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PubMed2006

Joint project of the International Network of Agencies for Health Technology Assessment--Part 2: Managing the diffusion of positron emission tomography with health technology assessment.

OBJECTIVES: Since 1997, members of the International Network of Agencies for Health Technology Assessment (INAHTA) have collaborated on a Joint Project to track the diffusion, evaluation, and clinical policy of positron emission tomography (PET). Part 2 of this updated Joint Project report summarizes HTA-based strategies for directing the clinical use of PET and a discussion on the value of HTA in managing the diffusion of high cost diagnostic technologies, which were presented at an INAHTA-sponsored workshop at the Health Technology Assessment International Annual Meeting in 2004 on strategies for managing high cost diagnostic technologies. METHODS: A summary of the workshop proceedings is presented. CONCLUSIONS: Sharing assessment work, universal agreement in assessment conclusions, stakeholder input, and modeling techniques help manage the uncertainty in the evidence base while targeting clinical use of PET toward the most promising indications. Emphasis on HTA findings, linkage between financing of clinical PET and outcome evaluation, and targeted dissemination of scientific findings empower providers to reduce unnecessary utilization and contain costs within a quality improvement framework. Above all, a trustworthy source of HTA information and a process that is conducive to using scientific evidence as the basis for decision making are essential for managing the diffusion of complex and costly diagnostic technologies in patient care.

Capital Financing↗
PubMed2006

International diffusion of new health technologies: a ten-country analysis of six health technologies.

OBJECTIVES: The objective of this study was to examine and explain the differential international diffusion of six health innovations. METHODS: A retrospective diffusion study was undertaken of sildenafil, cyclooxygenase-II (COX II) inhibitors, beta interferon, verteporfin, deep brain stimulators, and drug-eluting coronary stents in ten countries-Australia, Canada, Denmark, France, The Netherlands, Norway, Spain, Sweden, Switzerland, and the United Kingdom. We plotted diffusion curves of daily defined doses per quarter, vials or implants per million population, and examined the association between diffusion and five key variables. RESULTS: Canada, Switzerland, and Sweden are generally high users of new technologies; Spain, Denmark, and particularly the United Kingdom are low users. Almost all countries experienced rapid adoption of sildenafil with diffusion to a similar level; there was variable adoption and diffusion of COX II inhibitors, verteporfin, and interferon beta; drug-eluting stents penetrated the market in a similar way in all but one country; and two countries had very different adoption patterns for deep brain stimulators. Above average health spending and the presence of health technology assessment (HTA) or other guidance reports are consistently associated with increased diffusion. Early warning activity and a national coverage decision being taken are more likely to be associated with a reduced diffusion. CONCLUSIONS: The significant differences in diffusion between different countries are not consistent with a neat evidence-based world. The tools available to policy makers to control diffusion (early warning systems, HTA, and a fourth hurdle) play some part in influencing diffusion but need close scrutiny of how successfully they operate.

Australia↗
PubMed2002

Health technology: challenge to public health.

Health technology includes drugs, procedures, techniques, and equipment used by health professionals to provide health care, and the organizational and supporting systems within which the care is delivered. Such new technology may comprehend new drugs, new medical devices and appliances, new medical activities and surgical procedures, health promotion and disease prevention activities, and organizational and supporting systems. To achieve maximal use of available resources and constant selection among alternatives offered, health technology assessment is indispensable as a scientific effort to determine the extent to which and under what conditions a specific technology is efficacious, effective, safe, and cost-effective. Since today the greatest benefit to patients must be achieved at the lowest cost, one of the ways to achieve this goal is to promote health technology assessment and thus build the healthcare infrastructure on more scientific and objective foundations.

Biomedical Technology↗
PubMed1995

'Quick and clean': authoritative health technology assessment for local health care contracting.

Commissioners of health care require rapid, accurate and usable information on health technology effectiveness to help them to decide on the content of contracts. Despite major strides in the national initiatives in health technology assessment, such information is still in short supply at the local level. In 1991 the former Wessex region (now in the new South and West Region) established a mechanism which continues to provide carefully established recommendations on new technologies. Its features include: identification of locally important topics for evaluation by the purchasers and the providers; an evaluation team, working to a well-defined format in a service-led academic institute; an arbitration committee to deliver recommendations to purchasers on the basis of both the cost-utility of proposals and the quality of the evidence; and implicit obligations for purchasers to respond to strong recommendations.

