Inside the Canadian Common Drug Review: is information beyond evidence used in making recommendations?

Article type
Authors
Pagotto S, O'Grady T, Shukla V
Abstract
Background: Translating evidence into recommendations is a complex process and studies have shown that information beyond evidence is used when making recommendations in an evidence-based process1. The Canadian Expert Drug Advisory Committee (CEDAC) makes formulary listing recommendations for drugs submitted to the Common Drug Review (CDR) at the Canadian Agency for Drugs and Technologies in Health. The evidence used in support of the recommendation is based on the information provided in the CDR review report.

Objectives: The objective of this study was to explore if the 'reason' statements for CEDAC recommendations contain information beyond the CDR review report.

Methods: Twelve CDR drug reviews were randomly selected by the CDR Manager of Drug Reviews. Two reviewers independently
compared the conclusion statements of these reviews with their respective CEDAC final reasons for recommendation statements. Any reason for recommendation statement or part thereof which was not based on the conclusions of the CDR review report was identified. The CDR review report was further reviewed to determine if the information was included in other sections of the report such as the 'Discussion', 'Review of Therapeutics' or 'Appendices' sections. The data extraction results were compared by the two reviewers and conflicts were resolved by discussion. Information related to the economic evaluation of the drug was not considered in this study.

Results: There were 54 reason statements in the 12 final recommendation documents reviewed; of these 54 statements, 18 (33%) included information not found in any part of the CDR report.

Conclusions: These results conclude that similar to other literature, CEDAC reasons for recommendations include information beyond the evidence presented in the CDR review reports. Qualitatively these results are in agreement with an earlier study done by Raine et al2.

References
1. Burgers JS, van Everdingen JJ. Beyond the evidence in clinical guidelines. Lancet 2004; 364:392-3.
2. Raine R, Sanderson C, Hutchings A, Carter S, Larkin K, Black N. An experimental study of determinants of group judgments in clinical guideline development. Lancet 2004; 364:429-37.