provide guidance to those tasked with conducting an economic evaluation of complex health system interventions. The guidance will be an elaboration of existing National guidelines for economic evaluation, and serve as…

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…

  BACKGROUND: Interest in the impact of burnout on physicians has been growing because of the possible burden this may have on health care systems. The objective of this study is toestimate the cost of burnout on early retirement and reduction in clinical hours of practicingphysicians in Canada.

The objective of this paper is to estimate the additional costs to the criminal justice system associated with people with mental illness who go through the system. The focus of the report is on costs in Alberta.

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 –…

  Should vitamin B12 tablets be included in more Canadian drug formularies? An economic model of the cost-saving potential from increased utilisation of oral versus intramuscular vitamin B12 maintenance therapy for Alberta seniors. OBJECTIVE: The aim of this study was to estimate the cost-savings attainable if all patients aged ≥65 years in Alberta, Canada, currently on…

  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…

  The International Charter on Prevention of FASD has been published in The Lancet Global Health, one of the world’s most influential public-health journals.  The Charter – also known as the “Edmonton Charter” – was endorsed at the First International Conference on Prevention of FASD in September 2013.The Edmonton Charter was drafted by senior…

The International Charter on Prevention of FASD has been published in The Lancet Global Health, one of the world’s most influential public-health journals. The Charter – also known as the “Edmonton Charter” – was endorsed at the First International Conference on Prevention of FASD in September 2013.The Edmonton Charter was drafted by senior staff of…

The International Charter on Prevention of FASD has been published in The Lancet Global Health, one of the world’s most influential public-health journals. The Charter – also known as the “Edmonton Charter” – was endorsed at the First International Conference on Prevention of FASD in September 2013.The Edmonton Charter was drafted by senior staff of…

The International Charter on Prevention of FASD has been published in The Lancet Global Health, one of the world’s most influential public-health journals. The Charter – also known as the “Edmonton Charter” – was endorsed at the First International Conference on Prevention of FASD in September 2013.The Edmonton Charter was drafted by senior staff of…

The International Charter on Prevention of FASD has been published in The Lancet Global Health, one of the world’s most influential public-health journals. The Charter – also known as the “Edmonton Charter” – was endorsed at the First International Conference on Prevention of FASD in September 2013.The Edmonton Charter was drafted by senior staff of…

The International Charter on Prevention of FASD has been published in The Lancet Global Health, one of the world’s most influential public-health journals. The Charter – also known as the “Edmonton Charter” – was endorsed at the First International Conference on Prevention of FASD in September 2013.The Edmonton Charter was drafted by senior staff of…

The International Charter on Prevention of FASD has been published in The Lancet Global Health, one of the world’s most influential public-health journals. The Charter – also known as the “Edmonton Charter” – was endorsed at the First International Conference on Prevention of FASD in September 2013.The Edmonton Charter was drafted by senior staff of…

  BACKGROUND: The use of a restrictive formulary, with placement determined through a drug-reimbursement decision-making process, is one approach to managing drug expenditures.

IHE In Your Pocket 2014 – a handbook of health economic statistics includes the most currently available data, presented in separate sections on the economic burden of illness, health care resources, health behaviours, health status and demographics, and health system performance. IHE In Your Pocket was designed to provide a compact, comprehensive, and comparative overview…

    Abstract: The cost of drug development is commonly cited between US$800 and US$1.8 billion. A similar statistic for vaccines is yet to be estimated, and it is unclear whether the cost of vaccines is similar to drug development. Financial and regulatory policy significantly impacts the extent and cost of pharmaceutical development, and as such it is important that…

Objectives: To estimate the monetary benefits of ramipril and its distribution over time among four beneficiaries in Canada: the drug developing manufacturer, generic manufacturers, the healthcare sector and employment sectors.

  Objectives: To conduct a systematic review of the effectiveness of KT interventions for chronic noncancer pain management.

  Rationale, Aims, and Objectives: The Alberta Ambassador Program (AAP) adapted seven clinical practice guidelines on low back pain (LBP) into a single guideline spanning the continuum of care from prevention and diagnosis through to treatment. The Ambassador adaptation process was evaluated to 1 Identify the major challenges encountered and successful strategies utilized;…

  INTRODUCTION: Varicella vaccine was introduced to the infant immunization schedule in each province or territory between 2000 and 2007 as a result of the Canadian ImmunizationStrategy. The impact of vaccinating children against this disease is potentially far reaching, asimmunization may also benefit those segments of the population not immunized. The objective of this paper…

This report is an analysis of the theoretical basis for value-based pricing, relevant international developments, and areas for improvement within Canada’s current patented drug pricing system. This report intends to inform future policy research, advice, and Canadian drug policy discussions regarding the feasibility and implementation of value-based pricing approaches.

This consensus statement on Legal Issues of Fetal Alcohol Spectrum Disorder (FASD) is the product of a unique IHE Consensus Development Conference held in September 2013. The event was a three-day juried hearing of evidence and scientific findings that allowed for the engagement and collaboration of citizens and decision makers in government and the justice system in addressing…

Validation of a quality assessment checklist for case series studies poster presented at the Cochrane Colloquium in Quebec City in September 2013.

This service and evaluation project originated from the Alberta courts via the collaboration of two Alberta Ministries; (1) Alberta Justice & Soliciter General and (2) Alberta Environment and Sustainable Resource Development. The impetus arose when a judge in an environmental protection case observed a need for additional attention to the mental health of workers. An Alberta…

  Objectives: To estimate the break-even effectiveness of the Alberta Fetal Alcohol Spectrum Disorder (FASD) Service Networks in reducing occurrences of secondary disabilities associated with FASD.

