Health Technology Assessment gy(HTA)

Dr Hamid Ravaghi

Why?y

What?What?

How?How?

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Why?Why?

• New technologiesNew technologies

C f h l i• Cost of new technologies

• Limited resources

• Ethical questions

WHAT?Health Technology

Instruments, equipment, drugs and procedures used in prevention, diagnosis, t t t h bilit ti f h lthtreatment or rehabilitation of health conditions

M d f i t ti i l di d liModes of intervention including delivery facilities, financing systems and infrastructure characteristics affecting health gservices and health technology use

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HTA DefinitionHTA Definition

• HTA is “the systematic evaluation of properties, s t e syste at c e a uat o of p ope t es,effects, and/or impacts of health‐care technology. It may address the direct, intended consequences f h l ll h dof technologies as well as their indirect, 

unintended consequences. Its main purpose is to inform technology‐related policy‐making in healthinform technology‐related policy‐making in health care. HTA is conducted by interdisciplinary groups using explicit analytical frameworks drawing from g p y f g fa variety of methods”

WHAT?

Health Technology AssessmentHealth Technology Assessment

Multidisciplinary field of policy analysis. p y p y yIt studies the medical, social, ethical and economic implications of theand economic implications of the development, diffusion and use of health technology Its goal is to providehealth technology. Its goal is to provide input to decision making in policy and practice

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practice.

WHAT?Specific parameters

Technical properties and safety

Efficacy / effectivenessEfficacy / effectiveness

Efficiency (cost-effectiveness; cost-benefit)

Impact on health system: health-related, organizational and economic

Social acceptability (ethical and social aspects)

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p )

Evidence for informing decision‐making

Technological, ethical, legislativeconditions

Political, social, i

Intuitivedecision-making

economicconditions

WHAT?

T h l ATechnology Assessment

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AND THEN WHAT?Im pact o f H T A A genc ies

C d i iC o verag e d ec is io nY E S : C och lea r im p lan t (Q uebec, F rance )N O : T ransm yoca rd ia l revascu la risa tion byN O : T ransm yoca rd ia l revascu la risa tion by lase r (N o rw ay)

R estric tio n o f u se o f co s tly ytech n o lo g ies

B eta -in te rfe ron fo r m u ltip le sc le ros is (D enm ark)(D enm ark)Im p lan tab le ven tricu la r ass is t dev ices (Q uebec , O regon )

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AND THEN WHAT?

Im pact of HTA AgenciesIm pact of HTA Agencies

Control of inappropriate diffusionpp pThe use of PSA (France, Norway, Quebec)

Planning and deploym ent guidesPlanning and deploym ent guidesCoronary angioplasty centres (Quebec)PET scans (Quebec)PET scans (Quebec)M RIs (Austria)

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AND THEN WHAT?

Impact of HTA AgenciesImpact of HTA Agencies

Elimination of useless interventionsExtraction of wisdom teeth (UK)

Routine pre op chest X rays (Sweden Quebec)Routine pre-op chest X-rays (Sweden, Quebec)

Security of proceduresy pReuse of single-use catheters (Quebec)

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• Diagnostic accuracy of computer assisted sperm analysissperm analysis

Di ti f f t h i d• Diagnostic performance of techniques used for HER‐2 testing in breast cancer

• Diagnostic accuracy and cost‐effectiveness of occult blood used in screening for colorectal caner

• Its beginnings ‐ close to 30 years ago

• Its origin from the US, to Canada, Australia and Europe

• Its purpose ‐ to assess the consequences of medical technologiestechnologies

• Its foundation‐ the synthesis of existing evidenceIts foundation the synthesis of existing evidence

• Its definition‐more by its purpose than its methodology• Its definition‐more by its purpose than its methodology

Where can HTA have an impact?Where can HTA have an impact?

