Publications by authors named "Meghan McMahon"

22 Publications

  • Page 1 of 1

The Promise of Science, Knowledge Mobilization, and Rapid Learning Systems for COVID-19 Recovery.

Int J Health Serv 2021 Mar 18:20731421997089. Epub 2021 Mar 18.

Institute of Health Services and Policy Research, 27349Canadian Institutes of Health Research, Toronto, ON, Canada.

The health, economic, and social crises created by the coronavirus disease 2019 (COVID-19) pandemic have been global in scope and inequitable in impact. The global road to recovery can be enhanced with robust, relevant, and timely scientific evidence. This commentary seeks to illustrate the power of science, scientific collaboration, and innovative research funding programs to inform pandemic recovery and inspire transformational changes for a more equitable, resilient, and sustainable future. Specifically, this commentary provides an introduction to the United Nations (UN) Research Roadmap for the COVID-19 Recovery that was published in November 2020. It introduces 5 scoping reviews that helped inform the UN Research Roadmap and that are now available open access within this series of special papers, and it provides an overview of an innovative research funding program that facilitated rapid mobilization and collaboration to produce the scoping reviews. The publication of the scoping reviews in this journal series will help complement and amplify the UN Research Roadmap by furthering knowledge mobilization efforts and informing COVID-19 recovery around the world, to ensure a more equitable, resilient, and sustainable postpandemic future.
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http://dx.doi.org/10.1177/0020731421997089DOI Listing
March 2021

Informing Canada's Health System Response to COVID-19: Priorities for Health Services and Policy Research.

Healthc Policy 2020 08;16(1):112-124

Scientific Director, CIHR Institute of Health Services and Policy Research, Senior Scientist, ICES (Institute for Clinical Evaluative Sciences), Research Scientist, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Professor, Family and Community Medicine, University of Toronto, Toronto, ON.

To inform Canada's research response to COVID-19, the Canadian Institutes of Health Research's Institute of Health Services and Policy Research (IHSPR) conducted a rapid-cycle priority identification process. Seven COVID-19 priorities for health services and policy research were identified: system adaptation and organization of care; resource allocation decision-making and ethics; rapid synthesis and comparative policy analysis of the COVID-19 response and outcomes; healthcare workforce; virtual care; long-term consequences of the pandemic; and public and patient engagement. Three additional cross-cutting themes were identified: supporting the health of Indigenous Peoples and vulnerable populations, data and digital infrastructure, and learning health systems and knowledge platforms. IHSPR hopes these research priorities will contribute to the broader ecosystem for collective research investment and action.
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http://dx.doi.org/10.12927/hcpol.2020.26249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7435075PMC
August 2020

Exploring Mentorship as a Strategy to Build Capacity and Optimize the Embedded Scientist Workforce.

Healthc Policy 2019 10;15(SP):73-84

Dean, Professor, Dalla Lana School of Public Health, University of Toronto, Toronto, ON.

Background: Mentorship plays a significant role in career development in academic and applied settings, but little is documented about its role in the experiential learning of academic trainees embedded in health system organizations. The experiences of the first cohort of Canada's Health System Impact (HSI) Fellowship program can provide insights into how mentorship in this innovative type of training can work.

Objectives: To understand the mentorship strategies that were used and to explore fellows' and supervisors' perspectives and experiences on the effectiveness and value of those strategies.

Methods: Data from the surveys of fellows and their supervisors and a panel rooted in the lived experience of the first HSI Fellowship cohort were used.

Results: Health system and academic supervisors developed a range of innovative, individualized and effective approaches for guiding their fellows, such as providing the fellow with a committee of mentors within the organization, holding regular meetings with the fellow and both the health system and the academic supervisor and leveraging their own network to expand the network and resources available to the fellow.