  Abstract: Medical wait time is a top health policy issue in Canada. Reliable data on the referral wait time from primary to specialty care are limited. Existing data on referral wait times are generally self-reported by specialists. In 2008, the Edmonton North Primary Care Network (PCN) developed a Centralized Referral Program, including a specialist database that contains…

The Provincial Industry Payer Agreements in an Era of National Purchasing Strategies half-day invitational roundtable was part of the IHE's ongoing Methodology Forum series supported by the Institute of Health Economics, the Alberta government, and industry partners, AstraZeneca, Merck, and Eli Lilly. The event brought together academic experts, industry leaders and senior decision…

This health technology assessment report has been produced in response to a request from Alberta Health (AH) as part of the Alberta Health Technologies Decision Process (AHTDP) to perform an evaluation of the scientific evidence on the safety and effectiveness of TMJ Concepts® and Biomet® Microfixation TMJ prostheses for adults who are indicated for total TMJ replacement.…

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…

The review summarizes the current evidence on the safety, efficacy, effectiveness, and potential cost-effectiveness on the use of the BridgePoint Medical System (consisting of the CrossBoss™ catheter, Stingray™ catheter, and Stingray™ guidewire) for the recanalization of refractory coronary chronic total occlusions (CTOs). The report also describes the relevant…

  From the Introduction: In this paper, we report a discussion of available evidence regarding the association between poverty and FASD, and regarding the economic consequences of FASD on individuals and families which may materialize an FASD - poverty trap.

Alberta STE Report written under contract with the Alberta Health Technologies Decision Process (AHTDP). This report is an update of the 2008 report on islet transplantation (IT) for Type 1 diabetes (T1DM). Section One of this analysis was intended to describe the profile of T1DM (definition, progression, epidemiology, and population dynamics of affected adults in Alberta, in Canada,…

  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…

  BACKGROUND: Pay-for-performance (P4P) is increasingly touted as a means to improve health care quality. PURPOSE: To evaluate the effect of P4P remuneration targeting individual health careproviders.

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…

The EQ-5D is a standardized instrument developed by the EuroQol group for use as a measure of health outcome. It considers five dimensions of health-related quality of life: mobility, self-care, usual activities, pain/discomfort, anxiety/depression. When the need for greater collaboration around implementation and use of the EQ-5D in Alberta was recognized in eary 2012, colleagues…

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…

  Background: The aim of this study was to extend an earlier retrospective cohort study of schizophrenia via a prospective study to a follow-up of 34 years, with an emphasis on describing the life-course of the illness.

  Background: The benefits of pharmaceutical innovations are widely diffused; they accrue to the healthcare providers, patients, employers, and manufacturers. We estimate the societal monetary benefits of simvastatin in Canada and its distribution among different beneficiaries overtime.

  OBJECTIVES: In Canada, most mental health services are embedded in the publichealth care system. Little is known of the cost distribution within the mental healthpopulation. Our study aims to estimate the depression care costs of patients with adepression diagnosis, ranking them by the increasing total depression health carecosts.

  Abstract: The potential risks to patient safety in a primary care setting are different than the risks to patient safety in an acute care setting. The main differences arise from the organisational structures of primary care delivery and the greater involvement of patients in their care. To account for these differences, we present the Patient Safety in Primary Care Framework…

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…

The concept of “personalized medicine” in health is garnering increased attention. Personalized medicine can be defined as the tailoring of preventive, diagnostic, or therapeutic interventions to the characteristics of an individual or population. This may involve genetic or laboratory biomarker information. As personalized medicine promises to increasingly change the…

For which strategies of suicide prevention is there evidence of effectiveness? This report aims to synthesize research findings from existing systematic reviews to address two questions: What types of preventive interventions have been evaluated in the published literature? Which strategies have good-quality evidence to support them? Limited evidence - as well as variability by…

  STUDY OBJECTIVE: To quantify the potential cost savings of a community pharmacy-basedhypertension management program based on the results of the Study of Cardiovascular Risk Intervention by Pharmacists-Hypertension (SCRIP-HTN) study in terms of avoided cardiovascular events-myocardial infarction, stroke, and heart failure hospitalization, and to compare these cost savings…

  PURPOSE: This longitudinal study assessed the changes in drug use patterns and health-related quality of life (HRQL) among HIV-positive drug users in the first methadonemaintenance treatment (MMT) cohort in Vietnam.

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…

Alberta STE Report written under contract with the Alberta Health Technologies Decision Process (AHTDP). This report summarizes available key information on the use of bariatric treatments for adult obesity in Alberta and North America (mainly Canada). This analysis was intended to describe the profile of adult obesity (definition, progression, epidemiology, and population dynamics…

Alberta STE Report written under contract with the Alberta Health Technologies Decision Process (AHTDP). This report examines the research evidence on the safety and efficacy of insulin pump therapy, as compared to multiple daily insulin injections, in the treatment of children, adults, and pregnant women diagnosed with type 1 diabetes. The report also analyses the economic impact…

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…

  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…

In February 2012, the Canadian Institute for Health Information (CIHI) in partnership with the Institute of Health Economics (IHE) sponsored a two day meeting of content, administrative and research experts to identify the breadth of diagnostic imaging studies that CIHI might feasibly undertake with its data or with data that could be easily obtained. The purpose of this report…

Sponsored by the Institute of Health Economics (IHE) – Methodology Forum Series. Presented at the Health Canada and Canadian Institutes of Health Research Personalised Medicine in Canada: A Multi-Stakeholder Workshop to Examine the Canadian Perspective, January 12, 2012. The specific objectives of this session/workshop were to: Explore issues relevant to economic evaluation…

  Aim: To critically appraise the clinical research evidence on the safety and effectiveness of FT compared with standard care in the treatment of patients with CDAD.

