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Ministry Status: Activation Status

Ontario Public Drug Programs

Glossary – C

This glossary provides brief explanations of terms used in the Ontario Public Drug Programs web pages. To access a term definition, select the appropriate letter from the alphabet below.

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Canadian Drug Expert Committee (CDEC)

The federal government appoints the Canadian Drug Expert Committee (CDEC) to make recommendations to federal/provincial/territorial drug benefit plans in Canada (except Quebec) about whether or not to list a drug.

CDEC See Canadian Drug Expert Committee
CDR See Common Drug Review
CED See Committee to Evaluate Drugs
Chronic

Lasts indefinitely, or continues virtually unchanged. Often, chronic diseases are considered those that last three or more months. They generally cannot be cured and often come with age.

Clinical guideline

These guidelines are advice, based on experience about what works, that are developed to help physicians and patients make decisions about appropriate health care under specific clinical circumstances.

Clinical review

The critical appraisal of published and unpublished information about the safety, effectiveness, and use of a drug to manage a disease or condition.

Clinical reviewer

A reviewer who conducts a clinical review.

Cochrane Collaboration

A group of more than 6,000 specialists in health care that systematically reviews randomized trials of the effects of treatments and, when appropriate, the results of other research. Cochrane reviews are published in the Cochrane Database of Systematic Reviews section of the Cochrane Library. See Systematic Review.

Cohort

A group of individuals with some characteristics in common.

Committee to Evaluate Drugs (CED)

The Committee to Evaluate Drugs (CED) is an independent expert advisory group that makes recommendations to the Executive Officer. The CED is the Ministry's expert advisory committee on drug-related issues and its key mandate is the review of manufacturers' drug submissions for Formulary listing consideration.

The CED evaluates the clinical value of drug products, interchangeability of generic drug products and cost-effectiveness of drugs and makes recommendations to the Executive Officer regarding coverage of these products through Ontario Public Drug Programs and the New Drug Funding Program for cancer care. The CED also provides the Ministry with advice on a broad range of policy issues relating to the use of drugs.

Making the CED recommendations and Executive Officer decisions public provides a rational and balanced representation of the value of new drugs.

Common Drug Review (CDR)

CDR is a single national process for undertaking reviews and providing recommendations to provincial drug plans about whether to list new drugs and whether to approve new indications of existing drugs.

Compassionate Review Policy (CRP)

The Executive officer will consider requests for drugs or indications in the absence of a Committee to Evaluate Drugs (CED) review where there are rare clinical circumstances in immediately life-, limb-, or organ-threatening conditions. Requests must meet the criteria developed for the Compassionate Review Policy.

Conditional listing

A ‘conditional listing’ is a new listing on the Formulary that is intended to provide access to new and existing drugs under certain conditions, based on the recommendations of the CED. Conditional listings are established through negotiated agreements between manufacturers and the Executive Officer. They may include:

  • a commitment to promote appropriate use;
  • requirements to collect further outcome data;
  • a requirement to gather more evidence related to clinical or economic information, for CED’s consideration; and
  • expenditure contracts.

The Formulary publishes its criteria for reimbursement as therapeutic notes. It is the prescriber’s responsibility to prescribe the drug to patients in accordance with the listed criteria. Conditional listings allow recipients to access new drugs on a conditional basis, while the Committee to Evaluate Drugs collects and reviews information that might support continued listing. Conditional listings also ease the administrative burden on prescribers because they do not require forms or limited use codes. (See Limited Use)

Through open channels of communication with manufacturers, the CED will review their ODB reimbursement recommendations when new information becomes available and the ministry will continue to assess opportunities to enter into conditional listing agreements with manufacturers.

Confidence interval

The range of numerical values in which we can be confident (to a computed probability, such as 90 or 95%) that the population value being estimated will be found.

Confidence intervals suggest the strength of evidence. Where confidence intervals are wide, they indicate less precise estimates of effect. The larger the trial's sample size, the larger the number of outcome events and the greater the confidence that the true relative risk reduction is close to the value stated. When the confidence intervals are narrow, "precision" is increased.

In a “positive findings” study, the lower boundary of the confidence interval, or lower confidence limit, should still remain important or clinically significant if the results are to be accepted. In a "negative findings" study, the upper boundary of the confidence interval should not be clinically significant if the result is to be accepted with confidence.

Contraindication

A specific situation in which a drug, procedure, or surgery is not indicated and should NOT be used, because it may harm the patient.

For example, some medications may cause dangerous reactions in people who have allergies, high blood pressure, or are pregnant. The medications may interact with other drugs, so they are contraindicated in these situations.

Partial contraindication means that physicians should use caution when prescribing two drugs or procedures together.

Absolute contraindication means that using this drug or procedure in a specific situation could be life-threatening.

Control group

The group by which another group receiving experimental treatment is evaluated. In many clinical trials, one group of patients is given an experimental drug or treatment, while the control group receives either a standard treatment for the illness or a placebo. Also see Placebo and Standard treatment.

Controlled clinical trial (CCT)

A trial in which participants are assigned to two or more different treatment groups, where treatment is assigned by a method other than random allocation. Also see Randomized Control Trial (RCT).

Non-randomized controlled trials are more likely to suffer from bias than RCTs.

Cost-effectiveness

How well something works in relation to how much it costs.

A cost-effectiveness analysis is an economic study that considers both the comparative costs associated with the use of a drug and the clinical effects it achieves. Those effects are measured either as effectiveness, usefulness, or clinical outcomes (for example, quality of life, or dollars.)

Pure clinical units (effectiveness) or “natural units” refer to clinical endpoints such as heart attacks, minor side effects, strokes, premature deaths or other adverse reactions.

Also see Cost-utility Analysis.

Cost–utility analysis A form of cost-effectiveness analysis in which the units of effectiveness are expressed as quality-adjusted life years (QALYs).

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