February 2014 – by Drs. Wanrudee Isaranuwatchai and Jeffrey Hoch

The Centre for exceLlence in Economic Analysis Research (CLEAR) specializes in the economic evaluation of health care interventions and is one of the groups that make up the HUB Health Research Solutions – an interdisciplinary academic research organization (ARO) that is housed at St. Michael’s Hospital in Toronto, Canada. The goal of CLEAR research is to improve efficiency of the health care system by focusing on value for money.

The health economics unit of the HUB, known as CLEAR, is leading the economic evaluation of nine models of health service delivery funded under the BRIDGES1 project. The CLEAR team is working with each of the nine individual research teams to develop a tailored economic evaluation plan to examine the economic impact of each model of care.

Through its partnership with BRIDGES, the HUB has provided extensive support in evaluation design; data management, linkage (through the Institute of Clinical and Evaluative Sciences (ICES)) and analysis; and economic evaluation. Study designs range from a randomized controlled trial to a single-arm study. CLEAR uses both primary data collected specifically for the study, as well as administrative data from ICES.

The overarching objective of the economic evaluation is to examine the cost-effectiveness of each model from the perspective of the public payer by comparing the cost (and effect) of each model of care to usual care. In the interest of scaling effective models to other regions of the province, CLEAR also works with the research teams to conduct a budget impact analysis which estimates the total cost of implementing each model of care.

The BRIDGES project is jointly led by the Departments of Medicine, Family & Community Medicine and Psychiatry at the University of Toronto with funding from the Ontario Ministry of Health and Long-Term Care (MOHLTC). In alignment with the focus of the MOHLTC, BRIDGES aims to develop and test innovative models of health service delivery that integrate care across multiple organizations and providers and target reductions in avoidable hospitalizations and emergency department visits for patients with complex chronic diseases.

CLEAR’s work through the BRIDGES project is an example of how the HUB can help demonstrate the value of health programs/interventions using an economic perspective. To learn more about CLEAR and the other groups that make up the HUB, visit our website www.hubresearch.ca.

BRIDGES: Principle Investigators

Dr. Onil Bhattacharyya: Dr. Bhattacharyya is an Associate Professor and Frigon Blau Chair in Family Medicine Research at Women’s College Hospital at the University of Toronto. He studied medicine at the University of Montreal, did his PhD in Health Services Research at the University of Toronto and was a Takemi Fellow in International Health at the Harvard School of Public Health. His work focuses on innovative health service delivery models in both low and high-income settings. In addition to his work on BRIDGES, he is also co-lead of T-HOPE, which brings together medical students and MBAs to study social enterprises in health in low- and middle-income countries. He helped draft the Impact Reporting International Standards for health with the Global Impact Investing Network.

Dr. Vicky Stergiopoulos: Dr. Stergiopoulos, MSc, MD, MHSc, FRCPC, is a Clinician Scientist and the Psychiatrist-In-Chief at St. Michael’s. She is the Director of the Division of Adult Psychiatry and Health Systems and an Associate Professor in the Department of Psychiatry at the University of Toronto. Her clinical and research activities focus on the development and evaluation of complex interventions to address the needs of people who are homeless and of those who are frequent users of mental health services using mixed methods. Dr. Stergiopoulos has a keen interest in mental health policy, service and system integration, and the redesign of our system of mental health care using a needs and equity lens.

Dr. Gary Naglie: Dr. Naglie received his medical degree from McGill University, training in Internal Medicine and Geriatric Medicine at the University of Toronto, and graduate training in Clinical Epidemiology at McMaster University. He is a Professor in the Department of Medicine and the Institute of Health Policy, Management & Evaluation at the University of Toronto and holds the George, Margaret and Gary Hunt Family Chair in Geriatric Medicine. He is the Chief of Medicine at Baycrest Geriatric Health Sciences and is a Scientist at Baycrest’s Rotman Research Institute and at the Toronto Rehab Institute, University Health Network. His research focuses on outcomes evaluation and quality of life in older adults.

1.            BRIDGES. Project overview. 2013; http://www.building-bridges.ca/about/projects-overview/. Accessed July, 2013.