  From the Introduction: Until four or five decades ago, the clinical consensus about childhood depression was that it did not, and perhaps could not, occur (Lefkowitz & Burton, 1978; Rie, 1966; Rochlin, 1965; Wolfenstein, 1966). In fact, prior to 1960, childhood depression was rarely mentioned in the literature (Cytryn, 2003; Tisher, 2007). A number of studies and conceptualizations…

This study measures the return on investment for parent training at the pre- or early childhood stage. The purpose is to prevent conduct disorders in childhood, and mental health problems in adolescence and adulthood. The program studied is the Triple P program. The context is a one year birth cohort in Alberta. The costs are for a universal parental training program. The downstream…

  Background: To address public health risk factors, governments conduct interventions in many different ministries, including non-health ministries. In order to understand the scope and cost of public health in Alberta, we developed a survey of government public health interventions. We included any government ministry or public organization, which includes health as a stated…

  OBJECTIVE: About one-third of the annual $51 billion cost of mental illnesses is related to productivity losses. However, few studies have examined the association of treatment and productivity. The purpose of our research is to examine the association of depression and its treatment and work productivity.

The Institute of Health Economics organized the November 17 roundtable, with funding from Merck and in-kind support from the Canadian Health Services Research Foundation. The roundtable served as an initial gathering of the original partners and invited delegates (see Appendix I for full participant list) to further develop the HCiC partnership and begin planning…

  Abstract: In the 1980s, drug prices began rising considerably worldwide, and in the 1990s, countries began incorporating health economics into the scientific review process. Rising prices in vaccines began around the year 2000 and national bodies began to use health economics to review vaccines in the next decade. Health economics is a discipline that evaluates alternative…

The Alberta Diabetes Surveillance System (ADSS) was created in 2006 in partnership with Alberta Health and Wellness (AHW) and the Institute of Health Economics (IHE). The purpose of the ADSS is to provide information about diabetes within the province of Alberta. This information includes the incidence, prevalence and use of health care services for people with diabetes, along…

  Purpose: The concept of the suicidal process implies a progression from behaviour of relatively low intent to completed suicide. Evidence from the literature has given rise to the speculation that the age of onset of an early form of the suicidal process may be associated with the ultimate seriousness of suicidal behaviour. This study was designed to test the hypothesis…

The Institute of Health Economics (IHE) has completed a scan to determine what public health-related costs are borne by government departments, ministries, and agencies. The final report, Everybody’s Business: The Cost of Multi-Department Involvement in Public Health in Alberta, was funded by Alberta Health Services (AHS) as part of the Project 2030 initiative that saw the…

  Rationale, Aims, and Objectives: A collaborative, multidisciplinary guideline adaptation process was developed to construct a single overarching, evidence-based clinical practice guideline (CPG) for all primary care practitioners responsible for the management of low back pain (LBP) to curb the use of ineffective treatments and improve patient outcomes. Note: This is an…

The Alberta Survey of Addictive Behaviours and Mental Health in the Workforce: 2009 is the third such study conducted since 1992. It provides an interesting, comprehensive picture of many issues related to the mental health of workers across all sectors in Alberta. Introduction IHE is pleased to release the final report of The Alberta Survey of Addictive Behaviours and Mental Health…

This report describes the outcomes of a two day workshop that explored options for improving quality and access to diagnostic imaging services for low back pain (LBP) in Alberta through the engagement of stakeholders that are involved in the assessment, diagnosis, treatment, and management of this condition. These include health professionals, health service managers, administrators,…

As part of Alberta Health Services (AHS) Strategic Health Needs Assessment and Service Design 2030 project, “Becoming the Best: Building Sustainability” the Institute of Health Economics (IHE) was commissioned to conduct three Knowledge Exchange events between February and May 2011. These single-day conferences assembled leading international thinkers and experts in…

This one-day, invitational event engaged community experts and senior decision-makers involved in First Nations, Inuit, and Métis health policy in Canada in round-table discussions. Integrated Knowledge Exchange in health requires communities, researchers, and policy-makers utilize evidence from all sources in a culturally relevant way.

This in-depth book contains an introduction to prevention of FASD and to the different methods that are used. There is also a systematic review of the effectiveness of prevention approaches and an overview of reviews on FASD. The book ends with a chapter called “Five perspectives on prevention of FASD” written by professionals in the field who are working to prevent…

  Alberta STE Report written under contract with the Alberta Health Technologies Decision Process (AHTDP). Fecal transplantation for the treatment of Clostridium difficile-associated disease or ulcerative colitis examines the clinical research evidence on the safety and effects of fecal transplantation in the treatment of patients with Clostridium difficile-associated disease…

This article is an overview of systematic reviews reporting on the efficacy/effectiveness of psychotherapy and/or pharmacotherapy interventions delivered within Sex Offender Treatment (SOT) programs to reduce the risk of re-offending in convicted adult male sex offenders. Related Report: Treatment for Convicted Adult Male Sex Offenders

The IHE has produced a book of the proceedings from the Consensus Development Conference: FASD - Across the Lifespan. Hardcover copies are available for purchase at a unit cost of $25.00 CAD plus $2.50 shipping and handling. Click on the Add to Cart button at the bottom of this page to proceed with your purchase. In followup to the conference, the Institute has produced two…

  Objective: To ascertain knowledge gaps in the diagnosis and treatment of acute and chronic low back pain (LBP) in the primary care setting to prepare a scoping survey for identifying knowledge gaps in LBP management among Alberta's primary care practitioners, and to identify potential barriers to implementing a multidisciplinary LBP guideline. Note: This is an Alberta Ambassador…

  OBJECTIVE: Life course studies of schizophrenia that have used a 3-phase model (onset,course, and outcome) have had their use restricted owing to differences in definition and methodology. The purpose of this investigation was to describe life course data in mathematical terms and to compare the results with the findings from other life course studies.

