WHO Workshop, Bangkok, 11.09.2010 Health Technology Assessment 1. Introduction to Health Technology Assessment (HTA) Berit Mørland, Norway 2. HTA & Government Keng Ho PWEE, Singapore 3. HTA and Clinical Decision Making Joseph Mathew, India 4. International activities and networks; closing discussion 1 1
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WHO Workshop, Bangkok, 11.09.2010
Health Technology Assessment
1. Introduction to Health Technology Assessment (HTA)
Berit Mørland, Norway
2. HTA & Government
Keng Ho PWEE, Singapore
3. HTA and Clinical Decision Making
Joseph Mathew, India
4. International activities and networks;
closing discussion
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1. Introduction to HTA*)
- Health technology
- Health technology assessment (HTA)
-Current trends in HTA
*) Berit Mørland; DDS Dr philos
Establishing the national HTA agency in Norway 1998
Chair INAHTA 2001-2003
President HTAi 2005-2007
+ My thanks to Dr Cliff Goodman , Vice President of HTAi, for letting me use some of his slides
What is Health Technology? - and what do we (HTA) include by health technology: Physical Nature
HTA Priorities: What Gets Attention?� High individual burden of morbidity/mortality
� Large number of patients affected
� High unit or aggregate cost of disease
� High unit or aggregate cost of technology
� Substantial variations in practice
� Unexpected adverse event reports
� Evidence that available findings not well disseminated or adopted by practitioners
� Sufficient research findings available upon which to base assessment
� HTA findings likely to have impact on practice
� Political pressure
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Commonly Used Bibliographic Databases for HTA
� MEDLINE/PubMed
� EMBASE
� Health Technology Assessment (HTA) Database
� Cochrane Library
� CINAHL
� PsycINFO
� Health Economic Evaluations Database (HEED)
� (US) NLM Databases and Electronic Records
HTAi Vortal:
� http://www.htai.org/vortal
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HTAi Vortal for all doers and users
(www.htai.org) � How to do HTA
� HTA Data Sets
� HTA Glossaries
� HTA Information Resources
� Clinical Practice Guidelines
� Evaluated Sources
� Grey Literature
� Health Economics Information
� Literature Searching
� Search Engines - Medical
� Virtual Libraries
� Keeping Up: Stuff for Librarians & Info Specialists
� Methodology & Clinical Trials Information Resources
� HTA Methodology Resources
� Quality of Life
� Pharmacogenomics
� Web Usability
�
Current trends in HTA
greater emphasis on cost-effectiveness and economic impacts, rapid reviews / checklistsusing surrogate endpointsusing evidence from real-world practice (registries, surveillance, databases,) qualitative research (narrative synthesis)tailoring HTA methods to particular types of technology,looking at contexts international collaboration in HTA methods, reportsincluding patients viewsincluding needs for training (procedures and devices)
Provides rapidly completed, brief descriptions of new/emerging technologies and their potential impacts
Trade-off: Incomplete information early enough to act vs. better information when it may be too late to act effectively
Can be used to:
� Identify technologies that have potentially major implications for health care
� Manage adoption and use of new technologies
� Identify areas of technological change
� Identify inappropriately used (including under- and over-used) technologies
� Enable health care providers, payers to plan for, adapt to technological change
� Plan data collection to monitor adoption, use, and impacts
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Horizon-Scanning Programs - Examples
� EuroScan (members from INAHTA; secretariat at NHSC, UK)
� National Horizon Scanning Centre (NHSC, UK)
� Australia & New Zealand Horizon Scanning Network (ANZHSN)
� Canadian Agency for Drugs and Technologies in Health (CADTH) Horizon Scanning Service
� US Centers for Medicare and Medicaid Services Council on Technology and Innovation
� ECRI Emerging Technology Services (USA and Europe)
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Growing interest: HTA in Disinvestment(or Reinvestment)
� Obsolete technologies: Those technologies whose clinical benefit, safety or cost-effectiveness has been superseded by other available alternatives , or demonstrated to be ineffective or harmful
� Medical waste
� Economic waste
� Sarah Gardner, NICE: When you give recommendation on a new technology- do you relate this to those that may be removed?
A National Council (NC) for Priority Setting in 2007Terms of reference:Produce more comprehensiveness and transparency around the work on quality and prioritisation in the health service, by basing the discussions and conclusions on the best documented evidence, often in the form of HTA reports.
Example: Introduction of HPV vaccine
– A study of the decision-making process of whether or not introduce HPV-vaccination in Norway was performed
– Particularly attention was paid to how HTA-documents were instrumental in the judgments of HPV-vaccine against the priority setting criteria
Available documents (incl. HTAs) :
Results (I):
1. Efficacy
Expected outcomes of the intervention: The Council concluded that sufficient evidence existed on the protective effect of HPV vaccines on cervical cancer.
– SafetyConcerns about safety aspects (esp. long term) of the vaccines were expressed by all NC-members. The main cause of dispute during the debate.
3. Cost-effectivenessEmphasis was put on the costs, judged to be high, but not too high to not recommend the vaccine.
Results (II):
4. Organizational consequencesThe vaccine is to be integrated into a national cervix censer-program which also include the existing screening program.
5. Ethical aspectsEthical concerns were expressed throughout the discussions. Arguments were made both against and in favour of introducing the vaccine.
6. The decision making process:Stakeholders and NC-members have all emphasised the importance of having a transparent process (through open access to all meetings and all documents).
Conclusions:
– The process leading to the MoH’s decision to include HPV-vaccine into the National Immunization Program is, by most of the stakeholders, considered to be thorough.
– Specially drafted HTA-documents provided valuable support for members of the NC when asked to make an advise in this complex case
– Of particular importance was the documents providing information on: i) Medical efficacy and safety of the vaccines
ii) Health economic analyses
iii) Ethical and organizational aspects of the decision
Concluding remarks:
• The commitment by decision makers to base their discussion on best evidence, implies an important and continuous role for HTA when considering the implementation of new technologies.
• There are, on the other hand, limitations to the kind of answers HTA can provide. In these cases other kind of methods and documentation will become important ( epidemiological studies, ethical studies etc)
• The context (needs and culture) of the health care systems is always important!