Interferon Gamma Release Assay for the Identification of Latent Tuberculosis Infection in Rural and Remote Settings

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Question(s)

What is the clinical utility of the interferon gamma release assay for identifying latent tuberculosis infection in rural and remote settings?

Key Message

There is a lack of evidence on the clinical utility of the interferon gamma release assay for identifying latent tuberculosis infection in rural and remote settings. In remote Indigenous communities with known history of bacillus Calmette-Guérin vaccination, more positive tests results were reported with the tuberculin skin test than with the interferon gamma release assay.

Last Updated : April 9, 2021

Lenses and Spectacles to Prevent Myopia Worsening in Children

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Question(s)

What is the clinical effectiveness of soft contact lenses (MiSight lenses) for the prevention of myopia worsening in children?
What is the clinical effectiveness of DIMS spectacle lenses for the prevention of myopia worsening in children?
What is the clinical effectiveness of OK for the prevention of myopia worsening in children?
What is the clinical effectiveness of multifocal contact lenses for the prevention of myopia worsening in children?
What is the cost-effectiveness of soft contact lenses (MiSight lenses) for the prevention of myopia worsening in children?
What is the cost-effectiveness of DIMS spectacle lenses for the prevention of myopia worsening in children?
What is the cost-effectiveness of OK for the prevention of myopia worsening in children?
What is the cost-effectiveness of multifocal contact lenses for the prevention of myopia worsening in children?

Key Message

A total of 5 relevant systematic reviews and 7 randomized controlled trials (RCTs) were identified. Myopia progression and axial length elongation was less with omafilcon A (MiSight) contact lenses compared to single-vision lenses (1 RCT; statistical significance of difference was not reported). Myopia progression and axial length elongation was less with defocus incorporated multiple segments spectacle lenses compared to single-vision spectacle lenses (1 RCT; the between-group difference was statistically significant). Myopia progression was less with orthokeratology contact lenses compared to single-vision contact lenses or single-vision lenses (2 systematic reviews and 2 RCTs; between-group difference was statistically significant or statistical significance was not reported) and axial length elongation was less (5 systematic reviews and 2 RCTs; between-group difference was statistically significant or statistical significance was not reported). Myopia progression and axial length elongation was less with multifocal lenses compared with single-vision contact lenses (1 systematic review and 2 RCTs; between-group difference was statistically significant). Findings need to be interpreted in the light of limitations, such as limited quantity and quality of the included primary studies, limited information regarding adverse events, and lack of long-term data. No economic evaluations reporting on the cost-effectiveness of these interventions were identified.

Last Updated : April 9, 2021

International Plasma Collection Practices

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The Environmental Scan will gather evidence on best practices and policies regarding plasma collection from international jurisdictions. The information will be obtained from literature and website searches.

Last Updated : December 1, 2021

Yttrium 90 Microspheres for Advanced, Recurrent, or Inoperable Hepatocellular Carcinoma: A Review of Clinical and Cost Effectiveness

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Question(s)

What is the clinical effectiveness of 90Y microspheres for TARE of intermediate- or advanced-stage hepatocellular carcinoma?
What is the cost-effectiveness of 90Y microspheres for TARE of intermediate- or advanced-stage hepatocellular carcinoma?

Key Message

Transarterial radioembolization using yttrium-90 (90Y) microspheres is a therapeutic option for patients with intermediate- or advanced-stage hepatocellular carcinoma, including those with recurrent or inoperable hepatocellular carcinoma. Overall, the evidence suggests that patients treated with 90Y-based transarterial radioembolization may experience no difference in overall survival, progression-free survival, and tumour response when compared to patients who received transarterial chemoembolization therapies or systemic treatment with sorafenib or lenvatinib. Patients treated with transarterial radioembolization generally experienced similar rates of adverse events compared to those treated with transarterial chemoembolization, although there were some instances where treatment with transarterial radioembolization led to increased or decreased risks of specific adverse events. The comparative safety of transarterial radioembolization versus systemic treatment with sorafenib was unclear as the included studies did not statistically compare the risks of experiencing adverse events. Evidence regarding the cost-effectiveness of 90Y microspheres for treating hepatocellular carcinoma is conflicting. Three economic evaluations suggest treatment with transarterial radioembolization is likely to be cost-effective or dominant less costly and more effective compared to transarterial chemoembolization or systemic therapies, while a single economic study suggested treatment with sorafenib or lenvatinib is most likely to be cost-effective or dominant compared to transarterial radioembolization.

Last Updated : March 1, 2021

Point-of-Care Testing of International Normalized Ratios for People on Oral Anticoagulants: A Rapid Qualitative Review

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Question(s)

What are the perspectives and experiences of people who take oral anticoagulants, as well as their family and health care providers, on engaging with point-of-care testing to support the management of their INR levels?

Key Message

The opportunity to engage in self-testing can be experienced as simultaneously liberating and constraining. While self-testing may be appreciated as a form of point-of-care testing for international normalized ratio (INR) levels, some people engaged in self-testing were concerned with the limited amount of personalized care they received. People using oral anticoagulants described community pharmacist-led anticoagulation management services (CPAMS) as a convenient way of testing INR levels and learning about their health needs. Community pharmacists felt they were well-situated to provide care through CPAMS, but acknowledged the importance of ongoing training, oversight, and appropriate levels of resourcing.