On September 23rd and 24th, 2010, the Institute of Health Economics conducted an Inaugural IHE Methodology Forum: Prioritizing Methodological Research in Evaluation of Health Technologies. Delegates from academia, government, industry and other stakeholders involved in the production and use of evidence were brought together to discuss methodological challenges in…

Reflecting the recent increased public awareness of the topic, this is the first and most comprehensive resource for over a decade on the molecular basis, prevalence, treatment options, socioeconomic impact, and prevention strategies of FASD. Edited by world-renowned experts, this compendium includes the latest research results to provide new insights and realistic estimations…

Abstract: Within the school system, children with mental illness receive a variety of services that arise because of their conditions, and that require resources that exceed those provided to other students. Some of these services fall into the category of "specialized mental health" services, while others are additional services provided by teachers as part of their routine activities.…

  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.

This review considers the evidence of benefit from use of telerehabilitation (TRH) from studies that had clinical or administrative outcomes.

This overview provides an analysis of the economic landscape of primary care in Alberta and a discussion of the proposed reforms in terms of ends and means.

IHE In Your Pocket 2010 provides current health economic statistics, presented in separate sections on health care resources, health behaviours, health status and demographics, and health system performance. To access the IHE PowerPoint chartpack, please click the following link: IHE PowerPoint Slides.

  Objectives: To estimate the prevalence of drinking alcohol during pregnancy and examine the determinants of this behaviour.

  OBJECTIVE: In 2004, the three-module, three-year long patient safety program, Managing Obstetrical Risk Efficiently (MOREOB), was introduced to all clinicians providing obstetrical services in Alberta. We report on an outcomes evaluation of this initiative.

This health technology assessment report is an overview of systematic reviews reporting on the efficacy/effectiveness of psychotherapy and/or pharmacotherapy interventions delivered within Sex Offender Treatment (SOT) programs to reduce the risk of re-offending in convicted adult male sex offenders. Information Specialist: Liz Dennett

  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…

  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…

This report reviews the evidence of telehealth in substance abuse and addiction including the literature on smoking, alcohol, drug abuse and gambling. The included telehealth technologies include videoconferencing, computer, Internet, and telephone.

The economic impact of mental illness and addictions is felt throughout society - in the health care system, the social services system, education, criminal justice, and the workplace. In this booklet we conducted a provincial and national level analysis of the expenditures on mental health and addictions in Canada.

  OBJECTIVES: The aim of this study is to assess the cost-effectiveness of 21 alternativecervical cancer screening (CCS) strategies.

The Sexual Exploitation of Children and Youth Over the Internet: A Rapid Review of the Scientific Literature report examines the research evidence on the frequency, effects, risk factors of sexual exploitation of children and youth over the Internet. The report also provides information on available resources in Alberta and Canada regarding Internet safety and prevention of child…

Part of the successful Institute of Health Economics (IHE) book series, this handbook and ready reference adopts a unique approach in combining policy recommendations with specific treatment options for Parkinson patients. The first part of the book deals with the clinical medical, social and economical aspects of Parkinson Disease. These ten chapters include the latest diagnosis…

This booklet provides an overview of the System Dynamics (SD) approach and its potential applications in improving access to health services and quality of care. The specific application addressed here is the improvement of care of patients with hip and knee osteoarthritis (OA), as this is a pressing issue in Canada today. The specific health system and population addressed here…

  PURPOSE: A study was undertaken to evaluate the utilization rates of routine preoperativeelectrocardiogram (ECG) and chest x-ray (CXR) by sex, age, and most frequent surgery type, and to estimate the total cost of these screening tests.

The Effective Involvement of Patients in Health Technology Decisions: What Does Best Look Like? program presented some of the latest international and Canadian developments in policy in this important area. It also included presentations from experts and interactive discussion amongst the participants.

  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…

This report on Means Restriction for Suicide Prevention provides a summary of information regarding national means restriction policies/strategies and national/provincial intentional overdose prevention policies/strategies and their effectiveness. Policies/strategies that focus on children, youth, and young adults are of particular interest. This report consists of two parts: Part…

  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 Consensus Statement on Fetal Alcohol Spectrum Disorder (FASD) - Across the Lifespan was produced by a panel of experts led by the Hon. Anne McLellan, former Deputy Prime Minister of Canada. This consensus statement on fetal alcohol spectrum disorder is the product of a unique conference: The IHE Consensus Development Conference on Fetal Alcohol Spectrum Disorder - Across the…

Le présent énoncé consensuel a été préparé par un panel indépendant de professionnels de la santé et de représentants du milieu universitaire et du public en se fondant sur: les études publiées pertinentes réunies par le Comité scientifique de la conférence pour l’établissement…

The Alberta Diabetes Surveillance System (ADSS) was created in 2006 in a partnership between Alberta Health and Wellness (AHW) and the Institute of Health Economics (IHE). The purpose of the ADSS is to provide information about diabetes within the province of Alberta. This information includes the incidence, prevalence and use of health care services for people with diabetes, along…

Written by health policy experts, the book gives a comprehensive overview of 8 different national health care systems and focuses in particular on the different approaches to maintain efficiency and to contain overall healthcare costs. Each chapter identifies the 4-5 specific policies with the highest impact for the respective country over the past 20-30 years and the current policy…

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…

Les estimations indiquent que un canadien sur trois aura un problème de santé mentale durant sa vie. Peu de canadiens réalisent l’impact que la mauvaise santé mentale a sur les familles, les communautés, les systèmes de santé et l’économie. La santé mentale est aussi importante que la santé physique…

This report provides information regarding the impact of physician reimbursement models on five dimensions specified in the Provincial Alternate Relationship Plan Program Evaluation. The impact of physician reimbursement models were assessed on the following five dimensions: Health service utilization Access to care Quality of services Patient satisfaction Physician satisfaction…

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.

