MGA6 Survey Strategies in the Revision of the Guidelines for Economic Evaluation: Canada

Abstract

In 1994 the Guidelines for Economic Evaluations of Pharmaceuticals: Canada (1st ed) was published, and the Canadian Coordinating Office for Health Technology Assessment (CCOHTA) was assigned with its maintenance. In 1996, CCOHTA struck a Committee of experienced stakeholders to review the Guidelines. METHODS: The Committee distributed an initial survey (n = 1,500), directed specifically to those in economic evaluation research (“doers”), and to those who use the results for decision-making (“users”). Results from this survey guided the creation of the 2nd edition of the Guidelines. The survey process was repeated with a draft of the 2nd edition, and focused on the degree to which changes to the Guidelines met their objectives and were an improvement over the 1st edition. RESULTS: Respondents to both surveys were comparable in proportion and composition, with the majority of respondents being Canadian in origin (75–78%) and representing the doers (45–46%). Responses to the initial survey (10% response rate) suggested a need to clarify the Guidelines' audience. With this in mind, the Committee confirmed that the document should provide guidance for “doers” of evaluations but that this was for the purposes of providing a clear, comprehensive and scientifically satisfactory report for “users”. The initial survey also identified key areas of concern, which determined the changes introduced to the 2nd edition. This encompassed the following areas: format changes, cost issues, portability/generalizability, sensitivity analysis and statistics, HRQOL/QALYs, WTP/CBA, equity, limitations/assumptions, subgroup analysis, and meta-analysis. The responses to the follow-up survey (50% response rate) indicated that the goals of the revision process were achieved and provided an improvement over the 1st edition (70–80% agreement rating). Academics and users felt that the Guidelines were realistic, while less enthusiastic support came from governments and doers. CONCLUSIONS: Survey methodologies are an effective means of focusing efforts in the Guideline review process.