CADTH Annual Report 2020 – 2021

© 2021 Canadian Agency for Drugs and Technologies in Health


CADTH Annual Report 2020–2021

David Agnew

Board Chair

Message from the Board Chair

Health system decisions are shaped by many factors, but one of the most important is evidence.

In a year of unprecedented challenges, CADTH continued to deliver on a fundamental need of all health system decision-makers — credible evidence.

On behalf of the Board of Directors, I am delighted to present CADTH’s 2020–2021 Annual Report, outlining the many achievements of CADTH that were accomplished during the difficult circumstances of a global pandemic.

The pandemic touched all aspects of the agency’s work, directly or indirectly. And I am proud of how everyone at CADTH stepped up, with innovation, creativity, and resilience on full display.

Not only were the core activities of the agency delivered with their usual quality and care, but we also responded to the rapidly evolving needs of the health care system as it battled a virus spreading across the country.

At a time when large volumes of evidence moved to publication at a breakneck pace, CADTH’s skills in evidence appraisal, rapid synthesis, and horizon scanning were in demand. As emerging therapies and products for COVID-19 came to the fore, assessments were delivered to support pan-Canadian pandemic responses and to help guide implementation discussions for novel, and urgently needed, health technologies.

CADTH also recognized the importance of its core programs to jurisdictions. In the midst of intense disruption to parts of the health system, CADTH stayed the course and continued to deliver reimbursement recommendations to meet the needs of decision-makers and patients. Health technology reviews and rapid evidence reviews also continued without interruption, addressing critical practice and policy questions.

A heartfelt thanks to all employees and our partners for their dedication and commitment to CADTH, the health system, and ultimately the patients and members of the public who benefit from our work.

Less than four months after the onset of the pandemic in Canada, CADTH also had a change in leadership. Dr. Brian O’Rourke retired as President and Chief Executive Officer after more than a decade at the helm. The Board of Directors is grateful for the indelible legacy left by Brian, including increased stakeholder engagement, the incorporation of patient input into reviews, the establishment of the Patient and Community Advisory Committee, and the integration of the pan-Canadian Oncology Drug Review in CADTH, to name but a few.

In July 2020, we welcomed Suzanne McGurn as our new President and CEO. Suzanne has provided great leadership for CADTH during the most tumultuous period in our history, bringing to the position experience, knowledge, and a passion for the work we do. We are fortunate to have her steady hand on the tiller.

As we plan for the return to a more normal life in Canada, we look forward to the future with the confidence of an organization that met, and bested, the challenges of the past year.

Suzanne McGurn

President and CEO

Message from the President and CEO

I am pleased to share our 2020–2021 Annual Report — my first as CADTH President and CEO.

Leading an evidence-driven organization during a year when health care decision-makers were driven by “the evidence” has been incredibly daunting and humbling. It’s been a learning experience like no other, with unique challenges that come from joining an organization mid-pandemic and getting to know my exceptional staff through Zoom and MS Teams. It was not what I imagined when I accepted this position, but I’m so proud of my entire team, and, as highlighted in our annual report, everything we accomplished this year.

The pandemic’s impact on Canadian health care systems has been unprecedented, but it has also provided new perspectives on what is possible when it comes to health system transformation. It has underscored the changing nature of evidence — whether it be emerging, evolving, or well-established — and the critical role of science in health system decision-making. In response, our team has worked diligently to adapt quickly, develop new methodological approaches, and think differently to respond to the evolving needs of patients, policy-makers, and health care professionals.

During the past year, I’ve been reminded how much relationships matter. The relationships CADTH built over many years have been pivotal to our efforts. I am grateful to the patient groups, pharmaceutical and medical device industries, regulators, clinical societies, and pan-Canadian health organizations, as well as our Canadian and global health technology assessment colleagues, for their continued collaboration with CADTH under challenging circumstances. Our collective efforts have increased trust across the health care system and among organizations, and elevated discussions and expectations about what we can and should do in the future. Working together has highlighted Aristotle’s saying that “the whole is greater than the sum of its parts.”

