CADTH Overview Barb Shea, Vice-President, COMPUS COMPUS Expert Review Committee Orientation March 28, 2007

Who are we? Not-for-profit agency founded in 1989 by the Canadian federal, provincial, and territorial (F/P/T) Deputy Ministers of Health Funded by Health Canada, the provinces and territories Head office in Ottawa Second office in Edmonton Liaison presence in provinces 2006-07 Budget: $22 million 20% from provinces and territories 80% from Health Canada The Canadian Agency for Drugs and Technologies in Health (CADTH) was created in 1989 to address that need. As the Federal Health Minister of the day said, “We need a more coordinated approach across the country to ensure that all Canadians are benefiting from the advances being made in health technology. CADTH is funded by Health Canada, the provinces and territories.

CADTH mission www.cadth.ca CADTH’s mission is to provide timely, relevant, rigorously derived, evidence-based information to decision makers and support for the decision-making processes. www.cadth.ca CADTH does our work on behalf of the public, driven by the Deputy Ministers of Health. Some our work becomes publicly available for the private sector to review Private sector stakeholders may access CADTH products and services, for information at various stages during the lifecycle of a drug or technology CADTH programs are aligned strategically from pre-assessment to formulary recommendation to strategies toward optimal drug prescribing and use CADTH is a growing, independent, objective, evidence-based organization providing credible and reliable information to decision makers.

What do we do? Provide a basis for informed decisions about the purchase and use of drugs and health technologies by: Providing reliable and timely information Making complex research accessible Synthesizing relevant literature Providing tools and support to decision makers to help them to utilize our work CADTH has evolved from HTA to a broad service agency with programs that directly link to decision makers Our initial role was to assess medical devices. As Canada’s health system evolved, so did CADT, moving first into drug assessments, then the provision of expert advice and finally best practices. Our health technology assessment program also grew and and today we are a comprehensive service agency closely linked to decision makers through a network of liaison officers, committees and other mechanisms. We look at technologies from “cradle to grave” delivering the right information to the right people … and supporting evidence-based decision making. Of these various stakeholders, CADTH primarily serves: Government policy makers Drug plan managers Regional health authorities Hospitals Health professionals

CADTH Governance Committee Structure F/P/T Conference of Deputy Ministers of Health F/P/T Conference of Deputy Ministers of Health Policy Forum The Exchange Jurisdictional CADTH Board Non Jurisdictional Advisory Committee on Pharmaceuticals (ACP) Canadian Expert Drug Advisory Committee (CEDAC) COMPUS Advisory Committee (CAC) CADTH COMPUS Expert Review Committee (CERC) This is the structure that supports CADTH in delivering its mandate. These contributors are also some of CADTH’s key clients A network of HTA producers, the Exchange will coordinate the gathering of evidence and policy advice regarding health technologies, to support the needs of jurisdictions. Its membership will be voluntary. The Exchange will also link and consult with health technology innovators and developers including the industry. The Policy Forum will serve as a mechanism for Canadian policy makers to identify areas of common policy interest, share health technology information, and collaborate where beneficial to the jurisdictions. Membership will be voluntary and consist of representatives from the F/T/P Ministries of Health. Non-Jurisdictional These committees provide relevant direction and advice from recognized experts across the country: SAC provides advice about methods to all CADTH programs CEDAC provides formulary listing recommendations to the CDR CERC provides recommendations related to the identification, evaluation and promotion of optimal therapy in drug prescribing and use for COMPUS Jurisdictional These committees provide advice and guidance from our funders: DSAC supports HTA ACP supports HTA and CDR CAC supports COMPUS Devices and Systems Advisory Committee (DSAC) Scientific Advisors

Principal stakeholders in health technology management The primary stakeholder is the Public. They are the recipients and users of medical devices and ultimately they are the funders as well. An informed public with increased expectations and a desire for the latest technology have a growing influence on the system. As noted, the federal government, as regulator, has a legislated responsibility to ensure access to safe and effective medical devices. In Canada, the provinces and territories are responsible for health care delivery and -- with some assistance from the federal government in the form of transfer payments – for funding. Many purchasing decisions are delegated to the health authority or hospital level. Health care professionals play a critical role in relation to medical devices. They use them; they inform the public of the risks and benefits. And they are often the first to become aware of an adverse event related to a medical device. The medical device industry develops, manufactures and tests devices. Their legal requirements with respect to regulation are laid out in legislation. Of these stakeholders, our programs primarily serve policy makers in the federal and provincial ministries, regional health authorities, hospitals and continuing care facilities, and health professionals. The general public can access our publications for free on the CADTH web site, www.cadth.ca.

