McMaster University

McMaster University

Faculty of
Health Sciences

McMaster team on the right PATH to health technology evaluation

Published: November 14, 2003

With the increasing costs of the healthcare system, making decisions about which equipment and technologies are funded is a tough call.

At McMaster University, a team of researchers has been assembled to provide direction in assessing health technologies by Bernie O'Brien, a professor of clinical epidemiology and biostatistics. The team's work is being assisted by a $3-million grant over three years from the Ministry of Health and Long-Term Care (MOHLTC).

O'Brien is associate director of the Centre for Evaluation of Medicines located at St. Joseph's Hospital in Hamilton, and director of PATH (Program for Assessment of Technology in Health). He and his colleagues will assess the benefits and the costs of new health technologies through a series of research studies.

The resulting health economic evaluations will provide evidence to enable the government to make well-informed judgments as they relate to purchasing decisions.

"The delicate balance between cost and effectiveness of healthcare technologies places a heavy burden on decision makers," said O'Brien. "Whereas pharmaceutical products undergo a rigorous assessment process, the same standards do not exist when evaluating the cost effectiveness of emerging healthcare technologies."

With the PATH program, O'Brien and his team will assess several new therapeutic interventions, including drug-eluting stents, positron emission tomography (PET) scanning and endovascular aneurysm repair (EVAR).

An aortic aneurysm is a dilation of the aorta that will eventually rupture and result in death unless surgically repaired. Standard treatment for aortic aneurysms involves directly replacing that portion of the aorta with a synthetic graft by opening the chest or abdomen.

EVAR repair is a much less-invasive technique, which is safer and therefore the preferred method for the high-risk patients, because it involves excluding the aneurysm from the circulation by introducing a 'stent-graft' into the aorta through an artery in the groin. The costs associated with the stent device and its insertion in patients who are deemed non-surgical candidates creates a financial burden for hospitals. PATH will conduct a formal economic analysis of the costs, including outcomes, which will be used to inform the ministry's future funding policy on EVAR.

The team of researchers will also evaluate drug-coated stents used in angioplasty procedures to open clogged arteries. The stents release drugs that inhibit tissue growth in narrowed coronary arteries in an effort to prevent a re-narrowing of the artery. The ministry has provided $12 million for the new drug-eluting stents provided that the centres agree to participate in O'Brien's studies.

PATH is also assessing the economics of PET scanners, of which the MOHLTC will fund at least two randomized controlled trials. This sophisticated technology allows doctors to assess organs, muscle tissue and tumours in detail while the patient is awake. This is in contrast to traditional computed tomography (CT) scanners that show only structural details of the brain. Dr. Mark Levine, professor in the Department of Medicine at McMaster, is coordinating the PET clinical trials.

"An increased trend toward evidence-based medicine will only help to make the assessment of new technologies the standard for reimbursement decisions," said O'Brien.

"As the need to justify costs increases, providing evidence to support new healthcare technologies will soon become the standard and the PATH program will be well positioned to provide opportunities for other collaborative research partnerships."

PATH is an example of the growth in multi-disciplinary health research at McMaster and illustrates one of the university's new strategic directions in "integrated health."

Valid XHTML 1.0 Transitional Level Double-A conformance, W3C WAI Web Content Accessibility Guidelines 2.0