  Background: Although many programs targeting fetal alcohol spectrum disorder (FASD) are implemented, the province of Alberta is still lacking information on costs of FASD. Objectives: To estimate the costs of FASD in Alberta based on available US and Canadian research on costs of FASD, and Alberta data.

The purpose of this report is to advance the area of workplace mental health through a comprehensive synthesis of published research evidence. More specifically, this report examines the evidence on the effectiveness of organizational-level interventions for the prevention of stress in the workplace for adult employees without diagnosed mental illness. The main effectiveness outcomes…

This report on assisted reproductive technologies (ARTs) is a literature review and secondary analyses of administrative health data conducted to provide information on the direct health care costs associated with multiple pregnancies and the potential cost impact of ARTs in Alberta. It examines the impact of multiple pregnancies and Assistive Reproductive Technologies on health…

The Institute of Health Economics sponsored Dr. Arne Ohlsson and Dr. Prakeshkumar Shah to write this book to inform the May 2007 Consensus Development Conference on Healthy Mothers Healthy Babies: How to Prevent Low Birth Weight. The book provides a synopsis of the research evidence on the determinants and prevention of preterm/low birth weight births. This book is a synopsis (an…

The purpose of this report is to update an earlier HTA report published in 2003. This report examines the newly published clinical research evidence on the safety and efficacy/effectiveness of islet transplantation in type 1 diabetic patients who have severe hypoglycemia episodes or hyperglycemia unawareness but are without kidney failure. The main clinical efficacy/effectiveness…

This report presents summary information on computed tomography (CT) and magnetic resonance imaging (MRI) in Alberta, with comparison to the use of these diagnostic imaging technologies in other jurisdictions. The aims of the report are to: illustrate the capacity in Alberta to diagnose and manage health problems with the help of these important technolgies compare the numbers,…

The mental health economics literature review shows that about one third of the articles found in the search did not include any or just minimal economic information. The database of 4005 references can be used to analyze the mental health economic literature e.g. by diagnosis, type of economic analysis, treatment, publication year, and targeted population.

L’honorable Michael Kirby (président de la Commission de la santé mentale du Canada) a présidé un éminent panel de citoyens et d’experts pour formuler des recommandations pratiques sur la façon d’améliorer la prévention, le diagnostic et le traitement des troubles dépressifs chez…

The Consensus Statement on Depression in Adults: How to Improve Prevention, Diagnosis and Treatment was produced by a panel of experts led by the Hon. Michael Kirby Chair, Mental Health Commission of Canada. This consensus statement was prepared by an independent panel of health professionals, academics, and public representatives based on: presentations by and questioning of experts…

How much should we spend on mental health? provides an overview of the various approaches that have been used to answer the question of health spending, applied to the mental health context. Estimates using several of the approaches are provided. Information Specialists: Trish Chatterley, Liz Dennett

Discussing all aspects of chronic pain management, this is the second volume of the new book series on health care and disease management, published with the Institute of Health Economics (IHE) in Edmonton, Canada. The authors provide an introduction into the history, pathophysiology, ethics and epidemiology of chronic pain before covering the different aspects of treating chronic…

The Importance of Measuring Health Related Quality of Life report provides an overview of health-related quality of life (HRQL) measurement to facilitate and understanding of such measures to be used in both clinical practice and research. Health-related quality of life (HRQL) measures have been widely used in health research in recent years and have been the endpoint in many clinical…

IHE In Your Pocket (IHE IYP) presents a bird’s eye view of the economic aspects of the Canadian healthcare system with international comparisons. IHE IYP 2008 has been reorganized and expanded, and includes the most currently available data. Topics are presented related to resources first, addressing in turn economic burden of illness, expenditures, physical resources, prices,…

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…

  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…

This rapid assessment addressed a request to assess the published research evidence on how the Actim™ Partus test compares to the TliIQ® System in terms of diagnostic accuracy, clinical utility, and costs when added to preterm labour management in symptomatic women with intact membranes.

Air ambulance transportation with capabilities to provide advanced life support. The objective of this report is to present and synthesize the available published research evidence on the efficacy/effectiveness, safety, and efficiency of air ambulance transportation (helicopters) with on-board capabilities of advanced life support (ALS). The intent is to use this evidence to inform…

Discussing issues of health care financing, this is the first volume in a completely new public health book series, edited by the Institute of Health Economics (IHE) in Alberta, Canada. Starting with various funding methods, it also features sections on different health care payment and purchasing mechanisms, as well as equity issues. This book is of interest to medical and allied…

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…

The role of rapid fetal fibronectin assay in the management of spontaneous preterm labour The objective of this report is to evaluate the added value of using fetal fibronectin (Rapid fFN for the TLi™ System, referred to here as the rapid fFN assay) to diagnose spontaneous preterm labour (PTL) in symptomatic women, which is the only fFN detection modality currently available…

This report compares the use of telemental health services in Canada and Finland, focusing specifically on the use of videoconferencing. Information Specialist: Janice Varney

Evidence of benefit from telemental health applications: a systematic review. This review considers the evidence of benefit from use of telemental health (TMH) in studies that had clinical, economic, or administrative outcomes. The review also includes studies that provided information on the accuracy or feasibility of TMH. Information Specialist: Janice Varney

This booklet brings together information that demonstrates the burden of mental illness and where Canada’s mental health system ranks among other developed countries. It also provides important consolidated information on key indicators that depict the state of our mental health system.

