Key Message

Medication for opioid use disorder is essential for reducing cravings, withdrawal symptoms, and facilitating recovery, with buprenorphine being preferred over methadone by health care providers and people with opioid use disorder due to its lower overdose risk and perceived lower side effect profile. In Canada, buprenorphine is available in various formulations, including buprenorphine-naloxone (BUP-NAL), commonly chosen for its safety benefits and convenience. Sublingual buprenorphine-naloxone films offer faster dissolution and potentially other benefits compared to sublingual tablets, evaluating their comparative clinical and cost-effectiveness is important as they become more widely available.

Key Message

Wet age-related macular degeneration (AMD) is a serious health concern that causes reduced vision-related function, poor overall quality of life, and increased health care resource usage. Antivascular endothelial growth factor (VEGF) drugs are the first-line treatment for wet AMD, and they are injected into the eye. These drugs can slow disease progression but are expensive and require trained medical professionals to administer and monitor treatment response. The criteria for initial injection, maintenance, and discontinuation of anti-VEGF drugs in patients with wet AMD remain unclear.

Key Message

A cataract is an opacity of the lens and is the leading cause of reversible visual impairment worldwide. There are no medical treatments for cataracts but surgical procedures that replace the lens with a synthetic lens (called an intraocular lens [IOL]) have shown to be effective for restoring vision. Premium lenses, including lenses to correct astigmatism (called toric lenses), are available but may not be covered by public or private health plans. Given that there is an increased cost associated with toric lenses, there is a need to evaluate their effectiveness compared to other available corrective options, including glasses.

Key Message

None of the identified studies were of sufficient quality to formulate conclusions on the clinical effectiveness of refractive laser surgeries compared to conventional vision correction for people with vision conditions. The identified evidence for the clinical effectiveness of photorefractive keratotomy (PRK) was limited to 1 low-quality study that did not detect a visual acuity difference between participants who had PRK and participants who wore contact lenses. Low-quality evidence from 1 study found participants who had undergone PRK had greater vision-related quality of life (QoL) than participants who had not had PRK. Another low-quality study found that participants who wore contact lenses had greater vision-related QoL than participants who had undergone a laser-assisted in situ keratomileusis (LASIK) procedure. Low-quality evidence suggested that contact lenses resulted in fewer incidences of vision loss events than LASIK. No evidence-based guidelines on best practices for refractive laser surgeries met the criteria for this review.

Key Message

For patients with type 2 diabetes mellitus, a single randomized controlled trial (SUSTAIN FORTE) suggested that once-weekly subcutaneous semaglutide 2.0 mg may achieve better glycemic control than once-weekly subcutaneous semaglutide 1.0 mg. However, it is unclear whether between-group differences are clinically meaningful. Gastrointestinal disorders were the most common adverse event resulting in premature discontinuation in both groups. One participant in each study arm experienced a cardiovascular disorder serious enough for premature discontinuation. As most trial patients were white, it is unclear if the results are generalizable to groups with higher prevalence of T2DM in Canada, such as Indigenous peoples or those of South Asian descent. We did not find any studies on the cost-effectiveness of subcutaneous semaglutide 2.0 mg, compared to placebo or other doses of semaglutide.

Key Message

Limited evidence suggested that the use of point-of-care ultrasound (POCUS) to guide the insertion of central venous lines in adults was effective and safe compared with traditional or fluoroscopic guidance method.

All 3 included guidelines recommend the use of POCUS to guide cannulation through different locations of insertion in both adults and children.

We did not identify any economic studies on the cost-effectiveness of POCUS-guided central venous line insertion.

Key Message

For patients with knee osteoarthritis (OA), radiofrequency ablation may reduce pain and improve function compared to other nonsurgical interventions without increasing adverse events. There is insufficient evidence to suggest that radiofrequency ablation reduces pain or improves function among patients with chronic hip pain. We did not find any studies or guidelines on the clinical effectiveness of radiofrequency ablation for treating chronic shoulder pain that met the inclusion criteria for this review. Three guidelines conditionally recommend the use of radiofrequency ablation for patients with knee OA, and 1 guideline conditionally recommends the use of radiofrequency ablation for hip joint pain following diagnostic blocks.

Key Message

For adults with moderate to severe pain in the emergency department (ED), IV acetaminophen may offer similar levels of pain relief and a similar risk of adverse events as oral acetaminophen or IV nonsteroidal anti-inflammatory drugs (NSAIDs). For adults with moderate to severe pain in the ED, IV acetaminophen may offer a similar or modestly lower level of pain relief, and a lower risk of adverse events, when compared to IV opioids. We did not find any studies on the cost-effectiveness of IV acetaminophen compared to oral acetaminophen, IV NSAIDs, or IV opioids for treating patients with moderate to severe pain in the ED that met our inclusion criteria. One guideline recommends IV NSAIDs for the initial management of moderate to severe pain for patients in the ED. IV acetaminophen is recommended instead of IV opioids alone.