Conclusion: The results suggest that engaging senior leadership in health system settings has provided positive experiences for both fellows and their mentors.
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http://dx.doi.org/10.12927/hcpol.2019.25978DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017759PMC
October 2019

Developing Competencies for Health System Impact: Early Lessons Learned from the Health System Impact Fellows.

Healthc Policy 2019 10;15(SP):61-72

Professor, Department of Medicine and Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Scientific Director (former), CIHR Institute of Health Services and Policy Research, Montreal, QC.

Background: The Health System Impact (HSI) Fellowship program provides highly qualified post-doctoral fellows studying health services and policy research (HSPR) with opportunities for experiential learning, enriched core competency development and mentorship from senior-level leaders within health system organizations. Its overall aim is to prepare post-doctoral fellows with the research and professional skills, experiences and networks to make meaningful and impactful contributions in careers in academic and applied health system settings.

Objective: This study examined whether this HSI Fellowship program has contributed to the development of enriched core competencies in HSPR.

Methods: A competency assessment tool was developed and administered to the 46 fellows and their health system and academic supervisors from the inaugural HSI Fellowship cohort. Fellows' self-assessments at baseline, three months and 12 months were analyzed, along with supervisors' assessments at three and 12 months. Descriptive analyses were used to examine competency development over time. Differences by gender and between supervisor and fellow ratings were analyzed.

Results: HSI fellows' self-assessments indicate that they strengthened their skills in all 10 enriched core competencies. Supervisors' assessments of the fellows' competencies also improved from baseline to 12 months. Gender differences at baseline disappeared by the 12-month assessment.

Conclusion: The HSI Fellowship provides an opportunity to develop the full suite of enriched core competencies, particularly in competency domains that are not currently emphasized in HSPR doctoral curriculum.
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http://dx.doi.org/10.12927/hcpol.2019.25979DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017754PMC
October 2019

Training for Health System Improvement: Emerging Lessons from Canadian and US Approaches to Embedded Fellowships.

Healthc Policy 2019 10;15(SP):34-48

Professor, Department of Medicine and Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Scientific Director (former), CIHR Institute of Health Services and Policy Research, Montreal, QC.

The benefits of supporting experiential learning for improved health and societal outcomes have been recognized in many countries. A number of funding organizations have developed competitive funding opportunities to support experiential learning in health system organizations outside of the traditional university setting. AcademyHealth in the US is an early innovator that pioneered the Delivery System Science Fellowship (DSSF) and inspired Canada's creation of the Health System Impact (HSI) Fellowship program. The DSSF and HSI Fellowship have similar objectives: to improve the career readiness of doctorally prepared graduates and to build research capacity within health system organizations. However, the programs have taken different approaches to achieve these objectives and operate in different healthcare systems. This paper outlines the two models of embedded fellowships, analyzes their commonalities and differences, discusses lessons learned and suggests future directions for health services and policy research training.
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http://dx.doi.org/10.12927/hcpol.2019.25981DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017757PMC
October 2019

The Career Outcomes of Health Services and Policy Research Doctoral Graduates.

Healthc Policy 2019 10;15(SP):16-33

Professor, Department of Medicine and Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Scientific Director (former), CIHR Institute of Health Services and Policy Research, Montreal, QC.

Objective: To examine the career outcomes of 20 years of PhD graduates from Canadian health services and policy research (HSPR) doctoral training programs.

Methods: The deans of the doctoral training programs were invited to participate in this national cohort study. A standardized career-tracking template was developed. Internet searches of publicly accessible sources were used to track graduates' employment. Descriptive analyses summarized PhD program characteristics and current employment.

Results: Of the 1,208 trainees who graduated during our study period, 884 (73.2% of 1,208, or 90.3% of the 979 with complete data) could be successfully tracked. HSPR PhD graduates are highly employable, but employment trends have changed over time. Today's graduates are more likely to enter careers in a wider variety of sectors and roles and are less likely to be employed in academia than previous graduates. However, over 50% of graduates are currently employed in professorial positions within the academic sector or in research roles or departments within healthcare delivery organizations.

