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How Procurement Judges The Value of Medical Technologies: A Review of Healthcare Tenders

Published online by Cambridge University Press:  08 February 2019

Fiona A. Miller*
Institute of Health Policy, Management and Evaluation, University of Toronto
Pascale Lehoux
Department of Health Management, Evaluation and Policy, University of Montreal, Institute of Public Health Research of University of Montreal (IRSPUM)
Stuart Peacock
Canadian Centre for Applied Research in Cancer Control (ARCC) and Faculty of Health Sciences, Simon Fraser University
Valeria E. Rac
Institute of Health Policy, Management and Evaluation, University of Toronto Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre
Jeff Neukomm
Institute of Health Policy, Management and Evaluation, University of Toronto
Carolyn Barg
Institute of Health Policy, Management and Evaluation, University of Toronto
Jessica P. Bytautas
Institute of Health Policy, Management and Evaluation, University of Toronto
Murray Krahn
Institute of Health Policy, Management and Evaluation, University of Toronto Toronto Health Economics and Technology Assessment Collaborative (THETA)
Author for correspondence: Fiona A. Miller, E-mail:



Procurement's important role in healthcare decision making has encouraged criticism and calls for greater collaboration with health technology assessment (HTA), and necessitates detailed analysis of how procurement approaches the decision task.


We reviewed tender documents that solicit medical technologies for patient care in Canada, focusing on request for proposal (RFP) tenders that assess quality and cost, supplemented by a census of all tender types. We extracted data to assess (i) use of group purchasing organizations (GPOs) as buyers, (ii) evaluation criteria and rubrics, and (iii) contract terms, as indicators of supplier type and market conditions.


GPOs were dominant buyers for RFPs (54/97) and all tender types (120/226), and RFPs were the most common tender (92/226), with few price-only tenders (11/226). Evaluation criteria for quality were technical, including clinical or material specifications, as well as vendor experience and qualifications; “total cost” was frequently referenced (83/97), but inconsistently used. The most common (47/97) evaluative rubric was summed scores, or summed scores after excluding those below a mandatory minimum (22/97), with majority weight (64.1 percent, 62.9 percent) assigned to quality criteria. Where specified, expected contract lengths with successful suppliers were high (mean, 3.93 years; average renewal, 2.14 years), and most buyers (37/42) expected to award to a single supplier.


Procurement's evaluative approach is distinctive. While aiming to go beyond price in the acquisition of most medical technologies, it adopts a narrow approach to assessing quality and costs, but also attends to factors little considered by HTA, suggesting opportunities for mutual lesson learning.

Copyright © Cambridge University Press 2019 

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