  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.

The Alberta Diabetes Surveillance System (ADSS) was created in 2006 in a partnership between Alberta Health and Wellness (AHW) and the Institute of Health Economics (IHE). The purpose of the ADSS is to provide information on diabetes in the province of Alberta. This information includes the incidence, prevalence and use of health care services for people with diabetes, along with…

World In Your Pocket - A Handbook of International Health Economic Statistics includes the most current available data, presented in separate sections on health status, health care costs, health resources, health resources, health resource utilization, and health system performance.

This consensus statement on how to prevent low birth weight was developed to inform patients, health policy, and practice. It is a product of the IHE Consensus Development Conference on Healthy Mothers - Healthy Babies: How to Prevent Low Birth Weight held April 23 to 25, 2007

This booklet is a compendium of existing statistics related to the economic aspect of childhood immunizations in Canada. It brings together, in one document, data obtained from a wide range of sources. It covers topics related to the economic and epidemiological burden of childhood diseases, resources used, and system performance from provincial, national, and international viewpoints.

Routine Preoperative Tests - Are They Necessary? is about routine preoperative testing on otherwise healthy patients who are scheduled for elective surgery. This report is a synopsis of the findings from some of the major health technology assessments and systematic reviews on preoperative testing published during the last two decades. The implications of these results for Alberta…

Safety and efficacy of inhaled nitric oxide in the management of hypoxemic respiratory failure in adults with acute respiratory distress syndrome. This report was prepared in collaboration with the Health Technology Assessment program of the Institute of Health Economics, SEARCH Canada, and Calgary Health Region. It focuses on the published scientific evidence regarding the safety…

Evaluation of enzyme immunoassay and immunoblot testing for the diagnosis of syphilis in Alberta. A new protocol for testing and diagnosing syphilis has been proposed in Alberta. The protocol proposes replacing rapid plasma reagin (RPR) with enzyme immunoassay (EIA) as the standard initial test and replacing Treponema pallidum (T. pallidum) particle agglutination assay (TPPA) and…

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…

Teleoncology: Applications and associated benefits for the adult population. This report determines the current state of evidence on teleoncology applications to improve access to care closer to home for rural patients and families affected by a diagnosis of cancer. It follows an earlier report by Marie-Josée Paquin prepared as part of her participation in the SEARCH Classic…

The objective of this statement was to develop a consensus statement on the benefits and costs of testing supplies for self-monitoring of blood glucose in diabetes, to inform patients, health policy and practice.

This Mental Health Economic Statistics booklet brings together information that demonstrates the burden of mental illness and where Canada’s mental health system ranks among other developed countries. Mental Health Economic Statistics provides important consolidated information on key indicators that depict the state of our mental health system. NOTE: In 2006 the Alberta…

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…

Institute of Health Economics Working Paper WP 06-01. The purpose of this report is to examine the economic issues associated with LGB. The following analyses were conducted: a systematic review of the economic literature on obesity-related interventions, with special attention to the differences between gastric bypass and gastric banding; an estimate of the Alberta population…

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:…

  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…

Institute of Health Economics Working Paper WP 06-04. The purpose of this analysis was to compare health care utilization as well as costs and mortality of individuals with diabetes in the province of Saskatchewan from 1999 to 2001, according to residential location. NOTE: In 2006 the Alberta Heritage Foundation for Medical Research HTA unit moved to IHE. Documents produced in…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #38. This report aims to identify strategies that have been evaluated and reported in the literature and to assess their effectiveness in reducing emergency department overcrowding. Information Specialists: Seana Collins, Liz Dennett NOTE: In 2006 the Alberta Heritage Foundation for Medical Research HTA unit moved…

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…

This is the first edition of IHE In Your Pocket. This chart book is designed to be an easy reference guide to indicators of Canadian health care economic performance. Economic is broadly defined to include both means (personal and formal resources) and ends (health outcomes). The chart book is intended to provide the user with a concise, accessible, and reasonably comprehensive…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #37. The aim of this paper is to present the current evidence on the efficacy/effectiveness, safety, and efficiency of gastric electrical stimulation (EnterraTM Therapy System) used for the treatment of patients with severe gastroparesis (GP). Information Specialist: Liz Dennett NOTE: In 2006 the Alberta Heritage…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Initiative #22. We present a model process that will assist health care organizations in developing and implementing a formal management system for learning from incidens. Developed specifically for the Radiation Treatment (RT) Program at the Tom Baker Cancer Centre, a major cancer treatment centre in Calgary, Alberta,…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Initiative #23. This report is intended as a discussion primer for two challenges increasingly faced by health technology assessment (HTA), health impact assessment (HIA), health needs assessment, parliamentary technology assessment (PTA), participatory technology assessment, policy makers in numerous areas, health care…

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,…

Institute of Health Economics Working Paper WP 05-07. The aim of this paper is to compare health in Canada and the United States using a preference-based measure. 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 was determined by the agency for which the document…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #36. The objective of this report is to identify the most appropriate investigative protocol, or component of a protocol, for determining the cause(s) of stillbirth and to identify protocols that have been recommended by health authorities and professional associations both within Canada and worldwide. Information…

