health technology assessment - who.int€¦ · health technology assessment can it work here? can...
TRANSCRIPT
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Health Technology Assessment
Laura Sampietro-Colom, MD, MscPH, PhD
HTAi President
Review of Tools, Guidelines, and Procedures to
Promote Safe, Affordable, Quality Medical Device Use
WHO First Global Forum on Medical Devices
Bangkok, 9-11 September 2010
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Outline
• Health Technologies and global health care context
• Health Technology Assessment (HTA): a tool to
improve decisions in health care policy and practice
• Global available resources in HTA
• Final thoughts
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Context: From ancient times … to XX century
Innovation and medicine go together!
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Digital
Nano/BIO/Regenerative
Convergent
Burrill S, may 2009
Personal and Informational
Burrill S, may 2009
Context: The XXI century ... Medicine goes
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• Innovation in HTs do not always answers health needs
• Needed HTs are not distributed fairly
Nocturnal picture of our world
Equity in Healthcare remains a big issue !
Global Context
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Global Context
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“ Both politically, in terms of being
accountable to those who fund the
system, and also ethically, in
terms of making sure that you
make the best use possible of available resources, evaluation
is absolutely critical”
Julio Frenk, Minister of Health,
Mexico 2005
Lancet www.thelancet.com, 2010
“Because professionals sometimes do more harm than good
when they intervene in the lives of other people, their policies
and practices should be informed by rigorous, transparent,
up-to-date evaluations”
Ian Chalmers ,Editor, The James Lind Library, 2003
Context: Needs
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Context: questions faced by decision
makers
� Is this new HT necessary for my country?
� Is the new HT justified sufficiently by the overall
benefits achieved in terms of safety, health outcomes,
and costs in my country?
�Which patients can benefit the most from this new
HT in my country?
� Among the big number of choices of HTs, which are
the most appropriate for a specific health problem in
my country?
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Regu
lation
: Re
gulat
ion:
Regu
lation
: Re
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ion:
CE M
ark, F
DACE
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CE M
ark, F
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Can it work Can it work Can it work Can it work here?here?here?here?
Can it work?Can it work?Can it work?Can it work?PerformancePerformancePerformancePerformance
ImplementationImplementationImplementationImplementation
Effectiveness Effectiveness Effectiveness Effectiveness (relative/comparative)(relative/comparative)(relative/comparative)(relative/comparative)
Safety & Absolute EfficacySafety & Absolute EfficacySafety & Absolute EfficacySafety & Absolute Efficacy
ContextContextContextContextShould we do it Should we do it Should we do it Should we do it
here?here?here?here?
How should we How should we How should we How should we do it here?do it here?do it here?do it here?
Technical tests and
clinical evidence:
explanatory (RCT)
Global evidence:
MegaTrials, non-
experimental
Local evidence:
Pragmatic Trials
Country info &
Registries
Economic evaluati
Budget impact
Ethical, Legal
appraisal
Organizational
analysis
Social analysis
(values and needs)
Policy appraisal
What Health Technology Assessment is?
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MACRO
To Inform Coverage
Distribution and allocation resource
Design of payment systems
Entry Schemes mechanism
To guide disinvestments decisions
To guide Scientific and Industrial Policy
Identification of research gaps.
Info valorization & transfer
MESO
To Inform Investments (innovation “in”)
Research
To support Valorization & transfer (own innovat)
Assessment “in-time”
To teach Decision makers
MICRO
To Feed CPG development
To Support Adequate use oh Health Technol
To Teach Professionals & citizens
To disseminate Mas-media, users associati
Possibilities of HTA & Health Systems
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HTAi: The Scientific & Professional Society
Western Europe 572
Central/Eastern Europe 67
North America 167
South America 76
Asia/Middle East 78
Australia/NZ 50
Africa 16
Global resources on HTA
• 1062 members
• 48 Non-for-Profit
organizational members
• 16 for-profit
organizational members
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n = 1062
HTAi: The Scientific & Professional Society
Memorandum of
Understanding
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Which are the main HTAi Activities ?
1. Annual Meetings
2. Interest Subgroups
• Conditional coverage/access with evidence 159 members
• HTA in developing countries 66 members
• Disinvestment of obsolete or low added value 52 members
technologies (launched 2010)
• Ethics in HTA 40 members
• Hospital-based HTA 81 members
• Information resources 163 members
• Patient and citizen involvement in HTA 139 members
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Which are the main HTAi Activities ?
3. The HTAi Policy Forum
4. The Journal
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INAHTA: the Global Forum for HTA Agencies
Global resources on HTA
46 members
26 countries
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EUnetHTA
• 53 Organizations
• 23 EU countries + 2 EEA/EFTA countries
Funded by EU
• EUnetHTA (2006-2008): Tools development
• EUnetHTA Joint Action (2010-2012)
Global resources on HTA
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The international information network on new
and emerging health technologies
“A collaborative network of member agencies (n=20) for the
exchange of information on important emerging new drugs,
devices, procedures, processes, and settings in health care”
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WHO
Other Global Information Resources
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1. Strong and sustainable health care systems
should promote value-based models for the
introduction of HTs
2. HTA is the tool, is used, it works, and it is helpful
to make sound health policy and clinical practice
decisions
3. The more countries that use HTA in a systematic
way, the better the use of global and local health
care resources.
Final thoughts
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Thank you for your attention !!