Last Updated : March 30, 2021

Treatment Sequences of Androgen Receptor Targeted Agents for Patients with Prostate Cancer

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Question(s)

What is the comparative clinical effectiveness of various treatment sequences of ARTAs in patients with prostate cancer?
What is the comparative cost-effectiveness of various treatment sequences of ARTAs in patients with prostate cancer?

Key Message

No evidence was found on the treatment sequences of androgen receptortargeted agents in patients with castration-sensitive prostate cancer. Evidence from retrospective studies, including those within a systematic review, suggests that sequential treatment of abiraterone followed by enzalutamide is more favourable than enzalutamide followed by abiraterone in improving clinical outcomes such as response rate and progression-free survival, but not overall survival, in patients with castration-resistant prostate cancer. Evidence from a retrospective study suggests that docetaxel-containing treatment sequences with androgen receptortargeted agents may improve progression-free survival compared to sequential therapy with androgen receptortargeted agents alone in patients with castration-resistant prostate cancer. Evidence from a retrospective study did not reveal differences in clinical outcomes of patients with castration-resistant prostate cancer treated with sequential androgen receptortargeted agents with or without interposed chemotherapy or radium-223. These findings were in line with those observed in a 2019 Canada's Drug Agency report.1 However, the findings should be interpreted with caution due to low-quality evidence. No comparative cost-effectiveness studies were identified.

Last Updated : March 17, 2021

Electronic Aids to Daily Living

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Electronic Aids to Daily Living (EADLs) are a category of assistive technologies that include a range of devices used within the home to allow individuals with physical impairments to control their home environment and improve their independence, safety, and access to the community. This Environmental Scan is being conducted to gather information on Canadian and international programs that provide access to EADLs to individuals with physical disabilities.

Last Updated : May 6, 2021

Remote Monitoring Programs for Cardiac Conditions in Canada

(December 17, 2024)

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Abbreviations

AHRQ	Agency for Healthcare Research and Quality
COPD	chronic obstructive pulmonary disease
ED	emergency department
EMRs	electronic medical records
HF	heart failure
HHM	home health monitoring
HQO	Health Quality Ontario
NLCAHR

Interventions to influence the use of antibiotics for acute upper respiratory tract infections

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Question(s)

What is the clinical effectiveness of a delayed antibiotic prescription filling intervention to influence the use of antibiotics for suspected acute upper respiratory tract infections?
What is the clinical effectiveness of other family medicine interventions to influence the use of antibiotics for suspected acute upper respiratory tract infections?

Key Message

Thirteen systematic reviews (SRs) were identified. Two of these SRs addressed delayed antibiotic prescribing and 12 of these SRs investigated family medicine interventions. Delayed antibiotic prescribing reduced antibiotic use for upper respiratory tract infections (URTIs) compared to immediate prescribing and did not appear to impact patient satisfaction or re-consultation rates; however, there was less evidence on clinical outcomes, health care utilization, or antibiotic resistance. One systematic review concluded that there was no difference between delayed and immediate antibiotics for many clinical outcomes, but that immediate antibiotics may modestly improve symptoms for acute otitis media (AOM) and sore throat compared with delayed antibiotics.

Various family medicine interventions were evaluated; however, there were generally few relevant primary studies in each of these reviews for most of the interventions. Rapid or point-of-care tests to guide the treatment of URTIs appeared to reduce antibiotic prescribing compared to control or usual care; however, there was relatively little evidence on clinical outcomes for these tests. One systematic review on procalcitonin-guided treatment suggested that this intervention led to no difference in the number of days with restricted activities or rates of treatment failure compared to control, while another systematic review found that C-reactive protein (CRP) point-of-care tests to guide antibiotic prescribing resulted in no difference in recovery or time to resolution of the symptoms; however, this was based on only 2 randomized controlled trials (RCTs). Evidence was mixed on different patient- or provider-directed interventions, such as education, training, and tools. In some of the primary studies from the eligible SRs, these interventions reduced antibiotic prescribing; while in others, they had no effect on antibiotic prescribing.

Last Updated : March 12, 2021

Onabotulinum Toxin A for Spasticity Associated with Multiple Sclerosis

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Question(s)

What is the clinical effectiveness of onabotulinum toxin A (Botox) in the treatment of spasticity associated with multiple sclerosis?
What is the cost-effectiveness of onabotulinum toxin A (Botox) in the treatment of spasticity associated with multiple sclerosis?
What are the evidence-based guidelines for the use of onabotulinum toxin A (Botox) in a treatment regimen for spasticity associated with multiple sclerosis?

Key Message

Evidence-based clinical practice guidelines recommend the use of botulinum toxin (which includes onabotulinum toxin A [Botox]) to treat spasticity caused by multiple sclerosis. There is a lack of recent evidence regarding the clinical and cost-effectiveness of Botox as a treatment for spasticity caused by multiple sclerosis; thus, there is a need for well-designed studies on this topic.

Last Updated : March 11, 2021