• Geoff Sprang

    Traditional Reimbursement Decision-Making Misses the Big Picture

    Traditional Reimbursement Decision-Making Misses the Big Picture
    By Geoff Sprang

    Canadians are missing out on the health and wider societal benefits of new healthcare technologies because of our country’s overly simplistic drug evaluation process.

    In adopting a narrow health system perspective and in focussing its assessment of value exclusively on a single parameter known as the cost per quality adjusted life year ($/QALY), the current Health Technology Assessment (HTA) process used in Canada fails to account for other variables that can greatly affect patient outcomes and add to the overall societal value of a medication…

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  • Dr. Famida Jiwa, DC

    Reimbursement Decisions: There’s Always a Cost to Pay

    When deciding on reimbursement criteria for pharmaceutical products, it’s understandable that makers must take a hard look at cost-effectiveness. After all, health expenditures, which are on the rise, must be managed within our public system. Yet the emphasis on cost-benefit analyses, the lens through which we view public coverage, often leaves gaps in appropriate care options for Canadians. Often, when new and innovative therapies emerge, the focus of decision making can centre on cost-effectiveness, rather than clinical effectiveness. As a result, access to medicines can be uneven across Canada, depending on the decision-making process in each jurisdiction. This problem isn’t [...]

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  • Dr. Jacques LeLorier, MD, PhD

    Commentary by Dr. Jacques LeLorier MD, PhD

    I read with great interest the paper by Geoff Sprang entitled :”Traditional reimbursement decision-making misses the big picture”. The drawbacks and flaws of $/QUALY, so dear to Canadian Health Technology Assessment, are too numerous and too well recognized to deserve further listing. This does not mean it should be totally abandoned since, at the very least, it will provide a frame of reference on which to measure potential alternatives. An interesting alternative is the Comprehensive Benefits of Value (CBV) acting as a modifier of the Cost-effectiveness threshold (CET). The currently used CET is a mythical figure that is often discussed [...]

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