Cost-Benefit Analysis↗
PubMed1994

Evaluation of health technology: economic issues for health policy and policy issues for economic appraisal.

Economic evaluations of health care programmes and treatments have now been conducted for about 30 years. A number of key methodological principles have been specified and there has been an exponential rise in the number of published studies. However, there is relatively little evidence of the use of these studies in decision making about health technologies. Therefore, this paper considers what policy issues are amenable to economic analysis, or could be greatly informed by economic appraisal results. It is concluded that a wide range of mechanisms exist to influence the diffusion and use of health technologies and that economic appraisal is potentially applicable to a number of them. The paper also considers how economic appraisal could be made more relevant to decision making. It is concluded that methodological standards need to be maintained, that evidence needs to be produced in a timely fashion, that the local validity of study results needs to be increased, that the dissemination of study results needs to be improved and that more note needs to be taken of the available policy instruments.

Cost Sharing↗
PubMed2006

'Medicine's next goldmine?' The implications of new genetic health technologies for the health service.

There is considerable uncertainty about the implications of the new genetics for health services. These are the enthusiasts who argue that molecular genetics will transform health care and others argue that the scope for genetic interventions is limited. The aim of this paper is to examine some of the questions, tensions and difficulties which face health care providers particularly in developed countries as they try to come to terms with the dilemmas raised by new genetic health care technologies (NGHTs). It identifies questions for research which may help the development of robust and flexible strategies for implementation.

Attitude to Health↗
PubMed2006

Equity-efficiency trade-offs in health technology assessment.

Health technology assessment (HTA) currently focuses on efficiency, rather than equity, on the basis that its primary objective is to maximize population health. Yet a strict cost-effectiveness approach sometimes conflicts with important equity concerns, such as the reduction of socioeconomic health inequalities. Managing such equity-efficiency trade-offs on the basis of intuition is unsatisfactory in a democracy, as it arouses suspicions of special pleading and favoritism toward vested interests. Over the next few decades, therefore, decision making may progress through up to three further stages of development observed historically in other areas of resource allocation. Stage two involves case law, limited to principles distilled from precedent. Stage three involves codification, seeking to generalize these principles without specifying their relative weights. Finally, at stage four, quantitative trade-offs are incorporated into a formula. At stage four, deliberation centers on adjustments to the formula, which would then be applied impartially, transparently, and fair-mindedly to all future decisions. Methods already exist for valuing equity-efficiency trade-offs, based on established methodological principles for valuing trade-offs between different dimensions of health. Early findings indicate that the general public thinks that social class inequalities are more inequitable than those by smoking status, with inequalities between the sexes somewhere in between. Relative weights can be calculated from these data, although the data are not yet comprehensive enough to do this credibly for current policy purposes. In the mean time, the equity-efficiency trade-offs suggested by current decisions can be estimated using standard cost-effectiveness analysis. This is because every departure from a strict cost-effectiveness approach has an opportunity cost. The size of that opportunity cost is a test of how much weight a particular equity concern is deemed to merit.

Cost-Benefit Analysis↗
PubMed2004

The Health Technology Assessment-disease management instrument reliably measured methodologic quality of health technology assessments of disease management.

OBJECTIVE: Systematic reviews aim to summarize the evidence in a particular topic area, giving attention to the identified methodologic quality of published research. Because research in a specific area may be susceptible to specific biases, it is assumed that the methodologic quality of Health Technology Assessment (HTA) of disease management cannot properly be measured with the existing methodologic quality assessment instruments. The purpose of this study was to describe to what extent existing instruments are useful in assessing the methodologic quality of HTA of disease management. STUDY DESIGN AND SETTING: An inventory was made of the problems that arise when assessing the methodologic quality of six HTAs of disease management with three different instruments. Based on these findings, a new instrument is proposed and validated. RESULTS: Problems mainly concern the items related to the study design, criteria for selection and restriction of patients, baseline and outcome measures, blinding of patients and providers, and the description of (co)-interventions. CONCLUSION: With its more specific characteristics, the HTA-DM addresses the problems mentioned. The HTA-DM is a reliable instrument for methodologic quality assessment of HTA of disease management in comparison with the other three instruments.

Disease Management↗
PubMed2005

International comparison of the definition and the practical application of health technology assessment.