Conclusions: This article provides an initial descriptive profile of the career outcomes of HSPR PhD graduates in Canada from 10 university-based doctoral training programs. To ensure that PhD graduates are prepared to contribute fully within diverse sectors and roles, doctoral training must evolve to keep pace with employment trends and encompass, in addition to research skills, the professional skills demanded in the public, private, not-for-profit and healthcare delivery sectors.
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http://dx.doi.org/10.12927/hcpol.2019.25982DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017755PMC
October 2019

Training for Impact: PhD Modernization as a Key Resource for Learning Health Systems.

Healthc Policy 2019 10;15(SP):10-15

Professor, Department of Medicine and Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Scientific Director (former), CIHR Institute of Health Services and Policy Research, Montreal, QC.

The Institute of Medicine (IOM) has articulated a vision of a learning health system (LHS) as one that provides the best care at lower costs and that constantly, systematically and seamlessly improves based on data and evidence (IOM 2013). The IOM identifies the four foundational characteristics of an LHS as the real-time use of data and informatics to capture the care experience, patient-clinician partnerships, incentives aligned for value and a leadership-instilled culture of learning (IOM 2013). Although much policy research and commentary has focused on informatics and incentives, relatively less has focused on the critical question of creating a culture of learning in these systems. And although its source is debated, most management gurus agree with the adage that "culture eats strategy for breakfast" (Cave 2017), which is why a focus on the cultural dimension is critically important. Some scholars have recognized the important role of human capital - and of front-line clinicians in particular - in the LHS (Verma and Bhatia 2016). In addition to clinicians, doctorally prepared individuals, such as those with a PhD in health services and policy research (HSPR) and fields such as health economics, epidemiology and health informatics, have the potential to make significant contributions to LHSs and health system reform (Bornstein 2016; Brown and Nuti 2016; CIHR-IHSPR 2016). But having a PhD in these fields is not the same as being prepared to support progress toward an LHS. As argued in other papers, substantial change in doctoral training is needed so that graduates can contribute to their full potential and help drive real innovation within the health system (Bornstein 2016; CIHR-IHSPR 2016; Reid 2016).
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http://dx.doi.org/10.12927/hcpol.2019.25983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017756PMC
October 2019

The Health System Impact Fellowship: Perspectives From the Program Leads Comment on "CIHR Health System Impact Fellows: Reflections on 'Driving Change' Within the Health System".

Int J Health Policy Manag 2019 10 1;8(10):623-626. Epub 2019 Oct 1.

Canadian Institutes of Health Research, Institute of Health Services and Policy Research, Montreal, QC, Canada.

As the Canadian Institutes of Health Research (CIHR) leads in designing and implementing the new Health System Impact (HSI) Fellowship program, we congratulate Sim et al for their thoughtful contribution to the nascent literature on embedded research, and for advancing our own learning about the HSI Fellowship experience. In our commentary, we describe the HSI Fellowship and its key components, discuss the factors that motivated and inspired the creation of the program, and highlight successes thus far.
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http://dx.doi.org/10.15171/ijhpm.2019.59DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6819624PMC
October 2019

Mobile monitoring of air and noise pollution in Philadelphia neighborhoods during summer 2017.

Environ Pollut 2019 Dec 11;255(Pt 1):113195. Epub 2019 Sep 11.

Department of Geography and the Environment, Villanova University, USA.

