• What is the Medical Advisory Secretariat (MAS) and how is it related to OHTAC?
• What do you mean by health technology?
• What is a health evidence-based analysis?
• How does the Medical Advisory Secretariat conduct an evidence-based analysis?
• What is the decision-making framework?
• Is there a glossary that explains some of the medical terminology used in MAS publications?

The Medical Advisory Secretariat (MAS) is a unit within the Ministry of Health and Long-Term Care (MOHLTC).

The mandate of MAS is to provide evidence to inform policy on the uptake of health services and new health technologies in Ontario to the MOHLTC and other government agencies. The aim is to ensure that residents of Ontario have access to the best available new health technologies that will improve patient outcomes.

The MAS conducts systematic reviews of scientific evidence and consults with experts in the health care services community to produce up-to-date evidence-based health technology analyses. These analyses are also used by the Ontario Health Technology Advisory Committee (OHTAC) when it develops its recommendations on health care technologies in Ontario.

Health technology includes a wide range of procedures, devices and equipment applied to the maintenance, restoration and promotion of health. Technology encompasses interventions at any stage of health care including primary prevention, early detection of disease and risk factors, diagnosis, treatment, rehabilitation and palliative care.

The MAS focuses on the effectiveness of technologies in improving patient outcomes of new and emerging health technologies that have a significant impact on the health care system including :

• Individual health technologies
• Groups of integrated health technologies that relate to specific disease states
• Existing health technologies that have already diffused and are either related to a new or emerging technology or the health system regards a systematic evidence based analysis of the technology as appropriate

New technologies are introduced at an ever-increasing rate into health care systems, offering potential benefits to public health while also generally increasing costs. In Ontario, for example, the annual publicly funded health budget is approximately $40.4 billion and funding requests related to new health technologies (excluding drugs and information technologies) have compounded at approximately $0.5 billion per year in the last two years. Decisions for coverage are ideally based on reliable evidence of safety and effectiveness.

The evidence-based analyses, conducted by MAS, evaluate the effectiveness, safety, and cost-effectiveness of new technologies, in the context of existing health care delivery in Ontario, based on a comprehensive, formal systematic literature review process. These evidence-based analyses are prepared and transparently published on this web site as part of the Ontario Health Technology Assessment Series.

To conduct its comprehensive analyses, MAS systematically reviews available scientific literature, collaborates with partners across relevant government branches, and consults clinical and other external experts, manufacturers and others to gather information. It makes every effort to ensure that all relevant research, nationally and internationally, is included in the systematic literature reviews conducted.

The information gathered is the foundation of the evidence to determine if a technology is effective and safe for use in a particular clinical population or setting. Information is collected to understand how a new technology fits within current practice and treatment alternatives. Details of the technology’s diffusion into current practice and information from practicing medical experts and industry, adds important information to the review of the provision and delivery of the health technology in Ontario. Information concerning the health benefits; economic and human resources; and ethical, regulatory, social and legal issues relating to the technology assist policy makers to make timely and relevant decisions to maximize patient outcomes.

If you are aware of any current additional evidence to inform an existing evidence-based analysis, please contact the Medical Advisory Secretariat at masinfo@ontario.ca.

The Ontario Health Technology Advisory Committee (OHTAC) has adopted and applied the excellent international work done by others in the development of GRADE for grading quality of evidence.

As part of the systematic review, the relevant research is critically assessed and the quality of the pooled research (body of evidence) is determined according to the GRADE system. This assessment determines the overall quality of the body of evidence after considering the study design, methodological quality (threats to validity), the consistency of study results (e.g. direction and magnitude), and the directness of the evidence (e.g. generalisability).

In addition, other modifying factors are considered, including the presence of imprecise or sparse data, strong or very strong associations, high risk of reporting bias, evidence of a dose-response gradient and the effect of all plausible residual confounding. This process yields an overall quality rating of the body of evidence (by outcome measure) of either very low, low, moderate or high.

This rating speaks to the confidence in the estimate of the effect so that moving from very low to high quality evidence increases confidence in the validity of the estimates.

Please note that OHTAC is not responsible for implementation of its recommendations, beyond oversight of any field evaluations requested. If concerns of the reader relate to future implementation, the Ontario agency or department with responsibility for that implementation should be contacted directly.

The decision-making guidance document is available or read more about the decision-making framework and decision determinants that OHTAC uses.

A glossary is available that explains some of the health technology assessment terminology used in the evidence-based analysis produced by MAS. Please let us know if you find the glossary useful. We welcome any comments on how the glossary can be improved. Please contact us at : MASinfo.moh@ontario.ca

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