I would be remiss if I didn’t mention the excellent and unwavering support of the CADTH Executive Team, the CEO Office, and all staff throughout the organization. Everyone welcomed me to CADTH and helped me transition smoothly to my new role. I’d like to thank them for their expert advice and willingness to quickly adapt and respond to the emerging health priorities brought on by the pandemic.

Finally, I would like to thank David Agnew, Chair of CADTH’s Board of Directors, and all the Directors for their warm welcome to the organization. They have offered me valuable support and encouragement during this unprecedented year.

Created in 1989 by Canada’s federal, provincial, and territorial governments, CADTH was born from the idea that Canada needs a coordinated approach to assess health technologies. The result is a pan-Canadian organization that harnesses expertise from every region and produces evidence-informed solutions that benefit patients in jurisdictions across the country.

Over the years, we have grown to become a key resource to the health care system. Here is some of what we do:

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We support policy and practice decision-makers as they implement their evidence-informed decisions and CADTH recommendations.
We review and make recommendations on new and existing health technologies, including drugs, diagnostics, and medical and surgical devices and procedures.
We search the literature to find the best available evidence and identify knowledge gaps.
We scan the horizon to provide health care leaders a glimpse of the future in health technology.

CADTH is represented by a talented and highly skilled team of professionals with expertise in clinical and health economics research, information services and librarianship, policy analysis, ethics, knowledge translation, and implementation support. Through their day-to-day efforts, they continue to uphold our reputation for excellence. In turn, we are committed to nurturing an engaging workplace that fosters a diverse and inclusive culture, anchored in mutual respect and the promotion of wellness and well-being.

Expanding Our Reach to Patients and Clinicians

Patients and clinicians are among the most important beneficiaries of our work, and we strive to engage them in meaningful and constructive ways through our committees and panels and many opportunities for input and feedback. Stakeholder input provides CADTH with important insights through a real-world lens.

Zal Press, Vice-Chair of CADTH’s Patient and Community Advisory Committee, describes CADTH as a role model for patient engagement: “Money…enables participation. [CADTH] compensate[s] us for our time equal to the compensation they provide other experts.”

Setting the Standard

Sometimes there simply is not enough good evidence available to be able to answer an important health care question. We work with partners and stakeholders to cultivate an environment of evidence generation and adoption across Canada. CADTH is uniquely positioned to champion the importance of meaningful evidence and to direct its generation and use, which then leads to better health care decisions.

Dr. Idan Roifman from Sunnybrook Health Sciences Centre says that CADTH’s Health Technology Reviews were instrumental in helping the Canadian Society for Cardiovascular Magnetic Resonance and the Canadian Heart Rhythm Society develop guidance for MRI. CADTH’s work was considered “outstanding” and “it provided a serious basis for the recommendations.”

And That Is Just the Beginning…

The power of our knowledge is multiplied every time it is shared. Our website and journal are accessible to everyone. We also have Implementation Support and Knowledge Mobilization Officers located in communities across the country who can bring evidence and solutions to the doorstep of those who need them. And we continue to develop new ways to share our evidence.

CADTH recognizes the inherent and treaty rights of all First Nations, Inuit, and Métis peoples across this land. We acknowledge the harms and mistakes of the past and are committed to moving forward in partnership with Indigenous communities in a spirit of reconciliation and collaboration. CADTH staff work across Canada, residing on various traditional lands and collaborating with Indigenous governments, health care providers, and community members. Our Ottawa offices are located on the unceded, unsurrendered Territory of the Anishinabe Algonquin Nation. Our Toronto offices are located on the traditional territory of many nations, including the Mississaugas of the Credit, the Anishnabeg, the Chippewa, the Haudenosaunee, and the Wendat peoples.

The Year That Was

Unprecedented may be a clichéd and overused word these days, but 2020–2021 really was an unprecedented year for CADTH.

The world was rocked by the COVID-19 pandemic. The science community increased its acceptance and use of immature or uncertain data to inform health care decisions. And Canadian governments and organizations had to fully acknowledge and address systemic racism affecting Indigenous peoples and other marginalized groups.

When COVID-19 hit Canada, CADTH responded quickly.

