Canada - World Health Organization Regional Office for Europe

Health systems in transition Canada 45
with both types of technological change (Giacomini, Miller & Browman, 2003;
Morgan & Hurley, 2004; Rogowski, 2007). While HTA reports that include an
economic evaluation are useful to health system decision-makers operating
under a budget constraint, they involve more time and expense to complete than
HTAs, which only address clinical effectiveness. Tarride et al. (2008) found that
less than 25% of HTAs in Canada included an economic evaluation although it
is unclear how this compares with HTA agencies outside Canada.
HTA organizations operate at provincial and at the pan-Canadian levels.
Currently, there are three provincial HTA agencies. The first fully fledged HTA
agency, the Agence d’évaluation de technologies et des modes d’intervention
en santé (AETMIS) 4 , was established in Quebec in 1988. In 2011, AETMIS
was renamed INESSS – l’Institut national d’excellence en santé et en services
sociaux. The second is the Ontario Health Technology Advisory Committee
and the Medical Advisory Secretariat, once part of the Ministry of Health and
Long-Term Care, but now part of Health Quality Ontario, an arm’s length public
agency. The third provincially based organization is in Alberta, where the HTA
unit at the Institute of Health Economics (IHE) 5 makes recommendations to
Alberta Health Services and the provincial ministry of health (Hailey, 2007;
Menon & Stafinski, 2009). In addition, there are numerous academic and
hospital-based organizations that conduct HTAs (Battista et al., 2009).
The CADTH is the sole pan-Canadian HTA agency and it is also the largest
producer of HTAs in the country. Established and funded by F/P/T governments,
CADTH’s mandate is to provide evidence-based evaluations of new health
technologies including prescription drugs and medical devices, procedures
and systems (see section 2.3.3) to all participating governments. 6 These
recommendations are advisory in nature and it is up to the governments to
decide whether or not to introduce medical technologies or add prescription
drugs to their respective health systems and public drug plans (Hailey, 2007).
Established in 2003, CADTH’s CDR streamlines the process for reviewing
new pharmaceuticals and providing recommendations to all provinces and
territories except Quebec. The CDR process has three stages: (1) CADTH
does a systematic review of the clinical evidence and pharmaco-economic
data; (2) the Canadian Expert Drug Advisory Committee (CEDAC) under
4 AETMIS was originally incorporated as the Conseil d’évaluation des technologies de la santé, the name which it
retained until renamed in 2000.
5 Until 2006, the HTA unit at IHE was housed at the Alberta Heritage Foundation for Medical Research.
6 All participating member governments have a seat on CADTH’s board of directors. Quebec is not a founding
member of CADTH and has no seat on the CADTH board (CADTH, 2011).