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Screening and Treatment of Obstetric Anemia: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

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Question(s)

  1. What is the clinical effectiveness of screening obstetric iron deficiency in the first or second trimester using ferritin testing?
  2. What is the cost effectiveness of for screening obstetric iron deficiency in the first or second trimester using ferritin testing?
  3. What are the evidence-based guidelines for assessing and treating obstetric iron deficiency?

Key Message

This review included ten guidelines. No clinical or economic studies were identified on screening for obstetric iron deficiency anemia in the first or second trimester using ferritin testing.Routine hemoglobin measurement at each trimester of pregnancy is generally recommended to assess iron deficiency anemia. Serum ferritin testing should be reserved for pregnant persons with possible hemoglobinopathies (e.g., thalassemia, sickle cell anemia), anemia of infection, vitamin B12 or folic acid deficiency, unexplained iron deficiency anemia, non-anemic persons at risk of iron deficiency, or suspected chronic blood loss. After delivery, hemoglobin should be measured within 24 to 48 hours in persons with blood loss more than 500 mL, those with uncorrected anemia detected during pregnancy or those with symptoms suggestive of anemia postnatally. Oral iron is the first line treatment with repeated measure of hemoglobin to assess compliance, correct administration and response to treatment. Intravenous iron should be used in persons who are intolerant of, or do not respond to oral iron treatment, or those with moderately severe to severe anemia. One guideline could not assess the benefits and harms of screening and iron supplementation in pregnant persons due to insufficient evidence. While the scope and purpose of the included guidelines were clearly described, only half of the identified guidelines were explicit in terms of rigour of development and authors assessed the level of evidence, which was deemed to be of very low to moderate quality. Therefore, these recommendations should be interpreted with caution.

Last Updated : December 6, 2019

Biopsy for Adults with Suspected Skin Cancer: A Rapid Qualitative Review

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Question(s)

  1. How do people with suspected skin cancer view skin biopsy? What are their perspectives on, expectations of, and preferences for skin biopsy and the diagnostic process for suspected skin cancer?
  2. How do health care providers who care for people with suspected skin cancer view skin biopsy? What are their perspectives on, expectations of, and preferences for with skin biopsy and the diagnostic process for suspected skin cancer?

Key Message

This review used thematic synthesis to synthesize the results of 12 included publications and described how people with suspected skin cancer and their health care providers experienced the process of diagnosis. People who were diagnosed with skin cancer were often the ones who noticed a suspicious looking lesion or mole that triggered their diagnosis. They described experiencing delays in being diagnosed because they did not immediately present to a health care provider for a variety of reasons, including being busy or not thinking it was serious. Other times people experienced a delay in being diagnosed because their physician did not order further testing or offered them reassurances that their lesions were non-cancerous. People with a concerning lesion or mole were not always reassured by their health care providers words and instead persisted in getting diagnosed by seeking a second opinion or by continuing to bring their concerns forward to their health care provider. Health care providers raised worries about the impact of referring people who turn out to not have skin cancer on the health care system. Once diagnosed, people with skin cancer described how skin cancer was an emotionally destabilizing and shocking experience. Being diagnosed with skin cancer raised fears of death and about the future. People had to at once navigate their treatment while coping with their feelings. With clear information and adequate time for consultation, communication with health care providers left people diagnosed with skin cancer felt supported and informed and able to navigate their treatment. The importance of communication with health care providers in the experiences of those diagnosed with skin cancer highlights the emotional and physical needs of skin cancer patients.After treatment, people who had been diagnosed found themselves continuing to watch their bodies and coping with feelings of uncertainty and anxiety about their future. People who had been treated described how waiting for test results was particularly fraught with anxiety during the follow-up period.

Last Updated : November 21, 2019

Fecal Microbiota Therapy in Canada: Barriers and Facilitators to Access

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Evidence supports the use of fecal microbiota transplant (FMT) for recurrent Clostridium difficile (C. difficile) infection. Information on the potential of FMT for treating other conditions, such as inflammatory bowel disease, ulcerative colitis, and Crohn disease, is also emerging. Given this, the indications and demand for FMT may increase in the future; however, the infrastructure and standardized processes needed to provide this therapy are not yet in place across Canada.

Last Updated : September 17, 2020

Prostatectomy for People with Prostate Cancer: A Rapid Qualitative Review

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Question(s)

  1. How do people with prostate cancer experience prostatectomy?
  2. What are their expectations of and perspectives on prostatectomy?
  3. What are their experiences and those of their partners or spouses relating to decision-making, surgery, recovery and long-term impact of prostatectomy on their lives?
  4. How do health care providers who care for people with prostate cancer understand and perceive prostatectomy? 
  5. What are their experiences and expectations of decision-making, surgery, recovery and long-term impact of prostatectomy on their patients’ lives?

