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Methodology

The HSI team followed a four-stage process in identifying proven cost-effective interventions addressing Type-II Diabetes in Canada. Details on this process can be found below.


The HSI team first located cost-effective interventions for chronic diseases in OECD countries.

First Step: Locating Cost-Effective Interventions

In order to ensure our research methodology used to locate cost-effective interventions in OECD countries was as comprehensive as possible, we employed a review-of-reviews wherein we consulted reviews indexed in:

Additionally, we used data from:

In addition, throughout our review, we used the following inclusion and exclusion criteria when identifying cost-effective interventions:

Inclusion criteria for cost-effectiveness data:

  • Provides information that falls into most, if not all, categories on our coding frameworkquestion_mark
  • Provides cost-effectiveness data from 2000 to present
  • Provides cost-effectiveness data in the form of cost per health outcomequestion_mark
  • Cites interventions that are focused on prevention and control of type II diabetes in OECD countries

Exclusion criteria for cost-effectiveness data:

  • Gives a summary of the study but does not give cost-effectiveness data in the form of cost per health outcomequestion_mark
  • Cites cost-effectiveness data that is dated pre-2000
  • Cost-effectiveness data includes the burden of many health conditionsquestion_mark


Second Step: Establishing a Threshold for Cost-Effectiveness

We further refined the interventions identified throughout our review by establishing a threshold of cost-effectiveness for inclusion in the database. Specifically, those interventions included at this point met the following criteria:

Quality Adjusted Life Years (QALY): Any intervention below the cost of $50,000 per QALY is included. This is based on a search of the literature, which classified interventions as cost saving (more health benefit at a lower cost), very cost-effective (less than or equal to $25,000 per QALY added), and cost-effective (between $25,001 and $50,000 per QALY added). [1]

Disability Adjusted Life Years (DALY): Any intervention below the cost of $50,000 per DALY is included, following the rationale for QALY.

Years of Life Saved (YOLS): Any intervention below the cost of $50,000 per YOLS is included, following the rationale for QALY.

Dominance: Any intervention that dominates (i.e. more cost-saving) current practices is included.


After collecting evidence on cost-effective interventions throughout the OECD, we conducted our search for such interventions in Canadian provinces and territories.

Third Step: Identifying Relevant Canadian Policies and Programs

After identifying cost-effective interventions across OECD countries, we then sought to identify similar interventions in Canadian provinces and territories.

Many of the interventions identified in our initial review were very specific in nature. Therefore,  it was necessary to establish broad categories that effectively captured the essence of the cost-effective interventions identified in OECD countries before our search for Canadian interventions could begin. These categories then became the types of policy interventions we sought to identify at the provincial and territorial level in Canada.

Employing a different set of keywords for each type of intervention being sought, we then conducted a search in a variety of sources likely to contain specific information on provincial-level policies in Canada, including:

  • The cumulative legislation index of the Parliament of Canada
  • CanLII
  • Provincial and territorial e-Laws websites
  • Websites of relevant provincial ministries and departments (including annual reports, drug formularies, benefits schedules, drug plans, and chronic disease strategies)
  • Websites of provincial-level associationsquestion_mark

Inclusion criteria for policies and programs at the provincial level:

  • Time Frame: Interventions were ongoing policies or programs still in effect at the time of our search and not limited-duration or pilot programs
  • Budget: Publicly funded or, in cases where the intervention is delivered through a public-private partnership, the government must be a leading partner
  • Provincial-Level Measures: Interventions must not be an initiative of a municipal/regional government or body, and the intervention must be province-wide in scope

Exclusion criteria for policies and programs on the provincial level:

  • “Empty frameworks”question_mark
  • Planned initiatives that have not yet been realized.
  • “Tool kits” and other online information that is meant to be used on a discretionary basisquestion_mark


Fourth Step: Verifying Policies and Programs Captured with Provincial and Territorial Governments

Once coding of relevant policies and programs was complete, efforts were made to contact departments and ministries overseeing health care provision in each of the thirteen Canadian provinces and territories represented in the database. Representatives of those provinces and territories that responded were then provided with a detailed questionnaire which sought to:  1) provide verification of the accuracy of our findings, and 2) provide some additional information on the coverage (under their province’s public health insurance plan) of a few specific medical services and treatments. These surveys also allowed respondents to describe additional relevant policies or programs that we may have missed in our initial coding of the database.

Thus far, we have received completed questionnaires from representatives of each the following provinces and territories:

  • British Columbia
  • Manitoba
  • Northwest Territories
  • Nova Scotia
  • Nunavut
  • Prince Edward Island
  • Saskatchewan
  • Yukon

Additionally, we welcome the feedback of representatives of those provinces that have yet to respond to our validation questionnaire. Those affiliated with a provincial government department involved in the provision of health care and whom are willing to complete this questionnaire can contact us at info (at) healthiersocieties.org. Any updates will be included in the database and made available online.


 

[1] See Li, R. et al. (2010). Cost-effectiveness of interventions to prevent and control diabetes mellitus: a systematic review. Diabetes Care, 33(8): 1872-94.