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We learned new ways of doing business by using new technologies.
We moved our Board and expert and advisory committees online.
We proactively closed our offices and transitioned to a virtual organization.
The effects of the pandemic were felt throughout society — and the economic, environmental, and social impacts we are experiencing today will be with us for years.
We quickly pivoted our business to support Canada’s federal, provincial, and territorial-level responses to the pandemic. For example:

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We shifted CADTH’s annual, in-person, signature event — the 2020 CADTH Symposium — into a successful and engaging virtual one.
We developed new communications tools, including a COVID-specific microsite, a weekly CADTH COVID-19 Update newsletter, and a well-attended lecture series that shared the latest COVID-19 information and best practices.
We expanded the scope of our business beyond assessing drugs and medical devices to responding to a range of COVID-19–related questions.
We assessed and reported on emerging COVID-19 evidence as soon as it was available, which included conducting our first Ultra-Rapid Review and our first Living Rapid Review.
CADTH’s ability to manage through the pandemic was largely due to the resilience, dedication, and significant involvement of the CADTH Board of Directors; our advisory and expert committee members; former President and CEO, Dr. Brian O’Rourke; current President and CEO, Suzanne McGurn; the Executive Leadership Team; and CADTH staff.
In addition to our COVID-19 work, we delivered on additional priorities to serve those who rely on and trust our work. For example:

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We delivered a full suite of non–COVID-19 products, including Horizon Scans, Reference Lists, Reimbursement Recommendations, and Health Technology Reviews.
We moved forward with our efforts to comply with the Accessibility for Ontarians with Disabilities Act.
We implemented new technologies to modernize our Human Resource and Finance departments.
We contributed to the development of a national strategy for high-cost drugs for rare diseases.
We developed a framework for, and launched, our first condition-level review.
We updated and aligned our Common Drug Review, pan-Canadian Oncology Drug Review, and Interim Plasma Protein Product Review processes.
It truly was an unprecedented year.

CADTH Delivers

CADTH’s work is used to inform decisions about the appropriate use of drugs, diagnostics, and medical and surgical devices and procedures. Our programs and services include:

Horizon Scans A high-level summary of a new or emerging health technology that is likely to have a significant impact on the delivery of health care in Canada.
Reference Lists A compilation of references on a specific health care topic, with abstracts and links to full-text documents, if available.
Reimbursement Reviews A comprehensive assessment of the clinical effectiveness and cost-effectiveness of a drug or drug class that also includes clinician and patient perspectives. These assessments inform non-binding recommendations that help guide Canada’s federal, provincial (with the exception of Quebec), and territorial governments’ reimbursement decisions. Implementation advice and funding algorithms are provided if applicable.
Health Technology Reviews A customized review of a health technology that may consist of one — or a combination — of the following:
  • an Environmental Scan
  • a Rapid Review
  • a Clinical Review
  • a Pharmacoeconomic Review
  • patient perspectives
  • any legal, ethical, social, implementation, environmental, and policy implications.
Appropriate use recommendations are provided if applicable.

Other Programs and Services

Scientific Advice Advice to pharmaceutical companies on their early drug development plans from a health technology assessment perspective.
Implementation Support and Knowledge Mobilization Specialized products, tools, and services to help health care decision-makers use and implement CADTH information, recommendations, and advice.

CADTH by the Numbers

A snapshot of CADTH’s output in 2020 – 2021:


CADTH delivered the following number of reports:

Horizon Scans 23
Reference Lists 165
Reimbursement Reviews 58
Health Technology Reviews 129

Reimbursement Recommendation

CADTH issued the following number of Reimbursement Recommendations:

Reimbursement Recommendations 58
Alignment of Oncology Reimbursement Recommendations with Listing Decisions 98%
Alignment of Non-Oncology Reimbursement Recommendations with Listing Decisions 93%


CADTH hosted the following number of events:

Presentations and Webinars 120
Workshops 46


CADTH events had the following attendance:

2020 Virtual CADTH Symposium Registration 2,127
CADTH COVID-19 Lecture Series Attendance >18,000

CADTH Websites and the CADTH COVID-19 website received the following number of site visits: Site Visits 1,137,468 Report Downloads >4,733,014
CADTH COVID-19 Website Visits >47,000

Social Media

CADTH’s Twitter, LinkedIn, and Facebook pages had the following number of impressions and interactions from followers (measured as engagement):

Social Media Impressions 4,764,347
Social Media Engagement >113,467


Through our products, services, and partnerships, CADTH delivers trusted, evidence-based information, advice, and recommendations to senior health care decision-makers. Here are some highlights of what we accomplished this year.

