HSS 4108 A Methods of Health Technology Assessment PDF

Introduction to key concepts and definitions HSS 4108 A Methods of Health Technology Assessment Week 2- September 9  What we learn today … Health technology assessment (HTA) history HTA definition Considerations in defining HTA Who...

Introduction to key concepts and definitions HSS 4108 A Methods of Health Technology Assessment Week 2- September 9  What we learn today … Health technology assessment (HTA) history HTA definition Considerations in defining HTA Who uses HTA reports September 9 Information HTA produces HTA models 2  History and Development of HTA The field of HTA was developed systematically, HTA expanded globally in the late 1980s, beginning with the U.S. Office of Technology starting with the Swedish Council on Assessment's first report in 1976. Technology Assessment in Health Care (SBU) and spreading to Europe, Central Europe, Latin America, and Asia. September 9 HTA Programme was established due to: Numerous efforts have been made to 1) concerns about the increasing costs and improve and harmonize HTA methods and inefficiencies within the health system practices, however, there has not been a 2) a desire to improve the quality of global consensus on the definition of HTA 1. healthcare. 3  Why HTA s important HTA provides policymakers with By evaluating the economic impact of evidence-based information to health technologies, HTA helps Cost- make informed decisions about Informed Decision-Making determine which interventions provide Effectiveness which health technologies to the best value for money, crucial for fund and implement, ensuring healthcare systems with limited budgets. efficient resource allocation. HTA evaluates the social and ethical HTA assesses the clinical implications of health technologies, September 9 effectiveness of health technologies, ensuring that decisions are made with ensuring that patients receive a comprehensive understanding of treatments that are proven to be their broader impact. beneficial, leading to better health outcomes. Improved Patient Transparency Ethical and Outcomes and Social Accountability Considerations The HTA process is systematic and transparent, involving multiple stakeholders, which fosters 4 trust and accountability in healthcare decision-making. Global and regional health technology assessment networks September 9 5  International Collaborations International An example is the new collaborations are essential definition of HTA, which was for advancing the developed through a methodologies and collaborative task group knowledge produced by consisting of representatives of HTA creators. leading HTA networks, September 9 societies and global organizations. 6  Definition of HTA HTA is a multidisciplinary process that Definition uses explicit methods to determine the value of a health technology at different points in its lifecycle. The purpose of HTA is to inform decision-making to promote an Purpose equitable, efficient, and high-quality September 9 health system2 and to reduce duplication of effort. 7 What to consider?-1 HTA Process Formal, systematic, and transparent. Uses state-of-the-art methods to consider the best available evidence. A multidisciplinary process that requires different skill sets and collaboration among various disciplines and agencies. Definition of Health Technology September 9 An intervention developed to prevent, diagnose, or treat medical conditions; promote health; provide rehabilitation; or organize healthcare delivery. Includes tests, devices, medicines, vaccines, procedures, programs, or systems. 8  Examples of HT Medical Devices: Assistive Technology: Devices that help individuals with disabilities or impairments to perform functions that might otherwise be difficult or impossible (e.g., hearing aids, wheelchairs). Imaging Devices: Technologies used for diagnostic and monitoring purposes (e.g., MRI machines, X-rays, ultrasound). Surgical Devices: Instruments and devices used during surgical procedures (e.g., scalpels, laparoscopes, robotic surgery systems). Health Information Systems: Electronic Health Records (EHRs): Digital versions of patients' paper charts, containing comprehensive health information. Decision Support Tools: Software that aids healthcare professionals in making clinical decisions (e.g., diagnostic algorithms, treatment recommendations). September 9 Scheduling Systems: Tools used to manage and coordinate patient appointments and healthcare provider schedules. Information Resources: Digital tools providing access to medical knowledge, guidelines, and best practices (e.g., online databases, medical libraries). Training and Education: Technologies used for the education and continuous training of healthcare professionals (e.g., simulation tools, e-learning platforms). Pharmacological Interventions: This category includes drugs and biologics used for the treatment, prevention, or diagnosis of diseases. It covers a broad range of therapies, including prescription medications, vaccines, and advanced therapies like gene and cell therapies. 9 What to consider?-2 Dimensions of Value Ex. App to measure blood glucose levels for diabetics (intended consequence) - target is older ppl, however, they may not be tech savvy - not using app to full potential (unintended consequences - not adhering to treatment plan) Assesses the intended and unintended consequences of a health technology. ex. Can drug for cancer improve health for patient or not? ex 2. Safety: Vaccine: does it have side effects? are they Ex. Is it protecting personal info and user privacy ex. Using telemedicine: can it help to provide better access to healthcare for rural or underserved communities Dimensions include clinical effectiveness, safety, costs, ethical, social, minimal? Is it too expensive? Ex. Blood transfusions/vaccines are AI diagnosis tools: some responsibilities when you use If long-term use of electronic information records can help AI diagnostic tools; if there is a misdiagnosis who is workflow or affects the productivity of staff members cultural, legal issues, organizational, and environmental aspects. controversial in some groups disposal of tech can be dangerous and affect environment responsible and what should be the legal process? Overall value varies by perspective, stakeholders (e.g., patients, treatment is most important caregivers, healthcare professionals, insurers, regulators) , and decision Financial aspect more important September 9 context (e.g., clinical, economic, ethical considerations). Lifecycle Application Clinical trials - randomized control HTA can be