HTA and diffusion of health technologies

Context is essential for evidence‐informed decision makingdecision making

There are decisions that…

take good d it llin contexttake good evidence …

… and use it well

… and use it poorly poor evidence …

Adapted from Shaxson, L 2004: Evidence-based policy making: if it exists what makes it robust? Available at http://bit.ly/hIsNC

without context

Adapted from Shaxson, L 2004: Evidence based policy making: if it exists what makes it robust? Available at http://bit.ly/hIsNC

WHAT?Knowledge P d tiONKnowledge P d tiON Production

Synthesis ofInformation

Q lit A t

CONTNISTRATION Production

Synthesis ofInformation

Q lit A t

CONTNISTRATION

Data BasesHealth Policy

Quality Assessment of Services

NTENTADMIN

Data BasesHealth Policy

Quality Assessment of Services

NTENTADMIN

HTASocial and

(MACRO)

Practice Guidelines (MICRO)

Institutional Management (MESO) HTA

Social and

(MACRO)

Practice Guidelines (MICRO)

Institutional Management (MESO)

Ethical Factors(MICRO)

PROCESS

Ethical Factors(MICRO)

PROCESS

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RN Battista et al., 1999RN Battista et al., 1999

Layers of questions & layers of evidenceLayers of questions & layers of evidence

Implementation nt

How should we do it here?

Implementation

y assessmen

AppropriatenessShould we do it here?

techno

logy

EffectivenessCan it work here?

tion He

alth t

Efficacy

TechnicalPerformance Re

gulatCan it work?

Collaborating for improved healthCollaborating for improved health

HOW?Needs Assessm ent

Needs assessm ent docum ents the needs of the health system .

Priority SettingPriority Setting

Priority setting arises from needs assessm ent and negotiation w ith stakeholders.

Elem ents taken into account:Variation in use of technologyIm portance of diseaseIm pact on healthCostEthical and legal aspects

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HOW?

MethodsMethods

Synthesis methodsSy

Modeling (data banks; administrative data)

P i d tPrimary data

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HOW?

Synthesis M ethodsy

M edline and other databanks

INAHTA

Cochrane reviews

Q uality check

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HOW?

Modeling of DataModeling of DataEconomic evaluation

Cost-benefitCost-effectivenessCost-utilityCost-minimization

Social, ethical and legal aspects

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HOW?

P i d tPrimary data:

ExperimentalExperimental

Observational approachesObservational approaches

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HOW?The Practice of Health Technology

Assessment

University-based unit

National councilM inistry

unit

National council, office, agency

Health Technology

Regional or provincial council,

office agency

Third partypayer unit

Health TechnologyAssessm ent

office, agency

Privateagency

Unit of a professionalorganization

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HOW?INAHTA

41 member organizations in 21 countries

Europe (28)Europe (28)

North America (7)Middle East (1)

North America (7)Middle East (1)

Latin America (2) Australasia (3)Latin America (2) Australasia (3)

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Latin America (2) Australasia (3) Latin America (2) Australasia (3)

HTA in IranHTA in Iran

• National HTA office (MOHME)National HTA office (MOHME)

f i l ki• Professional working groups

• National decisions 

HOW?

C h a lle n g e sS c ie n tific c re d ib ilityA u to n o m yA u to n o m yS c ie n tific ca p a c ity

H u m a n a n d fin a n c ia l re so u rce sH u m a n a n d fin a n c ia l re so u rce sT ra in in g

S h a rin g a n d a d a p ta tio n o fS h a rin g a n d a d a p ta tio n o f in fo rm a tio nD ive rs ifica tio n o f p ro d u c ts

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D ive rs ifica tio n o f p ro d u c ts

Challenges• Balancing access, quality of care and sustainability of the health care system

• Population health benefit

• What results in the greatest clinical benefits to the it ?community?

• Are the interventions cost effective?

• Can we afford this? (appraisal)

Challenges• Available data is not context‐specific (often from high‐income countries with different contexts)high income countries with different contexts)

• Desirable or acceptable levels of safetyDesirable or acceptable levels of safety, effectiveness, cost‐effectiveness, and other attributes of a technology, as well as acceptable trade‐offs among these, may vary in different communities, countries, or other circumstances

• Planning and regulatory systems are often in their i finfancy

WHO Research Strategy and goals of HTAWHO Research Strategy and goals of HTA