Reimbursement-based economics - What is it and how can we use it to inform drug policy reform?

BACKGROUND: In Ontario, approximately $3.8 billion is spent annually on publicly funded drug programs. The annual growth in Ontario Public Drug Program (OPDP) expenditure has been limited to 1.2% over the course of 3 years. Concurrently, the Ontario Drug Policy Research Network (ODPRN) was appointed to conduct drug class review research relating to formulary modernization within the OPDP. Drug class reviews by ODPRN incorporate a novel methodological technique called reimbursement-based economics, which focuses on reimbursement strategies and may be particularly relevant for policy-makers. OBJECTIVES: To describe the reimbursement-based economics approach. METHODS: Reimbursement-based economics aims to identify the optimal reimbursement strategy for drug classes by incorporating a review of economic literature, comprehensive budget impact analyses, and consideration of cost-effectiveness. This 3-step approach is novel in its focus on the economic impact of alternate reimbursement strategies rather than individual therapies. RESULTS: The methods involved within the reimbursement-based approach are detailed. To facilitate the description, summary methods and findings from a recent application to formulary modernization with respect to the drug class tryptamine-based selective serotonin receptor agonists (triptans) used to treat migraine headaches are presented. CONCLUSIONS: The application of reimbursement-based economics in drug policy reforms allows policy-makers to consider the cost-effectiveness and budget impact of different reimbursement strategies allowing consideration of the trade-off between potential cost savings vs increased access to cost-effective treatments.This research was supported by the Ontario Drug Policy Research Network. CC is a recipient of a Vanier Canada Graduate Scholarship through CIHR (Funding reference number – CGV 121171) and a trainee on the CIHR Drug Safety and Effectiveness Network Meta-Analysis team grant (Funding reference number – 116573)

Stem Cell Research Ethics: Consensus Statement on Emerging Issues

This article is a consensus statement by an international interdisciplinary group of academic experts and Canadian policy-makers on emerging ethical, legal, and social issues in human embryonic stem cell (hESC) research in Canada. The process of reaching consensus included consultations with key stakeholders in hESC research (regulators, stem cell researchers, and research ethics experts), preparation and distribution of background papers, and an international workshop held in Montreal in February 2007 to discuss the papers and debate recommendations. The recommendations provided in the consensus statement focus on issues of immediate relevance to Canadian policy-makers, including informed consent to hESC research, the use of fresh embryos in research, management of conflicts of interest, and the relevance of public opinion research to policy-making. Le présent article est une déclaration de consensus émise par un groupe interdisciplinaire international de spécialistes universitaires et de décideurs canadiens au sujet des nouvelles questions éthiques, juridiques et sociales dans le domaine de la recherche sur les cellules souches embryonnaires humaines (CSEH) au Canada. Dans le cadre du processus visant l’atteinte d’un consensus, nous avons mené des consultations auprès d’intervenants clés du domaine de la recherche sur les CSEH (responsables de la réglementation, chercheurs s’intéressant aux cellules souches et spécialistes du domaine de l’éthique de la recherche), nous avons rédigé et distribué des documents d’information, et nous avons tenu un atelier international à Montréal en février 2007 pour discuter de ces documents et débattre de leurs recommandations. Les recommandations faisant partie de la déclaration de consensus sont axées sur des questions intéressant directement les décideurs canadiens, y compris le consentement éclairé en matière de recherche sur les CSEH, l’utilisation d’embryons frais à des fins de recherche, la prise en charge des conflits d’intérêt et la pertinence de la recherche sur l’opinion publique en ce qui a trait à l’élaboration des politiques

Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: systematic review

Aim: This paper is a report of a systematic review conducted to determine the effectiveness and feasibility of bedside screening methods for detecting dysphagia in patients with neurological disorders.\ud \ud Background: Dyspaghia affects 22–65% of patients with neurological conditions. Although there is a large variety of bedside tests to detect dysphagia, it is unknown which have the best psychometric properties and are feasible for nurses to use.\ud \ud Data sources and review methods: An electronic database search was carried out using Medline (PubMed), Embase, CINAHL, and PsychLit, including all hits up to July 2008. The search terms were dysphagia, sensitivity, specificity, diagnosis, and screening. The methodological quality of included studies was assessed.\ud \ud Results: Thirty-five out of 407 studies were included in the review. Eleven studies with sufficient methodological quality revealed that trial swallow tests using water had sensitivities between 27% and 85% and specificities between 63% and 88%. Trial swallow tests with different viscosities led to sensitivities ranging from 41% to 100% and specificities of 57% to 82%. Combining water tests with oxygen desaturation led to sensitivities between 73% and 98% and specificities between 63% and 76%. Single clinical features, such as abnormal gag, generally had low sensitivity and specificity.\ud \ud Conclusion: A water test combined with pulse oximetry using coughing, choking and voice alteration as endpoints is currently the best method to screen patients with neurological disorders for dysphagia. Further research is needed to establish the most effective standardized administration procedure for such a water test, and to assess the value of pulse oximetry, in addition to a trial swallow to detect silent aspiration