Mobile monitoring is a useful approach for measuring intra-urban variation of air pollution in urban environments. In this study, we used a mobile monitoring approach to study the spatial-temporal variability of air and noise pollution in urban neighborhoods of Philadelphia. During summer 2017, we used portable instruments to measure PM, black carbon (BC), and noise levels along 5 km paths in four residential neighborhoods (Tioga, Mill Creek, Chestnut Hill, and Northern Liberties) and one commercial district (Center City) in Philadelphia, Pennsylvania, USA. A total of 62 sets of measurements were made at three different times of day (during morning rush hour, mid-afternoon, and during afternoon rush hour) from June 5 to July 7, 2017. Spatially, there was a significant difference in PM concentrations among the four residential neighborhoods. Overall, the Chestnut Hill neighborhood had the highest PM concentrations (13.25 ± 6.89 μg/m), followed by Tioga (9.58 ± 4.83 μg/m), Northern Liberties (7.02 ± 4.17 μg/m), and Mill Creek (3.9 ± 4.5 μg/m). There was temporal variability of pollutants depending on the neighborhood; Northern Liberties demonstrated the highest temporal variability in these data. The highest PM (18.86 ± 3.17 mg/m) was measured in the Chestnut Hill neighborhood during mid-afternoon. Mean PM, BC, and noise levels based on mobile measurements at Philadelphia during summer 2017 were 8.41 ± 4.31 μg/m, 0.99 ± 0.44 μg C/m, and 62.01 ± 3.20 dBA, respectively. Environmental noise showed the highest temporal variation of the monitored components for 3 time periods. In general, tree cover showed a weak and inconclusive association with particulate pollution levels.
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http://dx.doi.org/10.1016/j.envpol.2019.113195DOI Listing
December 2019

Development of Enriched Core Competencies for Health Services and Policy Research.

Health Serv Res 2018 10 11;53 Suppl 2:4004-4023. Epub 2018 Mar 11.

Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Objective: To develop an enriched set of core competencies for health services and policy research (HSPR) doctoral training that will help graduates maximize their impact across a range of academic and nonacademic work environments and roles.

Data Sources/study Setting: Data were obtained from multiple sources, including literature reviews, key informant interviews, stakeholder consultations, and Expert Working Group (EWG) meetings between January 2015 and March 2016. The study setting is Canada.

Study Design: The study used qualitative methods and an iterative development process with significant stakeholder engagement throughout.

Data Collection/extraction Methods: The literature reviews, key informant interviews, existing data on graduate career trajectories, and EWG deliberations informed the identification of career profiles for HSPR graduates and the competencies required to succeed in these roles. Stakeholder consultations were held to vet, refine, and validate the competencies.

Principal Findings: The EWG reached consensus on six sectors and eight primary roles in which HSPR doctoral graduates can bring value to employers and the health system. Additionally, 10 core competencies were identified that should be included or further emphasized in the training of HSPR doctoral students to increase their preparedness and potential for impact in a variety of roles within and outside of traditional academic workplaces.

Conclusion: The results offer an expanded view of potential career paths for HSPR doctoral graduates and provide recommendations for an expanded set of core competencies that will better equip graduates to maximize their impact on the health system.
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http://dx.doi.org/10.1111/1475-6773.12847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6149358PMC
October 2018

Health services and policy research in the first decade at the Canadian Institutes of Health Research.

CMAJ Open 2016 Apr-Jun;4(2):E213-21. Epub 2016 May 5.

Institute of Health Services and Policy Research (Tamblyn, Girard, Nadigel), Canadian Institutes of Health Research, Montréal, Que.; Institute of Health Services and Policy Research (McMahon), Canadian Institutes of Health Research, Toronto, Ont.; Institute of Health Services and Policy Research (Drake), Canadian Institutes of Health Research, Ottawa Ont.; Data and Statistics (Gaudreau), Canadian Institutes of Health Research, Ottawa, Ont.

Background: Health services and policy research is the innovation engine of a health care system. In 2000, the Canadian Institutes of Health Research (CIHR) was formed to foster the growth of all sciences that could improve health care. We evaluated trends in health services and policy research funding, in addition to determinants of funding success.

