COVERAGE WITH EVIDENCE DEVELOPMENT IN ONTARIO: EXPERIENCE WITH DESIGNING FIELD EVALUATIONS TO INFORM HEALTH POLICY DECISIONS

Purpose: Field evaluations that provide evidence to inform health policy recommendations by the Ontario Health Technology Advisory Committee (OHTAC) have been conducted by PATH since 2003.  These studies examine healthcare technologies with uncertainty regarding their effectiveness and high impact on healthcare resources.  The purpose of this summary is to outline the processes developed to design and implement field evaluations and to discuss the associated challenges with these studies.

Method: Field evaluations have employed a variety of study designs including randomized controlled trials, observational studies, registries and retrospective chart reviews. The studies have been developed to capture clinical, economic, patient-related and organizational outcomes.  Implemented in a variety of health care settings within Ontario, using coverage with evidence development (CED) where appropriate, these studies are conducted in collaboration with clinicians and researchers to collect evidence to inform health policy decisions.  Following completion of the field evaluations the results are provided to OHTAC to help inform their recommendations to the Ontario Ministry of Health & Long-term Care.

Result: Ongoing field evaluations of pre-hospital diagnosis and management of chest pain, hyperbaric oxygen therapy, photo-selective vapourization of the prostate, electronic chronic disease management systems in diabetes care are at various stages. Completed field evaluations examining drug eluting stents, endovascular repair of abdominal aortic aneurysms, multifaceted diabetes care 64-slice computed tomography coronary angiography and the use of magnetoencephalography in children with epilepsy referred for surgery have presented various challenges related to subject recruitment, availability of research personnel in non-academic settings, diffusion of technology outside the study and alignment with policy decision making timelines.

Conclusion: Through PATH’s CED process, field evaluations have been used to inform health policy decisions in the province of Ontario resulting in support and funding of non-drug healthcare technologies.  Field evaluations of diffused new technologies have had limited impact on technology uptake thus demonstrating the need to implement conditional funding arrangements prior to widespread diffusion.  Lessons from this program can be useful to assist with the development of similar programs globally.