CADTH’s three core programs HTA (Health Technology Assessment) CDR (Common Drug Review) COMPUS (Canadian Optimal Medication Prescribing and Utilization Service) We offer three core programs: Health Technology Assessment (HTA) – which assesses drugs and health technologies Provides three services: Health Technology Assessments (HTAs) Horizon Scanning Health Technology Inquiry Service (HTIS) the Common Drug Review (CDR) – which reviews the clinical and cost evidence on new drugs and provides an evidence-based expert formularly listing recommendation A single process for: conducting objective, rigorous reviews of the clinical and economic evidence for new drugs providing formulary listing recommendations to the publicly funded drug plans in Canada Formulary decisions are made by the drug plans based on CDR recommendation, and plan mandates, priorities, resources CDR reduces duplication, maximizes use of limited resources and expertise, provides equal access to evidence and advice the Canadian Optimal Medication Prescribing and Utilization Service (COMPUS) –which identifies and promotes optimal drug prescribing and use

CADTH Programs Specialised programs for stages of technology lifespan and type of decision Innovation and R&D Adoption Decisions Ongoing and Re- assessment Optimal Utilisation Obsolescence Decisions Horizon Scanning Early Assessment HTIS HTA HTIS CDR (Drugs) HTA HTIS CDR COMPUS HTA COMPUS HTA HTIS Liaison Program and Knowledge Transfer

Why COMPUS? Drugs are the fastest growing category of health care spending in Canada, yet evidence shows that pharmaceuticals are not always used effectively or appropriately.

Issue COMPUS response Inconsistent evidence Gaps between evidence & practice Inappropriate prescribing & use Information overload Need for collaboration Evaluate quality & source of evidence Promote evidence-based practices Provide strategies to support optimal therapy Provide concise evidence-based information Build linkages among optimal therapy initiatives COMPUS helps health care providers and consumers make decisions about the appropriate use of drugs based on the evidence. As such, we: Review clinical and economic evidence and identify inconsistencies and gaps. Fill information gaps by providing optimal therapy information and suggest evidence-based interventions. Inappropriate prescribing and/or drug utilization have been identified as key factors in rising healthcare costs. Reduce duplication of effort by building on existing research. Eliminate the need for jurisdictions to develop initiatives in relative isolation, fostering collaboration and allowing for more targeted spending. Many provinces and territories have launched successful optimal therapy initiatives that could be used in other jurisdictions – COMPUS is well-positioned to be the focal point for coordination and information sharing.

COMPUS impact COMPUS identifies the gaps between what we know (from evidence) and what typically occurs when prescribing drugs. This valuable information can help health care providers, policy makers and consumers choose the most optimal drug therapy based on the best available evidence. Through the uptake and adoption of COMPUS key messages health outcomes will be improved and limited health care resources will be targeted effectively. COMPUS contributes to the re-assessment of a drug or a class of drugs during its lifecycle. COMPUS Impact COMPUS identifies the gaps between what we know (from evidence) and what typically occurs when prescribing drugs. This valuable information can help health care providers, policy makers and consumers choose the most optimal drug therapy based on the best available evidence. Through the uptake and adoption of COMPUS key messages health outcomes will be improved and limited health care resources will be targeted effectively. COMPUS contributes to the re-assessment of a drug or a class of drugs during its lifecycle. Looking at drug therapies that have been in the market place for a time, COMPUS investigates the evidence concerning their optimal use. According to Health Canada, 51% of approved drugs have serious side effects that are not detected before the drug is approved for sale٭.

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