Methods: All applications submitted to CIHR strategic and open operating grant competitions between 2001 and 2011 were included in our analysis. Age, sex, size of research team, critical mass, season, year and research discipline were retrieved from application information. A cohort of 4725 applicants successfully funded between 2001 and 2005 were followed for 5 years to evaluate predictors of continuous funding. Multivariate generalized estimating equation logistic regression was used to estimate predictors of funding success and sustained funding.

Results: Between 2001 and 2011, 80 163 applications were submitted to open and strategic grant competitions. Over time, grant applications increased from 327 to 1137 per year, and annual funding increased from $12.6 to $48.0 million. Grant applications from young male researchers were more likely to be funded than those from female researchers (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.01-1.95), as were applications from larger research teams and institutions with a large critical mass. Only 24.0% of scientists whose first funded grant was in health services and policy research had sustained 5-year funding, compared with 52.8% of biomedical scientists (OR 0.34, 95% CI 0.24-0.49).

Interpretation: The CIHR has successfully increased the amount of health services and policy research in Canada. To enhance conditions for success, researchers should be encouraged to work in teams, request longer duration grants, resubmit unsuccessful applications and affiliate themselves with institutions with a greater critical mass.
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http://dx.doi.org/10.9778/cmajo.20150045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4933636PMC
July 2016

Will your data take you to the championship?

Authors:
Meghan McMahon

MGMA Connex 2013 Jan;13(1):56-7

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January 2013

Use CPT codes to analyze practice operations.

Authors:
Meghan McMahon

MGMA Connex 2012 Nov-Dec;12(10):15-6

MGMA-ACMPE.

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March 2013

Population health intervention research in Canada: catalyzing research through funding.

Can J Nurs Res 2011 Dec;43(4):93-8

School of Nursing, Department of Epidemiology and Community Medicine, University of Ottawa, Ontario, Canada.

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December 2011

Cost-effectiveness analysis of implantable venous access device insertion using interventional radiologic versus conventional operating room methods in pediatric patients with cancer.

J Vasc Interv Radiol 2010 May 27;21(5):677-84. Epub 2010 Mar 27.

Institute of Medical Science, University of Toronto, Toronto, ON, Canada.

Purpose: Percutaneous image-guided techniques are associated with less tissue trauma and morbidity than open surgical techniques. Interventional radiology has received significant health care investment. The purpose was to determine the cost effectiveness of inserting implantable venous access devices (IVADs) by interventional radiologic means versus conventional operating room surgery in pediatric patients with cancer.

Materials And Methods: In a retrospective cohort analysis, patients presenting with a new tumor diagnosis and receiving a first-time IVAD in January to June 2000 (operative group; n = 30) and January to June 2004 (interventional group; n = 30) were included. A societal costing perspective was adopted. Costs included labor, materials, equipment, inpatient wards, parent travel, and parental productivity losses for 30 days after insertion. Severe complications related to IVAD insertion were microcosted. Costs related to cancer therapy were not included. Incremental cost-effectiveness analysis and sensitivity analysis were performed.

Results: Interventional patients were older (7.3 years vs 4.1 years; P = .01). There were no significant differences between groups in sex, American Society of Anesthesiologists score, or length of hospital stay. Interventional radiologic procedures were shorter (84.9 minutes vs 112.8 minutes; P = 0.01). Interventional radiologic insertion was slightly less costly than operative insertion (Can$622,860 and Can$627,005 per 30-patient group, respectively) and more effective in reducing the complication rate (two vs eight complications per group, respectively; P = .039). The results were sensitive to the cost of operating the operating room.

Conclusions: Interventional radiology was slightly less costly than operative IVAD insertion and resulted in fewer serious complications. It should be considered for IVAD insertions in pediatric patients with cancer.
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http://dx.doi.org/10.1016/j.jvir.2010.01.014DOI Listing
May 2010

Balancing health and industrial policy objectives in the pharmaceutical sector: lessons from Australia.

Health Policy 2008 Aug 4;87(2):133-45. Epub 2008 Mar 4.

Centre for Health Services and Policy Research, Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC, Canada.