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Introducing the “What Does the Evidence Say About COVID-19?” Portal

In April 2020, we launched our CADTH COVID-19 web portal to provide Canadian health care decision-makers with the most relevant and timely evidence about COVID-19.

This special site features evidence, tools, and resources from CADTH and other trusted sources that covered a range of COVID-19 topics, including prevention, testing, and treatment. It was continually updated and expanded throughout the year as new evidence became available.

Canadian ministries and departments of health, publicly funded organizations responsible for health service delivery, and clinical society stakeholders were encouraged to submit requests to CADTH through the portal, and we responded with materials tailored to meet their specific requirements.
Uncovering Whether the Evidence Supports the Hype Around Antiviral Treatments for COVID-19

In May 2020, we launched our COVID-19 Webinar series.

More than 1,500 people registered for the first webinar, which featured Dr. Gordon Guyatt, Distinguished Professor at McMaster University, and Dr. Tarry Ahuja, Manager of Program Development at CADTH.

Dr. Guyatt discussed “Treatment of Patients With Nonsevere and Severe Coronavirus Disease 2019: An Evidence-Based Guideline,” which had been recently published in the Canadian Medical Association Journal. He also explored the challenges of evidence-based decision-making in a time of crisis and efforts to balance potential benefits and harms.

Dr. Tarry Ahuja summarized recent CADTH reports on remdesivir and hydroxychloroquine, 2 high-profile therapies that were touted as possible treatment options for COVID-19.

The webinar’s success spawned an ongoing webinar series. Another 9 COVID-19 webinars were presented in 2020–2021.
Collaborating With the Canadian Association of Radiologists to Help Address COVID-19 Restrictions on Medical Imaging Services

In the summer of 2020, as COVID-19 restrictions were loosening, governments began to consider how to safely resume medical imaging procedures and address the significant patient wait lists that resulted from the pandemic.

During this time, we joined a pan-Canadian Radiology Re-entry Taskforce to provide guidance to Canadian health care systems on how best to safely resume the provision of medical imaging services; our Implementation Support and Knowledge Mobilization team led the work of one of the Canadian Association of Radiologist’s Taskforce working groups, and we were a key contributor to the association’s evidence-based report Radiology Resumption of Clinical Services, which was widely shared among the Canadian radiology community.
Aligning the Reimbursement Review Processes

In September 2020, we took a significant step forward in making its Reimbursement Review program more cohesive, transparent, and responsive by establishing a harmonized review process for drugs submitted to CADTH for assessment.

Previously, there were different procedures for each of our review pathways: Common Drug Review, pan-Canadian Oncology Drug Review, and Interim Plasma Protein Product Review. Today, there is a single procedure that incorporates best practices from each program.

The aligned procedure was the outcome of an extensive program review. Brent Fraser, CADTH Vice-President of Pharmaceutical Reviews, led a 6-week public consultation period during which CADTH received and considered input from 80 organizations or individuals representing public payers, drug manufacturers, patient groups, clinician groups, consultants, and others.

The new aligned process provides the opportunity for drug sponsors to comment on scientific reports before expert committee meetings and for patient and clinician groups to comment on draft reimbursement recommendations.
Recognizing Outstanding Leaders in Health Technology Assessment

In November 2020, we presented Dr. Wendy Ungar with the 2020 Dr. Jill M. Sanders Award of Excellence and Dr. Kelvin Chan with the Dr. Maurice McGregor Award.

The Jill M. Sanders Award of Excellence honours individuals whose outstanding achievements have significantly advanced health technology assessment in Canada. The Dr. Maurice McGregor Award honours rising stars early in their health technology assessment careers.