OBJECTIVES: Health Technology Assessment (HTA) is defined as a policy research approach that examines the short- and long-term social consequences of the application or use of technology. Internationally different institutions have translated this definition to local contexts. In Denmark, HTA is comprehensive with focus on four aspects of the problem in question (technology [clinical evidence], economy, patient, and organization). The objective of this study is to study how the application of HTA differs across leading countries and to study the extent to which Danish HTA reports differ from foreign HTAs. METHODS: A sample of 433 HTA reports published in the period 1989--2002 by eleven leading institutions or agencies in Denmark and eight other countries were reviewed. We looked at the characteristics of the HTA with respect to focus on the four main aspects and the manner in which each aspect has been approached. RESULTS: The study shows health technology procedures to be the most common type of health technology assessed in HTAs and literature review to be the most often used method of analysis. Policy recommendations are only present in approximately half of the HTA reports. CONCLUSIONS: In the HTAs one generally sees a great focus on the clinical aspect of health technologies, leaving the economic, the patient-related, and the organizational aspect much more unanalyzed. The Danish HTAs generally have a wider scope than HTAs produced in other countries and tend to focus more frequently on patient-related and organizational dimensions.

Denmark↗
PubMed2005

Mentoring a developing health technology assessment initiative in Romania: an example for countries with limited experience of assessing health technology.

OBJECTIVES: The aim of this study was to assist and facilitate introduction and development of a health technology assessment (HTA) program in Romania. METHODS: Mentoring of an initiative group in Romania was provided by an HTA program in Canada. Mentoring activities included provision of HTA materials, participation in local seminars, facilitating contact with HTA and funding organizations, and in-house training of a professional from Romania. RESULTS: Since 1998, when the relationship was initiated, the Romanian group has been successful in developing an understanding of HTA and awareness of its utility among various decision-makers in the health system. Currently, although the need for HTA in Romania exists and interest in developing this activity has been officially expressed, HTA is still early in its development phase. The mentoring support helped to identify and define the need for HTA in Romania. Continuation of the existing relationship can be expected to strengthen the expertise in this country. However, while mentoring has been a valuable activity, it is not, by itself, sufficient to ensure development of an HTA program in Romania. The actions and decisions that could lead to implementing HTA in Romania depend on the local context. CONCLUSIONS: Mentoring services assisted the initiative group in promoting HTA in Romania. The implementation of HTA in Romania has not happened yet, and efforts need to continue to sustain the existing momentum. However, success in implementing an HTA program will depend on essential factors such as local political, economical, and educational support for this initiative and others like it.

Alberta↗
PubMed2000

Technology assessment and the sociopolitics of health technologies.

In a growing number of countries, health technology assessment (HTA) has come to be seen as a vital component in policy making. Even though the assessment of the social, political, and ethical aspects of health technology is listed as one of its main objectives, in practice, the integration of such dimensions into HTA remains limited. Recent social scientific research on the inherently political nature of technology strongly supports such a comprehensive approach. The growing claims by and on behalf of consumer groups also suggest that HTA should be informed by a broader set of perspectives. Using the example of the cochlear implant in children, this essay compares the professed objectives of HTA with typical practice and explores possible explanations for the discrepancies observed. A second example, home telemonitoring for elderly persons, demonstrates how the types of evidence considered by HTA and the process through which assessments are produced may be reconsidered. We argue for the formal integration of the sociopolitical dimensions of health care technologies into assessments. The ability of HTA to more fully address important issues from a public policy point of view will increase by making explicit the sociopolitical nature of health care technologies.

Aged↗
PubMed1994

Current status of economic appraisal of health technology in the European Community: report of the network. The EC Network on the Methodology of Economic Appraisal of Health Technology.

The use of economic evaluation to assess the costs and consequences of health care technologies has steadily increased in recent years. However, little is known about the influence economic studies have on health care decision makers or policy at local and national level. This paper reports the results of a survey of economic evaluations in EC countries to identify the impact of the results on decision and policy making in health care. Health service researchers in 10 EC countries were identified and asked to participate in the survey. The researchers were asked to locate economic evaluations in their country and complete a standardised questionnaire for each study. The criteria for inclusion in the survey were first, the studies should have been started or reported since 1987, second, the evaluations should include a comparison of the cost and consequences of the technologies assessed and finally, the appraisals should include a comparison of alternative health care technologies or programmes. A total of 66 studies which met the survey criteria were reported. Of these, 27% were thought to have influenced health care decision makers or policy. The results suggested that method of dissemination, source of funding and purpose of the study may be important determinants of whether an economic evaluation will be used in health care policy or decision making. The results of the survey suggest that economic evaluation currently has a relatively low impact on health care policy or decision making.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost-Benefit Analysis↗