Introduction: Policy-makers worldwide struggle to balance health with industrial policy objectives in the pharmaceutical sector. Tensions arise over pricing and reimbursement in particular. What health plans view as necessary to maintain equitable access to medicines, industry views as inimical to R&D and innovation. Australia has grappled with this issue for years, even incorporating the goal of "maintaining a responsible and viable medicines industry" into its National Medicines Policy.

Methods: This case study was conducted via a narrative review that examined Australia's experiences balancing health and industrial policy objectives in the pharmaceutical sector. The review included electronic databases, grey literature and government publications for reports on relevant Australian policy published over the period 1985-2007.

Results: While pharmaceutical companies claim that Australia's pricing and reimbursement policies suppress drug prices and reduce profits, national policy audits indicate these claims are misguided. Australia appears to have secured relatively low prices for generics and "me-too drugs" while paying internationally competitive prices for "breakthrough" medicines. Simultaneously, Australia has focused efforts on local pharmaceutical investment through a variety of industry-targeted R&D incentive policies.

Discussion: Despite the fact that policy reviews suggest that Australia has achieved balance between health and industrial policy objectives, the country continues to face criticism from industry that its health goals harm innovation and R&D. Recent reforms raise the question whether Australia can sustain the apparent balance.
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http://dx.doi.org/10.1016/j.healthpol.2008.01.003DOI Listing
August 2008

Canadian media and health policy research: the limits of stories.

Am J Bioeth 2007 Aug;7(8):19-21; discussion W1-2

Dalhousie University, Halifax, NS, B3H 4H7, Canada.

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http://dx.doi.org/10.1080/15265160701462301DOI Listing
August 2007

Influencing Drug Prices through Formulary-Based Policies: Lessons from New Zealand.

Healthc Policy 2007 Aug;3(1):e121-40

Centre for Health Services and Policy Research, Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC.

A national formulary has been proposed as a priority element of Canada's National Pharmaceuticals Strategy. We review a variety of formulary-based policies that might be used in conjunction with a national formulary, drawing on the policies and practices of the Pharmaceutical Management Agency of New Zealand. We consider the potential price impact of an actively managed national formulary by conducting a Canada-New Zealand price comparison for equivalent products in the four largest drug classes: statins, angiotensin-coverting enzyme (ACE) inhibitors, selective serotonin reuptake inhibitors (SSRIs) and proton pump inhibitors (PPIs). The results suggest that potential price savings for Canada in these drug classes are on the order of 21% to 79%. Such price differences would translate into billions of dollars in annual savings if applied across Canada, potentially offsetting the costs of the expansion of pharmacare coverage necessary to achieve both equity and efficiency goals in this sector.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645129PMC
August 2007

Centralising drug review to improve coverage decisions: economic lessons from (and for) Canada.

Appl Health Econ Health Policy 2006 ;5(2):67-73

Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada.

Drug coverage decisions require information about clinically relevant benefits and risks, as well as economic information about direct and indirect costs, in comparison with relevant treatment alternatives. A recent Canadian initiative aims to improve the evidentiary basis for drug coverage decisions through centralised evaluation of the clinical and economic value of new drug products. Centralised review can make important, 'positive' contributions to decision making by raising the evidentiary basis for decisions. Even in the absence of a single-payer for medicines, such information can directly inform decisions focussed on matters of technical efficiency. Centralised review also provides necessary but not sufficient information for the many decisions in this sector that concern allocative efficiency and therefore have 'normative' implications. Thus, in addition to processes for collecting and critically assessing clinical and economic data, effective priority setting requires processes at a local level for engaging affected populations in the consideration of the trade-offs inherent in coverage decisions.
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http://dx.doi.org/10.2165/00148365-200605020-00001DOI Listing
December 2006

Centralized drug review processes in Australia, Canada, New Zealand, and the United kingdom.