Both recipients were nominated by their peers and celebrated at the Virtual 2020 CADTH Symposium.

“We are proud to honour Dr. Wendy Ungar and Dr. Kelvin Chan for their immense scientific achievements,” said Suzanne McGurn, CADTH President and CEO. “Credible evidence matters now, more than ever, and their individual contributions have significantly advanced the field of HTA and improved the quality of evidence that underpins sound decision-making in Canadian health systems.”
Updating the Patient Input Guide Through Consultations

In December 2020, we released our updated Guidance for Providing Patient Input. The guide is a key resource for patient groups, patients, and caregivers who contribute to the CADTH Reimbursement Review process.

We updated the guide with help from feedback from more than 35 patient groups. Key improvements suggested by patient groups included:
  • expanding the definition of a “patient group” and outlining patient group eligibility criteria
  • providing clear examples of how patient input is used as part of CADTH’s review process and during expert committee deliberations
  • offering a step-by-step description of the Reimbursement Review process and highlighting opportunities and expectations for patient group involvement
  • clarifying the conflict of interest declaration and the type of information to be disclosed to support transparency and help ensure consistency across patient group submissions
  • updating our list of commonly used acronyms to help patient groups who may be navigating our process for the first time.
Launching the Canadian Journal of Health Technologies

In January 2021, we launched the Canadian Journal of Health Technologies.

This open-access journal provides CADTH with an online presence to showcase our wide-ranging scientific reports and make our reports more accessible to the Canadian and global health technology assessment community.

Improved searching and indexing via PubMed and Google Scholar, standardized formats, and a continuous publication model in which reports are published as soon as they become available provide health care researchers and decision-makers with more timely, relevant, and accessible information.

Most of the content currently published in the journal is authored by CADTH. However, this is expected to change. Dr. Nicole Mittmann, CADTH’s Chief Scientist and Vice-President of Evidence Standards, sees the publication evolving. “As the journal matures, it should help foster a collaborative space among diverse audiences, where authors from Canadian and international jurisdictions can have in-depth discussions about the opportunities and challenges confronting HTA and Canadian policy as they relate to health technology management.”
Showcasing 2021 Health Technology Trends on CADTH’s Watch List

On February 17, 2021, we published our list of Health Technology Trends to Watch. Included in this report were 10 emerging health technology trends poised to have a significant influence on the future of health care in Canada that we identified through our Horizon Scanning program.

Artificial intelligence, connected devices, and COVID-19 home sampling were among the trends expected to gain momentum through 2021. Some of these technologies were new or recently approved by regulators, while others were already in use in Canada. They all pointed to a growing need for the health care system to prepare for disruption and potential adoption.

As noted by Dr. Lesley Dunfield, CADTH’s Acting Vice-President of Medical Devices and Clinical Interventions, “Health technologies are major drivers of change in Canadian health systems. When decision-makers are aware of what is in the pipeline, they have a greater ability to plan for the budgetary, operational, and ethical aspects of implementing a new technology.”

Our Health Technology Trends to Watch list garnered subsequent media attention and was featured on the cover of the April 2021 issue of Hospital News.
Developing Our First Condition-Level Review on Tuberculosis Care

In March 2021, on World Tuberculosis Day, we launched our first condition-level review on tuberculosis, one of the world’s most infectious diseases.

Tuberculosis is a highly preventable disease that disproportionately affects communities experiencing higher rates of poverty, crowded living conditions, and poor access to health care. Through a digital platform on the CADTH website, we have been able to support Canadian health care decision-makers treating this disease. Policy-makers, clinicians, and patients have access to more than 35 synthesized and appraised evidence reviews mapped to the prevention, identification, treatment, and management of tuberculosis.

CADTH acknowledges the research methods and recommendations from McMaster University, Michael G. DeGroote Cochrane Canada Centre, National Collaborating Centre for Infectious Diseases, and Evidence Prime for their assistance in developing our digital evidence platform.
Partnering With Choosing Wisely Canada

In March 2021, under the leadership of CADTH’s Executive Strategy Lead, Heather Logan, we partnered with Choosing Wisely Canada to identify actions that could lead to better post-pandemic health care for Canadians.

