To sustain our health systems, evidence matters more than ever
How do we preserve what’s most important to us as a country?
These days, it’s a crowded ticket for the top concerns in the hearts and minds of Canadians. It ranges from trade tensions to affordability to climate change, and how all those issues impact our families and communities. In addition to those topics, health care is always a top priority for Canadians.
Health care is not only important to us as a service, but it’s also part of our national identity. Our public health systems are a source of pride, and help define what we value as a society and distinguish ourselves from our neighbours. Our health systems are not perfect, but we want to embrace and preserve what we have to ensure system sustainability and value for the next generations to come.
As a former orthopedic cancer surgeon, I understand the challenges our health systems face and the desire of health care professionals to provide the best treatments to patients and their families. There were times throughout my career where I had to make difficult decisions and choices, knowing that I had to prioritize available therapies for patients facing a hard road ahead.
Difficult decisions are made every day by people across our federal, provincial, and territorial governments regarding what gets covered by our public drug plans. However, few people understand how these decisions are made and why. Those decisions affect patients and their loved ones, taxpayers, and—ultimately—the long-term sustainability of our health systems.
A health technology assessment (also known as an HTA) is probably an unfamiliar concept to most Canadians. It’s a process that looks at the benefits, risks, costs, and impact of a health technology like a drug, medical device, or health service. It helps decision-makers understand the technology’s value so they can make informed choices that support an effective and high-quality health-care system.
HTA assists leaders across Canada’s health systems who are constantly faced with the ‘health technology trilemma,’ which includes the pressures of balancing financial sustainability, innovation, and equity of access. Health technology assessments help decision-makers to navigate these competing priorities and ensure decisions are based on evidence, not hype.
HTA can be seen as an instrument to calibrate innovation. It's a step in the process where a product (like a drug) is measured or assessed against existing products and treatments, and determines whether innovation addresses a gap in treatment options.
In short, HTAs help decision-makers evaluate difficult investment choices using the best available scientific evidence, and providing due diligence, accountability, and value-for-money analysis. Just as consumers (usually) don’t buy the newest product at a high cost without gathering evidence from trusted sources first, governments need evidence before making major investments with public dollars.
Why is there an urgent need to use HTA evidence to make decisions? Health spending has increased over the last decade, with drug spending expected to continue to grow, driven by an aging population with increased chronic and complex diseases resulting in increased use of high-cost specialty drugs. More therapies are entering the market with greater uncertainty around long-term effectiveness. The question becomes: should you fund something that’s extremely expensive if you’re not sure if it will work well in the long run?
We all want to embrace innovation, while ensuring that new therapies deliver meaningful benefits for patients and their families. Newer products don’t always result in better outcomes, and this is a hard message to deliver when the promise of a new drug creates hope for patients and their families.
HTA is not about denying access to drugs or undervaluing new drugs. It is about promising Canadians that leaders will make informed choices that maximize patient benefit while ensuring that we can pay for critical services like emergency departments, family doctors, and better access to surgery.
There are many different parts that are essential for a strong health care system. New drugs and innovative therapies are important to improve outcomes and save lives. However, better analysis provided by HTAs leads to better decisions about investing in new therapies. Careful evaluation of scientific evidence in developing good advice matters more than ever to protect and sustain the health systems that we hold so dear.
Canadians deserve both innovation and a sustainable health system. Evidence is not a barrier to providing new treatments; it is how we ensure that innovation delivers real value for patients today and for future generations.
Dr. Robert Bell is a former orthopedic oncology surgeon and fellow of the Royal College of Physicians and Surgeons of Canada. He is the chair of the board at Canada’s Drug Agency and the Health Data Research Network Canada.
The Hill Times