Health Aff (Millwood) 2006 Mar-Apr;25(2):337-47

University of British Columbia.

Many countries have centralized the clinical and economic assessments necessary for evidence-based drug coverage policy. We analyze such processes in Australia, Canada, New Zealand, and the United Kingdom. These countries apply comparable approaches to the assessment and appraisal of evidence but apply the processes to different types of drugs and use the reviews within different decision-making contexts. Review processes applied to all medicines and clearly tied to coverage decisions appear to influence national drug use. Rigor of process and transparency of data and rationale are believed to be important for maximizing the impact and political acceptability of the processes.
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http://dx.doi.org/10.1377/hlthaff.25.2.337DOI Listing
October 2006

Centralized drug review processes: are they fair?

Soc Sci Med 2006 Jul 20;63(1):200-11. Epub 2006 Jan 20.

Faculty of Health and Social Development, University of British Columbia Okanagan, 3333 University Way, Kelowna, British Columbia, Canada V1V1V7.

Numerous countries have implemented centralized drug review processes to assist in making drug coverage decisions. In addition to examining the final recommendations of these bodies, it is also important to ensure fairness in decision making. Accountability for reasonableness is an ethics-based framework for examining the fairness of priority setting processes. The objective of this study was to assess the fairness of four internationally established centralized drug review processes using accountability for reasonableness. Semi-structured telephone interviews were conducted with stakeholders in Canada, New Zealand, Australia and the UK (n=16). Participants were asked to evaluate their country's centralized drug review process against the four conditions of accountability for reasonableness. Each centralized drug review process satisfied at least one of the four ethical conditions, but none satisfied all four conditions. All participants viewed transparency as critical to both the legitimacy and fairness of centralized drug review processes. Additional strides need to be made in each of the four countries under study to improve the fairness of their centralized drug review processes. Ideally, a fair priority setting process should foster constructive stakeholder engagement and enhance the legitimacy of decisions made in assessing pharmaceutical products for funding. As policy makers are under increasing scrutiny in allocating limited resources, fair process should be seen as a critical component of such activity. This study represents the first attempt to conduct an international comparison of the fairness of centralized drug review agencies in the eyes of participating stakeholders.
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http://dx.doi.org/10.1016/j.socscimed.2005.11.049DOI Listing
July 2006

The Common Drug Review: a NICE start for Canada?

Health Policy 2006 Aug 6;77(3):339-51. Epub 2005 Oct 6.

Centre for Health Services and Policy Research, University of British Columbia, 429-2194 Health Sciences Mall, Vancouver, BC, Canada V6T 1Z3.

Prescription drugs are one of the fastest growing cost components of modern health care systems. Efforts to control escalating costs while simultaneously maximizing population health outcomes have led many countries to implement restrictive criteria on the funding of certain drugs. While drugs are licensed for sale based on evidence of safety and efficacy versus a placebo, many funders now require evidence of clinical- and cost-effectiveness compared to existing drugs as part of their reimbursement criteria. In some countries, concerns about duplication of drug assessment and administrative effort across different jurisdictions have led to experimentation with various forms of centralized drug review processes. Centralized drug reviews strive to standardize, inform, and improve drug reimbursement decisions through critical assessments of comparative clinical- and cost-effectiveness. The ultimate objective is to inform formulary listing decisions that both maximize health outcomes and achieve good "value for money". This paper describes the Common Drug Review (CDR), a uniquely Canadian version of a centralized drug review process, and compares it with the much-studied National Institute for Health and Clinical Excellence (NICE) in the United Kingdom. Through this analysis, which draws on prior critiques and experiences of NICE, we highlight several critical issues for pharmaceutical priority setting that must be considered in the operation and appraisal of centralized drug review processes. These include the selection of drugs for review, centralized versus decentralized decision-making, receptor capacity at local decision making levels, and public participation.
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http://dx.doi.org/10.1016/j.healthpol.2005.08.006DOI Listing
August 2006