Institute of Health Economics Working Paper WP 05-03. Missing data is a common problem in studies that collect data on patient-reported outcomes data. This paper reports the methods, results, and an evaluation of one method for imputing missince Centre for Epidemiological Studies-Depression (CES-D) data in a study of health-related quality of life (HRQL) in a cohort of patients…

Institute of Health Economics Working Paper WP 05-06. The purpose of this study was to analyze epidemiologic and cost trends from 1991 to 2001 in the province of Saskatchewan for a cohort of individuals identified as having diabetes and for a randomly selected control cohort. The objectives were to: explore epidemiologic trends (i.e., prevalence, incidence and mortality) in diabetes…

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…

Institute of Health Economics Working Paper WP 05-02. The purpose of this report was to assess the cross-sectional construct validity of the Health Utilities Mark 3 (HUI3) in type 2 diabetes using population-health survey data. 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;…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Initiative #17. This paper focuses on incident reporting systems relevant to the hospital and efforts to improve patient safety and clinical outcomes. Costs associated with incident reporting systems are included wherever possible. This paper aims to assess the effectiveness of hospital incident reporting systems in improving…

Alberta Heritage Foundation for Medical Research (AHFMR) Information Paper #26. The aim of this study was to determine whether laparoscopic adjustable gastric banding (LAGB) is a safe and effective procedure compared with open and/or laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical banded gastroplasty (LVBG), especially in the longer term (> or = five…

Alberta Heritage Foundation for Medical Research (AHFMR) Information Paper #25. The aim of this report is to provide a cost estimate, over a one year time period from a payer’s perspective, of Biosite Triage Point-of-Care (POC) B-Type Natriuretic Peptide (BNP) assay used to rule out congestive heart failure (CHF) from other pulmonary conditions for patients presenting in…

Institute of Health Economics Working Paper WP 05-01. The objective of this paper is to assess a broad range of determinants of health to determine which are most strongly associated with health-related quality of life (HRQL) in people with type 2 diabetes. NOTE: In 2006 the Alberta Heritage Foundation for Medical Research HTA unit moved to IHE. Documents produced in and prior…

Alberta Heritage Foundation for Medical Research (AHFMR) Information Paper #24. The objective of this paper is to present the current evidence on the efficacy/effectiveness and safety of celeoxib (Celebrex®) for the treatment of pain in patients with osteoarthritis (OA) and rheumatoid arthritis (RA). Information Specialist: Seana Collins NOTE: In 2006 the Alberta Heritage Foundation…

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…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #35. The objective of this report is to assess the efficacy and safety of using trigger point injection (TPI) to treat patients with chronic non-malignant musculoskeletal pain, based on a systematic review of the current published evidence, and to determine the current state of the procedure, the feasibility of…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #34. This report reviews the literature on assessment of telecardiology, considering applications in pediatric care, hospital or clinic use for adults, emergency care, and home care. Information Specialist: Seana Collins NOTE: In 2006 the Alberta Heritage Foundation for Medical Research HTA unit moved to IHE. Documents…

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) Information Paper #21. The objective of this report is to evaluate the published evidence on the safety, efficacy, and current status of living donor liver transplantation for the treatment of end stage liver disease in children. Information Specialist: Leigh-Ann Topfer NOTE: In 2006 the Alberta Heritage Foundation for Medical…

Alberta Heritage Foundation for Medical Research (AHFMR) Information Paper #19. The objective of this report was to conduct a systematic review of the published research on the use of sclerotherapy to manage varicose veins of the legs. The intent of this paper was to answer the following questions: Is sclerotherapy effective for varicose veins of the legs and if so, is one approach…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report. In this systematic review, we have critically reviewed the literature addressing the social, legal and ethical issues related to genetic testing for cancer susceptibility, synthesized current information and identified existing gaps in knowledge. We believe the review will prove valuable to policy- and decision-makers…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #33. This report is a systematic review and critical appraisal of the evidence on the use of ovulation induction (OI) drug therapy to manage anovulatory infertility associated with polycystic ovary syndrome (PCOS) in women of reproductive age. The aim was to provide the current published scientific evidence about…

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 #32. The aim of this report was to critically appraise and synthesise the published evidence regarding the short- and long-term efficacy/effectiveness of surgical techniques for patients with deep venous incompetence, and attendant skin changes/ulceration, that is refractory to standard care. Information Specialist:…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #31. This report was prepared in response to a request from Alberta Health and Wellness (AHW) for information about the use of islet cell transplantation for patients with type 1 diabetes. AHW was specifically interested in the current status of islet cell transplantation using the Edmonton protocol for a sub-population…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #28. This report provides an overview of the evidence from systematic reviews on the effectiveness of suicide prevention strategies. 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 was determined…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #30. Using the 1996 National Population Health survey data, this report provides an estimate of the prevalence of chronic pain (CP) among Albertans. It was estimated that 11.2% of Albertans suffer some level of CP and about 2.3% suffer from severe CP. As the proportion of individuals suffering from CP increases…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #29. The aim of this report was to present and critically appraise the published evidence on the prevalence of chronic non-malignant pain in the general population and the primary care setting. A secondary objective was to summarize all the available information in the primary studies about characteristics of pain…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #27. This project is Part II of a request from several Regional Health Authorities and Alberta Health and Wellness, regarding two key objectives: to present information on the regulation of acupuncture in Alberta, including the scope of practice and coverage of services; and to conduct a systematic review of current…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #26. Given the very broad range of suicide prevention strategies, it is unrealistic to cover all of them in this report. Thus, the main focus of this review is to present the findings from primary research that assessed the efficacy/effectiveness of suicide prevention programs on school aged children and youth…