Throughout the COVID-19 pandemic, the effects of delayed non-urgent care and elective procedures were a top concern of patients, health care professionals, and policy-makers. As our health systems began to reopen, it was important tackle the issue of low-value care — the tests and treatments that offer little benefit to patients and can waste health system resources —to help ensure that patients would receive high-quality and necessary care.

Choosing Wisely Canada reviewed its existing evidence-based recommendations with clinician experts and curated a short list of low-value treatments. CADTH then convened a panel of Canadian clinician, patient, and policy experts to review the shortlist and develop final recommendations.

The results of this work were presented at Choosing Wisely Canada’s National Meeting. A report was also published in CADTH’s Canadian Journal of Health Technologies.

Looking Ahead

The COVID-19 pandemic deeply affected patients, families, communities, health systems, governments, and economies. But it also brought new attention and importance to the role that science and evidence brings to public policy and decision-making.

In 2020–2021, we demonstrated our ability to adapt quickly to deliver evidence, recommendations, and advice to our federal, provincial, and territorial jurisdictional partners. However, the pandemic underscored the importance of making scientific evidence more broadly accessible. Going forward, to maximize our value and ensure that our evidence delivers impact, CADTH’s work needs to be understandable and usable to a wider range of health care stakeholders, including the public.

We are in the midst of establishing our next 3-year strategic plan. We’re confident that the lessons we learned during the COVID-19 pandemic — and our trusted reputation, expertise in assessing health technologies, and strong relationships with stakeholders across the health care spectrum — position us well to continue to serve the Canadian health care system in the post-pandemic era and in a rapidly changing health care landscape.

CADTH Board of Directors and Executive Team

Board and Executive

Board of Directors (March 2021)

Board Chair

David Agnew President, Seneca College
Toronto, Ontario

Health Systems

Dr. Brendan Carr President and CEO, Nova Scotia Health Authority
Halifax, Nova Scotia

Dr. Charmaine Roye Ottawa, Ontario


Dr. Stuart Peacock Co-Director, Canadian Centre for Applied Research in Cancer Control (ARCC) Distinguished Scientist, Cancer Control Research, British Columbia Cancer Agency Professor, School of Population and Public Health, University of British Columbia
Vancouver, British Columbia


Cathy McIntyre Victoria, British Columbia

Ellen Pekilis Toronto, Ontario

Jursidictional Directors


Marcel Saulnier Associate Assistant Deputy Minister, Strategic Policy Branch, Health Canada
Ottawa, Ontario

Western Provinces

Mark Wyatt Assistant Deputy Minister, Government of Saskatchewan
Regina, Saskatchewan

Mitch Moneo Assistant Deputy Minister, Pharmaceutical Services Division, BC Ministry of Health
Victoria, British Columbia


Patrick Dicerni Assistant Deputy Minister and Executive Officer, Drugs and Devices Division, Ontario Public Drug Programs, Ministry of Health and Long-Term Care
Toronto, Ontario

Atlantic Provinces

Karen Stone Assistant Deputy Minister of Health and Community Services, Government of Newfoundland
St. John’s, Newfoundland and Labrador

Jeannine Lagasse Assistant Deputy Minister, Nova Scotia Department of Health and Wellness
Halifax, Nova Scotia


Stephen Samis Deputy Minister of Health and Social Services, Government of Yukon
Whitehorse, Yukon


Dr. Luc Boileau President and CEO, INESSS
Québec, Québec

CADTH Executive Team

(March 2021)

Suzanne McGurn President and CEO

Dr. Nicole Mittmann Chief Scientist and Vice-President, Evidence Standards

Brent Fraser Vice-President, Pharmaceutical Reviews

Dr. Lesley Dunfield Acting Vice-President, Medical Devices and Clinical Interventions

Heather Logan Executive Strategy Lead

Megan Ashlee Bowes Vice-President, Corporate Services

Financial Statements

Independent Auditor's Report

Prepared by PricewaterhouseCoopers LLP