applied at different points: pre-market, during market approval, post-market, and disinvestment. Ex. Invasive open heart surgery used for long time at hospital HTA helps to find less invasive heart surgery method 10 Who uses HTA reports? Private health insurers: Use HTA to determine which treatments and technologies to cover in their insurance plans. Government payers (e.g., Medicare, Medicaid) and other agencies: Rely on HTA to make funding decisions and ensure cost-effective use of public resources. make sure they are allocated efficiency Researchers: Utilize HTA findings to identify gaps in knowledge and prioritize future research efforts. Patients: Benefit from HTA by receiving treatments that are proven to be effective and safe. Caregivers: Use HTA information to understand the best care options available for those they support. September 9 Doctors, nurses, and other healthcare providers, including medical societies: Refer to HTA to guide clinical practice and ensure they are using the most effective treatments. Manufacturers of health technologies: Depend on HTA to demonstrate the value and effectiveness of their products to gain market approval and reimbursement. Hospitals: Implement HTA recommendations to improve patient care and optimize resource allocation. 11  Basic HTA Orientations TECHNOLOGY PROBLEM PROJECT ORIENTED ORIENTED ORIENTED Purpose: Evaluate the Purpose: Focus on solutions or Purpose: Evaluate the local characteristics or impacts strategies for managing specific implementation of a September 9 of specific technologies. diseases or conditions. technology within a specific Example: Assessing the Example: Developing clinical institution or project. clinical, economic, and practice guidelines for Example: Deciding whether a social impacts of cochlear diagnosing dementia using a hospital should purchase a implants or PET scanners. combination of clinical history, PET scanner, considering neurological exams, and resources, financial status, diagnostic imaging. and market potential. 12 What products does HTA produce? Agency/ governmental level Full HTA Reports: Detailed and extensive assessments of specific technologies. academic Systematic Reviews: Reports based on existing literature. Joint Papers: Reports published collaboratively with other organizations. September 9 Short Documents: Technical briefs, rapid assessments, and updates 5. 13  What information does HTA produce? Effectiveness: Does the technology improve health outcomes compared to current alternatives? Does the technology work? Ex. Cancer drug: clinical may four son survival rate but patients may focus on the pain or social well-being Patient Benefit: Which patients benefit the most from the technology? Is there meaningful improvement in health status for these patients? can they be managed Safety: What are the potential risks and adverse effects of the technology? when using ht tech Is the technology safe? September 9 Cost-Effectiveness: Is the technology a good value for the money spent? Can we afford to pay for all people Access to equity and technology who might need the technology? Is the technology a good value in the long run? 14 What information does HTA produce? Ethical and Social Impact: What are the ethical, social, and cultural implications of using the technology? Legal Considerations: Are there any legal issues related to the technology's use? Organizational Impact: How will the technology affect healthcare delivery and organization? Patient and Caregiver Experience: How will the technology affect patients, their relatives, and caregivers?Not frequently produced in HTA reports, but important to address September 9 Environmental Impact: What are the environmental consequences of the technology? Additional Considerations: What other considerations make this technology important? 15  Basic HTA Steps 1. Identify assessment topics Is it a cost-effectiveness report? An effectiveness report? Ethical implications of using a specific health tech report? specific & clear 2. Specify the assessment problem or questions population, intervention, competitiors/ Scope of report alternatives, outcome, timeframe 3. Scoping (PICOT) 4. Retrieve available relevant evidence May find gap in existing knowledge 5. Generate or collect new evidence (as appropriate) 6. Appraise/interpret quality of the evidence See if methodology is high quality or not to determine if evidence is reliable September 9 7. Integrate/synthesize evidence 8. Formulate findings and recommendations ex. In format of paper, full HTA report (4 types) Ex. In a conference, publish a paper, send findings to decision makers, regulatory bodies 9. Disseminate findings and recommendations 10. Monitor impact track use of drug in specific hospital to see if it is effective - has gd impact or not 16 Frameworks and Guidelines Different guidelines and methods have been developed for better HTA conduct and processes by HTA agencies: One of the most popular models Canadian Agency for Drugs and Technologies in Health (CADTH) Model HTA Core Model® by the European network for Health Technology Assessment September 9 Institute for Clinical and Economic Review (ICER) HTA Process The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Good Practices in HTA 17 References 1- Babidge, W. J. (2021). Global HTA: past, present, and future. Medical Writing, 30, 16-21. 2- O’Rourke B, Oortwijn WJ, Schuller T. The new definition of health technology assessment: A milestone in international collaboration. IJTAHC. 2020;36(3): 187-190. 3- Guidelines for the economic evaluation of health technologies: Canada. 4th ed. Ottawa: CADTH; 2017 Mar. 4- Kristensen, F. B., Lampe, K., Wild, C., Cerbo, M., Goettsch, W., & Becla, L. (2017). The HTA Core Model®—10 years of developing an international framework to share multidimensional value assessment. Value in Health, 20(2), 244-250. 5- Besar-Sa’aid, H., Stewart, D. E., England, I. W., Sun, J., & Zakaria, A. B. (2015). The Influence of Organizational Contextual Factors on Health Technology Assessment (HTA) Adoption in Selected Hospitals, Southeast Queensland, Australia. International Journal of Social Science and Humanity, 5(4), 352. DOI: September 9 10.7763/IJSSH.2015.V5.479 6- Guide to Understanding Health Technology Assessment (HTA). Institute for Clinical and Economic Review, 2018 7- Kristensen, F. B., Husereau, D., Huić, M., Drummond, M., Berger, M. L., Bond, K.,... & Wailoo, A. (2019). Identifying the need for good practices in health technology assessment: summary of the ISPOR HTA Council Working Group Report on Good Practices in HTA. Value in health, 22(1), 13-20. 18