Objectives: Since 1988, four government-funded health technology
assessment (HTA) agencies have been established in Canada. This paper
is a descriptive review of reports issued by these organizations
during the period from 1988 to 1998.
Methods: Publications from the national and three provincial HTA
agencies in Canada were obtained and reviewed. Only the 117
assessment reports that were reported to have undergone external
review were included in this analysis. Each report was classified on
a standard abstraction form according to criteria such as technology
type(s), assessment focus, whether a specific policy question was
clearly stated and relevant decision maker(s) identified, description
of search strategy and selection criteria, sources of data and
assessment methods used, whether recommendations or conclusions were
made, and duplication or overlap of reports. The trends in these
qualities over the 10-year period were also examined.
Results: Therapeutic technologies have received the most attention
from all four agencies, although the focus on devices, drugs, and
procedures varied between agencies. The policy question under
investigation was clearly identified in 82% of reports, and 71% clearly identified the decision maker toward whom the assessment was
targeted. Efficacy or effectiveness was examined in 81% of reports,
and costs were assessed in 65% of studies. These were the two most
frequently examined aspects. Almost all assessments were descriptive
literature reviews; 9% included meta-analyses and 32% had cost
analyses or economic evaluations. Forty-four percent of reports had a
clear description of the literature search strategy, and selection
criteria were clearly specified in 38% of studies, but there was
considerable variation among agencies in the level of description
of these methods. Conclusions were clearly stated in 83% of the
assessments' conclusions, and 13% had recommendations. When analyzed
longitudinally, it is apparent that the quality of reports has
improved markedly during the past decade. This was determined by
examining the clarity of specifying the policy question(s) under
investigation, the identification of the target audience of decision
makers for the information, and by evaluating the thoroughness of the
description of the methods used in the assessment.
Conclusions: Canadian government agencies have contributed a
considerable quantity of health technology assessments. There has
been very little duplication of technologies evaluated, and the
quality of the assessment reports has markedly improved during the
past decade.