Evidence of excellence

Leading the way in the pursuit of evidence-based use of health technologies has garnered Alberta Health Services Board member Dr. Andreas Laupacis an inaugural national award.

Laupacis has been named the first recipient of the Jill M. Sanders Award of Excellence in Health Technology Assessment (HTA), presented by the Canadian Agency for Drugs and Technologies in Health – an independent agency that provides advice and evidence-based information about the effectiveness of drugs and technologies.

“Dr. Laupacis is a nationally and internationally recognized leader in the science and application of (HTA),” said Dr. Brian O’Rourke, President and CEO of the agency.

“He has made remarkable contributions to the uptake and use of evidence-based information in Canada, including improving HTA methodology, conducting substantive assessments, supporting the adoption of evidence-based policies, and inspiring the next generation of researchers.”

Laupacis’ extensive work in health technology assessment is as simple – and as complicated – as wanting to know what works before he makes patient care decisions.

“As a practising doctor, I use health technology all the time,” said Laupacis, a general internist and executive director of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto. “I’m keen for my recommendations to patients to be evidence-based. I want to know what works; what the benefits and harms are.”

At the same time, figuring out which technologies and drugs provide the greatest benefit at the level of the health-care system is also part of the draw.

“I’m also interested in the management of the health system, which is one of the reasons I’m on the (AHS) board,” he said.

And while it may seem like a simple question – is a given technology effective or not? – it’s one of the more complicated issues facing health systems. Sometimes evidence is available; in many cases, it isn’t.

And since increasing drug and technology costs are a major contributor to health spending growth around the world, decisions have to be made about which drugs or technologies provide the greatest benefit for their cost.

“These can be tough, value-sensitive decisions,” Laupacis said. “It isn’t easy deciding whether to pay for a new drug that has, on average, only a small benefit for patients but is hugely expensive.”

The use of diagnostic technologies, for example, often seems to occur without explicitly weighing the potential risks and benefits – although there does seem to be some movement in that direction.

“There’s more discussion these days on the potential harm, such as with radiation from CT scans,” Laupacis said. “I’m having more of those discussions with my patients – recently, with a young woman as to whether we should do a CT scan to diagnose what was going on with a stomach issue.

“Because her symptoms were spontaneously getting better, we decided together not to expose her to that risk of radiation.”

That said, technologies, overall, have made an enormously positive contribution to health care.

“I remember when we didn’t have CT scans, and the terribly invasive things that would be done to diagnose the cause of headaches, compared to what we’re able to do now,” he said.

The future of health technology assessment, Laupacis said, includes two important improvements: a more comprehensive approach and better communication with the public.

“What we’re going to see is less one-off evaluations of individual technologies and more work on how technology can be better integrated into care,” he said. “Take diabetes, for example. Instead of asking whether this drug or that technology is effective, the question will be broader: What’s the best way of managing diabetes overall?”

Those questions, and their answers, also need to be better shared with patients.

“One area for improvement is how we communicate evidence to the public,” he said. “We need to help them understand what’s believable out there and what’s not. Health technology assessment has not focused on the general public. Maybe we should start.”