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 #24. This report has been produced in response to a request from Alberta Health and Wellness for an update on the use of vagus nerve stimulation (VNS) for refractory epilepsy. The intent was to inform health policy makers, medical practitioners, and the public on the current status of the use of VNS for refractory…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #23. This report is a systematic review and critical appraisal of the literature on the use of formal outpatient diabetes education as a therapeutic tool for self-management in adult patients with type 2 diatetes. It has been prepared to provide information to the Capital Health Authority in Alberta, Canada and…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #22. This review was requested to determine whether conductive education as a learning approach or therapeutic intervention is safe and efficacious for children with disabilities such as cerebral palsy that impact neuromotor functioning. The review also addresses the profile of the child who would benefit from…

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…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #18. This report has been prepared following interest by the Alberta Cord Blood Bank in obtaining advice on the comparative effectiveness and costs of different types of stem cell transplantation. Earlier assessments by the Foundation have considered peripheral blood stem cell transplantation and cord blood transplantation.…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #17. The present report has been prepared as a follow up to the previous assessment because of continued interest in the technology by the health ministry and others. It considers studies that have been reported in the literature since completion of the earlier assessment (1997-1999) and focuses on the efficacy…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #20. This report presents data from the telepsychiatry program subsequent to the pilot project. The assessment of telepsychiatry beyond the pilot project stage had two primary focuses: a) to develop and document information collection systems initiated during the pilot project evaluation, and b) to assess the operation…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #19. A request for information about the use of low level laser therapy (LLLT) to assist wound healing was received from the Capital Health Authority (CHA). This technology has been increasingly used within the Edmonton area, with somewhat different approaches being taken by individual operators. The concern was…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #16. This report has been prepared in view of the continuing interest in positron emission tomography and other functional diagnostic imaging (FDI) methods within the Alberta health care system. It also continues the work at the Alberta Heritage Foundation for Medical Research in developing approaches to assessment…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #16. This is the second volume of an assessment of functional diagnostic imaging methods in imaging of the myocardium. Volume 1 included an overview of the assessment findings and provided comments on the place of the FDI techniques in this application. In this volume, further details are given of the assessment…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #15. The present health technology assessment report has been prepared following a request by Alberta Health and Wellness for additional information on the use of stereotactic radiosurgery (SRS) in the treatment of acoustic neuroma, one of the applications considered in an earlier publication on SRS. Two main issues…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #14. This report has been prepared because of the interest by the Consumers' Association of Canada and the Health Ministry in the increasing use of newer types of intraocular lenses (IOLs) and in their comparative advantage. The focus of the report is on the safety, efficacy and effectiveness of the three types…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #13. This assessment has been prepared in view of the interest at the University of Alberta Hospital in developing a cord blood banking facility in the province and to provide information to decision makers on the current status of cord blood transplantation (CBT). The principal purpose of the assessment was to…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #12. This report has been prepared following a request from the provincial Clinical Practice Guidelines Program for information on the accuracy of diagnostic tests for the detection of bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomoniasis in females of reproductive age. The intention of this…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #11. This report has been prepared in view of the increasing interest in ultrasound technology for diagnosis of osteoporosis. Until recently, quantitative ultrasound (QUS) was mainly being used in research settings. This procedure is still not covered by provincial fee schedules. The recent FDA pre-marketing approvals…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #10. This report has been prepared as part of a project to assess the role of high cost functional diagnostic imaging (FDI) and related methods in routine health care. In the present paper, the potential application of four FDI methods to the management of epilepsy is considered. The assessment considered the current…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #8. This report has been prepared to provide information to health authorities and others on the available evidence on effectiveness of HBOT and the possible economic impact on health care should a second HBO facility be established in the province. Issues addressed in the report include: Whether HBOT has been…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #9. The present report has been prepared following a request by Alberta Health in relation to referral of patients outside the province for treatment with stereotactic radiosurgery (SRS). There was interest by the department in the comparative effectiveness of the two main approaches to SRS (GK and LINAC) and in…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #7. This assessment was undertaken at the request of a Regional Health Authority to provide input into a funding decision on a computerized dynamic posturography (CDP) system for use by a rehabilitation department. The focus of this study was restricted to the clinical use of CDP by the rehabilitation community.…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #6. This report provides details of a telepsychiatry pilot project undertaken by the Provincial Mental Health Advisory Board-Central Alberta (PMHAB) in cooperation with four Regional Health Authorities. It supplements an earlier report issued by the Board describing the pilot project evaluation and has been prepared…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #5. This assessment of computerized gait analysis in the management of children with cerebral palsy (CP) or spina bifida (SB) has been prepared at the request of the Glenrose Hospital, Edmonton. The hospital has already undertaken developmental work towards establishing a gait analysis facility. Advice was sought…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #4. This outline of issues in the assessment of telehealth is intended as a resource document for health care funders, providers and administrators. Health authorities and others in Alberta face decisions on the procurement and use of this information and communication technology. Such decisions should be informed…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #3. The intent of this report is to inform medical practitioners and the public on the current status of in vitro fertilization and embryo transfer (IVF-ET) as a treatment for various types of infertility, and on its use and coverage in Canada. The report has been prepared because of the interest and debate regarding…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #2. This paper is intended as a short overview of the effectiveness and status of a neurosurgical procedure, posteroventral pallidotomy (PVP), which is used in the treatment of some people with Parkinson's Disease. NOTE: In 2006 the Alberta Heritage Foundation for Medical Research HTA unit moved to IHE. Documents…

Alberta Heritage Foundation for Medical Research (AHFMR) HTA Report #1. This report has been prepared to provide information and assist discussion on the management of pressure sores, a significant source of morbidity in health care institutions. The focus of the report is on a specific technology, interface pressure measurement. It is expected that other issues in this are will…