Key Message

A total of 38 publications were included in this review that investigated how people with prostate cancer perceived and experienced prostatectomy. No studies investigated health care providers’ views on and experiences with prostatectomy. A diagnosis of prostate cancer raised difficult emotions for people diagnosed and their partners, who then sought information from a variety of sources. They particularly turned to those with experience with prostate cancer, but above all valued their specialists’ recommendations in informing their treatment decision. People with prostate cancer saw radical prostatectomy as a way to ‘get the cancer out’ quickly and effectively. They appreciated that they would receive more information on their cancer after surgery, and that it left other treatment options open.The transition from hospital to home was difficult for many people who underwent prostatectomy as they struggled emotionally and physically, particularly with having an indwelling catheter and experiencing incontinence upon its removal. While there was limited information on experiences of radical prostatectomy by type of surgical technique, people who had chosen laparoscopic prostatectomy as their treatment described pre-surgery that they appreciated the minimal invasiveness of the procedure. However, after surgery, some were surprised by the level of pain and discomfort they experienced post-operation. People who had undergone prostatectomy done with minimally invasive surgical techniques wished to stay in hospital longer and found themselves unprepared to be discharged to home.  People who had undergone a prostatectomy struggled with the long-term impact of urinary incontinence and erectile dysfunction, which affected their sense of self, their relationships with their partners, and their ability to engage socially. Despite this, people sought to find a new normal afterwards and tried to return to routines, and physical, social and work activities as quickly as possible.

Last Updated : November 12, 2019

Screening and Diagnostic Services for People at Risk of Breast Cancer: A Rapid Qualitative Review

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Question(s)

  1. How do people at risk of breast cancer understand, communicate, experience, and make decisions to undergo screening and diagnostic services in rural or urban settings?
  2. How do families, caregivers, and health care providers who care for people at risk of breast cancer, understand, communicate, experience, and make decisions regarding screening and diagnostic services in rural or urban settings?

Key Message

When determining whether, or when, to engage with breast cancer screening or diagnostic mammography, women indicated these decisions could be impacted by logistical challenges of attendance. These could include where one lived in relation to screening centres, the scheduling flexibility of screening centres, other life plans (e.g. upcoming vacation), and the ability to navigate daily responsibilities such as work or childcare. While screening for breast cancer was often understood as a choice, women described feeling as though it were more of a responsibility to attend than an option. Trust in the health care system broadly, and primary care providers specifically, played a pivotal role in the decision to pursue screening, or not. This included more than direct experiences with breast cancer screening or diagnostic services. It was also possible for women to rely on their own knowledge of their bodies and desire to control what happens to them. Decisions to engage with available screening services could also be influenced by whether people were aware of the screening services available to them or what breast cancer screening guidelines recommended, as well as how people perceived the potential for screening and diagnostic mammography to impact their lives. Women described learning about the services available to them and the importance (or not) of engaging with them through the experiential knowledge of mothers or friends. It was important for women to feel comfortable with the individuals conducting the screening and the attention paid to their concerns while undergoing screening.

Last Updated : October 31, 2019

Healthy Aging

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This Environmental Scan focuses on interventions to promote healthy aging and prevent frailty in older, community-dwelling adults. Interventions may be offered at various levels of health and social care, and identifying effective interventions could help to increase the uptake of best practices. The scan is based on a literature review and a survey of Canadian contacts working in this area.

Last Updated : October 31, 2019

The Use of Real-World Evidence for Medical Device Assessment: An Environmental Scan

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Health Canada and the Pan-Canadian Health Technology Assessment Collaborative have developed a strategy for optimizing the use of real-world evidence (RWE) to improve the accessibility, affordability, and appropriate use of medical devices across the product life cycle. To inform the development of an RWE framework, Canada's Drug Agency undertook an Environmental Scan to determine how RWE is being used in Canada by both regulators and health technology assessment (HTA) producers.

The key objectives of this Environmental Scan were to:

Last Updated : March 19, 2020

Hemin for Injection (Panhematin): Budget Impact Analysis

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This report aims to:

  • Assess, from the Canadian health care system perspective, the budgetary impact of reimbursing hemin for injection (Panhematin) over a three-year period for the amelioration of recurrent and sporadic attacks of acute intermittent porphyria temporally related to the menstrual cycle of susceptible women, after initial carbohydrate therapy is known or suspected to be inadequate.
Last Updated : October 16, 2019

csDMARDS for Rheumatoid Arthritis

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The project OP0539 csDMARDs for Rheumatoid Arthritis will not be conducted as proposed due to changes in the needs of the jurisdictional customer. As a result, the objectives and needs are being reassessed and a revised project will be introduced in the near future.

Last Updated : January 16, 2020

Second-Line Therapy for Patients with Relapsing-Remitting Multiple Sclerosis: A Review of Guidelines

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Question(s)

  1. What are the evidence-based guidelines regarding switching to a second-line therapy in patients with relapsing-remitting multiple sclerosis?

Key Message

One evidence-based guideline was identified with one strong recommendation regarding switching from an interferon or glatiramer acetate to a second-line therapy in patients with relapsing-remitting multiple sclerosis and evidence of disease activity. Consensus statements provided by the guideline suggest that there is insufficient evidence on patient factors or disease activity considerations to make more specific recommendations for switching to second-line treatments. The consensus statements presented in this report should be interpreted with caution based on the limitations and paucity of evidence.

Last Updated : September 26, 2019