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PharmacoEconomics DOI 10.1007/s40273-015-0278-7 LETTER TO THE EDITOR Does it Matter Whether Canada’s Separate Health Technology Assessment Process for Cancer Drugs has an Economic Rationale? Jeffrey S. Hoch 1,2,3,4 • Jaclyn Beca 1,2,3 • Mona Sabharwal 5 • Scott W. Livingstone 6 Anthony L. A. Fields 7 The Author(s) 2015. This article is published with open access at Springerlink.com ‘‘What our health-care systems need to do with their limited budgets is maximize value and no dimensions of health … will be a good measure of value because people consider other aspects in their evaluations … We must back out of the dead end that is pursuing overall efficiency’’ [1]. 1 Introduction We are grateful for the opportunity to comment on the results of McDonald et al. [2]. In this note, we summarize their findings, build on their interpretations, and suggest future directions for researchers interested in improving a health technology assessment (HTA) process. 2 Summary of the Findings McDonald et al. searched for reasons why Canada and other countries might separate their cancer drug HTA process. They appraised whether any of the rationales they & Jeffrey S. Hoch jeffrey.hoch@utoronto.ca Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, Canada Jaclyn Beca becaj@smh.ca Canadian Centre for Applied Research in Cancer Control (ARCC), Toronto, ON, Canada Mona Sabharwal monas@cadth.ca Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada Scott W. Livingstone scott.livingstone@saskcancer.ca Pan-Canadian Oncology Drug Review (pCODR), Canadian Agency for Drugs and Technologies in Health (CADTH), Toronto, ON, Canada Saskatchewan Cancer Agency, Saskatoon, SK, Canada University of Alberta, 11560 University Ave NW, Edmonton, AB T6G 1Z2, Canada Anthony L. A. Fields afields@ualberta.ca found were derived from the assumption commonly made by health economists that ‘‘the goal of society or decision makers is to maximize the total aggregate health benefit conferred to a population for a given level of resources’’. They found that this rationale was not used by Canada or any country to support the use of a separate HTA process for cancer drugs. The researchers were also not able to find another country besides Canada that had a separate cancer drug HTA process. These findings may seem surprising: Canada is the only country in the world that has a separate cancer drug HTA process; and McDonald et al. could find no justification based in economic theory for a separate process. To be clear, the authors reported that other countries (e.g. Den- mark, Belgium, the UK) set aside a separate budget for cancer drugs, and the authors found several ‘‘non-eco- nomic’’ rationales for Canada’s separate HTA process. There are two potential interpretations of these search re- sults: (1) the search missed something or (2) there really is no economic rationale in print for a separate cancer drug HTA process. Although their study might not be Centre for Excellence in Economic Analysis Research (CLEAR), Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada