New agency to evaluate medical technologies, drugs, protocols

QUEBEC – There is new acronym in the alphabet soup of Quebec health care.

Added to CLSC, CSSS, CRSSS, CHSLD, MUHC, CHUM and MSSS, is a new string of initials – INESSS, for Institut national d’excellence en sante et en services sociaux.

INESSS replaces AETMIS – the Agence d’evaluation des technologies et des modes d’intervention en sante, and the Conseil de medicament.

Patterned on NICE, Britain’s National Institute for Health and Clinical Excellence, provincial Health Minister Yves Bolduc explained Monday that INESSS will evaluate the clinical advantages and the costs of new technologies, medication and procedures.

Unlike the British model, social services will also be part of its mandate.

INESSS will make recommendations and issue guidelines with the goal of raising the quality of care and adopting best practices, Bolduc told reporters.

"This formula has proven successful in other countries, notably the United Kingdom," the minister said.

Much of the work of INESSS will be weighing the costs and benefits of adding new drugs to those covered by Quebec’s public health-care system, which does not always pay for all the new drugs available in the United States or other provinces.

"It is not because a product is available elsewhere that is necessarily the best choice," Bolduc said, adding that Quebec’s medicare plan also covers things not available elsewhere, such as in vitro fertilization.

And he recalled that Quebec’s health-care network had an advantage when there was a shortage of radioactive isotopes, used in diagnosis and treatment. Quebec had the alternative of PET – Positron Emission Tomography – scan machines installed all over the province.

Juan Roberto Iglesias, a former Quebec deputy health minister who headed AETMIS, will be CEO of the new agency, with a $12.5-million annual budget. He will be paid $196,819 a year, plus an $11,040 housing allowance for his Quebec City accommodations.

Iglesias noted that other provinces may approve expensive treatments, but often their availability is limited.

Iglesias said his objective is to make new products "generally available" without offering an "open bar" when other products will do the same job, at a lower cost.

Yves Robert, who in his role as secretary of the Quebec’s College of Physicians, was part of a committee headed by Claude Castonguay, which recommended creation of INESSS, said it’s importance is that it centralizes decision-making.

"I think it is something new that will clearly improve the quality of health care," Robert said, adding that officials of NICE in Britain and HAS – the Haute autorite de sante – in France were "very interested" that Quebec is including social services.

But Wendy Thomson, who heads the McGill School of Social Work, noted no one on the INESSS board, which is dominated by people with medical backgrounds, is involved in dispensing social services.