Cost-Consequence Analysis of Nitisinone for Treatment of Tyrosinemia Type I.

Background: Tyrosinemia type I is a rare but severe genetic metabolic disorder. Nitisinone combined with a diet low in tyrosine and phenylalanine became first-line therapy in 1994.

Objectives: To estimate the direct medical costs of health care services related to the treatment of tyrosinemia type I, taking into consideration the real-life efficacy of nitisinone.

Lion king or Aslan: a tale from Narnia!

In the Chronicles of Narnia series by C.S. Lewis, Aslan the all-powerful but benevolent lion does not need to have his tail twisted; rather, he twists tails to create convergence and harmony in his dream world.

The "natural history" of health technology assessment.

The collective experience of health technology assessment (HTA) in different countries delineates a pattern of development, a "natural history," of HTA in three phases: emergence, consolidation, and expansion. This study examines the rationale for HTA, definitions of its scope and breadth, its methods and organizational models, and its knowledge translation strategies, as HTA moves from one phase to the next. The study then identifies factors that facilitate or delay the transitions.

Health technology assessment in Canada.

Canada's health system is a unique combination of public financing and private provision. With the significant government role in financing health services, health technology assessment (HTA) has found a ready audience as a form of policy research. In addition, Canada has been a leader in HTA and is entering a phase of deepening and maturation of HTA activities.

Health technology assessment: a review of international activity and examples of approaches with computed tomographic colonography.

The growth of health technology assessment (HTA) internationally is currently reflected in the growing membership of the International Network of Agencies for Health Technology Assessment. Many national and regional HTA institutions emerged in the 1980s and 1990s, and more recently, HTA has emerged in newly industrialized countries and in European Union member states in transition. Health technology assessment activities are becoming an increasingly important part of health care culture, with the appearance of HTA units in hospitals and hospital departments.

The helix in the labyrinth: do we need genetic health services and policy research?

In Canada and elsewhere, targeted health services and policy research (HSPR) has been suggested as a means to clarify the health system implications of developments in genetics and genomics. But is such research really needed? We argue that substantial investments in basic genetic and genomic research, coupled with persistent uncertainty about the health system implications of advances in these fields, justify the development of specialized HSPR in genetics and the sustained involvement of the wider HSPR community. Genetic health services and policy research will play a crucial role in informing decision-makers at all levels of the health system about whether and how to integrate developments in genetics, genomics and other complex new technologies.

Assessing the performance of health technology assessment organizations: a framework.

In light of growing demands for public accountability, the broadening scope of health technology assessment organizations (HTAOs) activities and their increasing role in decision-making underscore the importance for them to demonstrate their performance. Based on Parson's social action theory, we propose a conceptual model that includes four functions an organization needs to balance to perform well: (i) goal attainment, (ii) production, (iii) adaptation to the environment, and (iv) culture and values maintenance. From a review of the HTA literature, we identify specific dimensions pertaining to the four functions and show how they relate to performance.

Expanding the scientific basis of health technology assessment: a research agenda for the next decade.

Objectives: The complexity of health technology assessment (HTA) has increased, in part because of its evolution through three distinct phases: the machine, the clinical outcomes, and the delivery models. However, the theoretical foundation for the field remains underdeveloped.

Methods: It is high time for HTA to bring together aspects of conceptual and theoretical works from other fields to strengthen the foundation of HTA.

International Master's Program in health technology assessment and management: assessment of the first edition (2001--2003).

Background: Despite a clear call for greater input from health technology assessment (HTA) in the areas of clinical practice and policy making, there are currently very few formal training programs. The objectives of our Consortium were to (i) develop a master's level program in HTA, (ii) test its content with a group of Canadian and European students, and (iii) evaluate the Program's strengths and weaknesses.

Objectives: This study presents the results of our evaluation of the first edition of the Master's Program (2001--2003).

Determinants of discordance between patients and physicians in their assessment of lupus disease activity.

Objective: We evaluated different methods for quantifying patient-physician discordance and identified factors associated with discordance in the assessment of lupus disease activity.

Methods: Data from 208 female patients who had a comprehensive annual examination were extracted from the Montreal General Hospital Lupus Registry. Discordance was measured by the difference between the patient self-reported 10 cm visual analog scale (VAS) and the physician VAS for global disease activity (VASDIFF).

Field triage of trauma patients: improving on the Prehospital Index.

The purpose of the present study was to evaluate the predictive ability of the Prehospital Index (PHI) in identifying injury severity and to develop a trauma triage scale that incorporates, along with the PHI, a subset of time independent variables to improve the predictive ability of the PHI-based triage instrument. This study included 1,291 trauma patients treated in Montreal, Canada. The developed trauma triage protocol was based on logistic regression analysis, in which the model that predicts the data best was selected by using Bayesian information criterion.