DO TECHNOLOGY EVALUATIONS BASED ON EVIDENCE FROM CONDITIONAL FUNDING LEAD TO AN INCREASE IN POLICY FORMATION?: FINDINGS FROM, AND IMPLICATIONS OF, ONTARIO'S EVIDENCE-BASED HTA PROCESS

Background: There have been numerous concerns and criticisms that results from Health Technology Assessment (HTA) reports or economic evaluations are infrequently used in health care decision making and subsequent policy formation. It is apparent that favorable and good quality clinical and economic evidence is not a sufficient condition for policy development. It has been hypothesized that Conditionally Funded Field Evaluations (CFFEs)/Conditional funding with Evidence Development (CED) may provide decision makers with the information they need to better inform policy recommendations and development.
Purpose: To compare, in a large health care system, policy development and uptake for technologies based on information collected from local/geographic-specific clinical and cost-effectiveness studies showing how a technology works in a ‘real world’ setting to policy uptake for technologies based on traditional HTA evidence collection and synthesis techniques.
Methods: The Ontario Ministry of Health and Long Term Care (MOHLTC) has embarked on a relatively new initiative for publicly financed health care decision making for new devices and medical technologies that is embedded in an evidence-based framework. All requests for new public funding are funneled through an independent multi-disciplinary decision making body (Ontario Health Technology Advisory Committee). OHTAC may either request that the MOHLTC conduct an internal review of the available evidence surrounding the technology (i.e. traditional literature review and syntheses techniques) or that a CFEE/CED be conducted due to insufficient information and high decision uncertainty. This uncertainty can arise from conflicting, poor quality, or insufficient evidence or simply due to concerns about generalizability of the technology to the Ontario setting. Based on whether the technology followed the traditional approach for evidence generation or the CFEE/CED approach, the rates of subsequent policy development and uptake over the last 5 years have been compared.
Results: Since its inception in 2003 OHTAC has reviewed over 100 technologies. Of the technologies that have resulted in recommendations for funding, 5 of these were based on completed CFFE/CED. The policy uptake rate for technologies based on favorable reviews from the traditional review and synthesis approach has been low (less than 20%) while the policy uptake rate for technologies based on CFFE/CED has been 100%.
Conclusions: Reducing decision uncertainty through CFFE/CED appears to provide policy makers with the stronger evidentiary base they need for reimbursement and policy decision making.