ELSIcon2024: Incorporating Equity Considerations in Health Technology Assessment and Funding of Genome Medicine Technologies in Ontario, Canada

ELSIcon2024 • Paper • June 10, 2024 

Authors:

Speaker: Wendy J. Ungar, MSc, PhD (she/her/hers) – The Hospital for Sick Children Research Institute (Canada)

Genome medicine (GM) technologies are diffusing into clinical practice for multiple indications. The publicly funded healthcare system in Ontario, Canada uses health technology assessment (HTA) to inform funding recommendations. The HTAs include systematic reviews of effectiveness, safety and cost-effectiveness; patient preference literature reviews; model-based cost-effectiveness analyses; budget impact analyses; prospective patient engagement; and ethical analysis, when indicated. In 2017, the Ontario Genetics Advisory Committee was established to review HTA evidence specifically for GM technologies and a working group was convened to ensure the incorporation of equity considerations. Equity is considered at each phase of the HTA process, from topic scoping and prioritization, reviews of clinical and cost-effectiveness evidence, cost-effectiveness analysis, analysis of patient values and preferences, and committee deliberation. The PROGRESS-Plus framework (O’Neill 2014) is used to guide consideration of factors that may contribute to inequity, including: Place of residence; Race, ethnicity, culture, and language; Occupation; Gender and sex; Religion; Education; Socioeconomic status; Social capital, and other considerations such as age, disability, and sexual orientation. Data permitting, findings for each HTA component are stratified according to these factors. The absence of data for vulnerable groups, such as those with higher than average rates of disease-causing genetic variants, or those facing barriers to access to health services are also called out as these aspects will influence policy-making and implementation planning. The process for capturing equity consideration in HTA in Ontario may serve as a template for other jurisdictions facing GM technology funding decision-making.

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