From health technology assessment to research on the organisation and delivery of health services: addressing the balance

Health Policy ◽  
2003 ◽  
Vol 63 (2) ◽  
pp. 155-165 ◽  
Author(s):  
Naomi Fulop ◽  
Pauline Allen ◽  
Aileen Clarke ◽  
Nick Black
2019 ◽  
Vol 109 (2) ◽  
pp. 250-257
Author(s):  
Tita Mensah ◽  
Anders Hjern ◽  
Kickan Håkanson ◽  
Pia Johansson ◽  
Ann Kristine Jonsson ◽  
...  

2000 ◽  
Vol 16 (2) ◽  
pp. 449-458 ◽  
Author(s):  
Frank Ahern ◽  
Nessa O'Doherty

Ireland's health system is primarily funded from general taxation and is publicly provided, although private health care retains a considerable role. It is a unique structure, a mixture of universal health service free at the point of consumption and a fee-based private system where individuals subscribe to private health insurance that covers some of their medical expenses. The recent history of the Irish health services saw consolidation of existing services and an expansion into new areas to adapt to changing practices and needs. There has also been a drive to extract maximum efficiency so as to maintain the volume and quality of patient services at a time of very tight financial constraints. Introduction of new health technologies continued to accelerate. New technologies tended to spread rapidly before systematic appraisal of their costs and benefits. When the state is involved in funding the public hospital system, acceptance of new technology is a matter for discussion between agencies and the Department of Health and Children. Decisions about spending annual “development funding” have generally not been based on careful assessment of proposals for new technology. In 1995, a healthcare reform put new Public Health Departments in Health Boards in a prime position in Ireland's health services organization. These departments now emphasize evidence-based medicine. While Ireland does not have a national health technology assessment (HTA) program, there are plans to form an advisory group on HTA in 1998. HTA is seen as a significant element of future health policy in Ireland.


Author(s):  
Andrew Cook ◽  
Elke Streit ◽  
Gill Davage

INTRODUCTION:The National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme commissions research to inform health services in the United Kingdom. The program prioritises research ideas from literature, guidelines, patients, and clinicians, to decide which research should be funded. We get clinical input on these ideas through (i) committees of clinicians and patients and (ii) seeking written advice from multiple clinicians — a refereeing process. Chairs of our committees suggested that the material we sent to clinicians was too extensive and the method of response too burdensome. We set out to determine whether reducing the information provided or burden of response would improve the engagement of clinicians with our processes, and hence improve the quality of advice provided, and the research available to health services.METHODS:We undertook a factorial randomized controlled trial (University of Southampton Faculty of Medicine Ethics Committee #8192, Trial registration: ACTRN12614000167662). Each participant was randomized to receive one of two types of material to comment on, and one of two means to respond. In the first allocation participants were randomised in a 1:1 ratio between receiving a ‘vignette’ (a briefing paper of up to ten pages discussing possible research = usual practice), or a ‘commissioning brief’ (a single page summarising the proposed research). In the second allocation, the method of response was randomized, between a structured form and free text email.RESULTS:We randomized 460 clinical experts, and 356 (77.4 percent) responded. The responses were graded for quality on a scale of 0 to 4 (higher scores better). Non-response was scored as 0. Analysis using ANOVA gave results of a structured response scoring .34 points (Standard Deviation, SD .36) over a freeform response (p = .02); and the commissioning brief as .04 points over a vignette (p = .81).CONCLUSIONS:This was the first randomized trial to take place inside the secretariat of the HTA program. The difference in quality score between the brief and the vignette allocations was neither statistically nor practically important. The difference between the structured and freeform response was statistically significant, and sufficiently large to be important in practice. While the choice of material to share with clinicians seems unimportant we have shown that it is worth sending a structured response form to experts.


Author(s):  
Amy von Huben ◽  
Martin Howell ◽  
Joseph Carrello ◽  
Sarah Norris ◽  
Sally Wortley ◽  
...  

Abstract Background As health services increasingly make investment decisions in digital health technologies (DHTs), a DHT-specific and comprehensive health technology assessment (HTA) process is crucial in assessing value-for-money. Research in DHTs is ever-increasing, but whether it covers the content required for HTA is unknown. Objectives To summarize current trends in primary research on DHTs that manage chronic disease at home, particularly the coverage of content recommended for DHT-specific and comprehensive HTA. Methods Medline, Embase, Econlit, CINAHL, and The Cochrane Library (1 January 2015 to 20 March 2020) were searched for primary research studies using keywords related to DHT and HTA domains. Studies were assessed for coverage of the most frequently recommended content to be considered in a nine domain DHT-specific HTA previously developed. Results A total of 178 DHT interventions were identified, predominantly randomized controlled trials targeting cardiovascular disease/diabetes in high- to middle-income countries. A coverage assessment of the cardiovascular and diabetes DHT studies (112) revealed less than half covered DHT-specific content in all but the health problem domain. Content common to all technologies but essential for DHTs was covered by more than half the studies in all domains except for the effectiveness and ethical analysis domains. Conclusions Although DHT research is increasing, it is not covering all the content recommended for a DHT-specific and comprehensive HTA. The inability to conduct such an HTA may lead to health services making suboptimal investment decisions. Measures to increase the quality of trial design and reporting are required in DHT primary research.


2013 ◽  
Vol 23 (2) ◽  
Author(s):  
Brynjar Fure ◽  
Vigdis Lauvrak ◽  
Helene Arentz-Hansen ◽  
Åse Skår ◽  
Sari Susanna Ormstad ◽  
...  

I Norge har vi siden slutten av 1990-tallet utført metodevurderinger om effekt av tiltak i helsetjenesten som støtte til beslutningstakere. Metodevurderingene ble frem til 2004 utført ved Senter for medisinsk metodevurdering, og deretter ved Nasjonalt kunnskapssenter for helsetjenesten, som i dag er landets nasjonale metodevurderingsorganisasjon. Metodevurderinger kan i prinsippet brukes som beslutningsstøtte på alle nivåer i helsetjenesten, men i praksis benyttes metodevurderinger først og fremst som en del av et kunnskapsbasert beslutningsgrunnlag på overordnet politisk eller administrativt nivå. Hovedhensikten med metodevurderinger er å bidra til at gode og nyttige metoder kommer raskt ut til pasientene. Med metoder menes alle tiltak som er aktuelle i helsetjenesten, både legemidler, medisinsk utstyr, prosedyrerelatert diagnostikk og behandling, screening og organisatoriske tiltak. Metodevurderingene sammenfatter først og fremst kunnskapsgrunnlaget om klinisk effekt og sikkerhet, men ofte inngår også en helseøkonomisk evaluering. Her benyttes en strikt og etterprøvbar metodikk utarbeidet av anerkjente og veletablerte internasjonale metodevurderingsmiljøer. Avhengig av hva slags metode det er snakk om, vurderes også andre aspekter, som for eksempel etiske, sosiale, organisatoriske eller juridiske konsekvenser av å innføre metoden. For å sikre metodevurderingenes relevans i de kliniske miljøene, inviteres vanligvis kliniske spesialister til å delta i arbeidet. Metodevurderingsorganisasjoner samarbeider i økende grad med søsterorganisasjoner i andre land, ikke bare rundt forskning og utvikling av metodikken som benyttes i metodevurderinger, men også ved å dele resultater fra metodevurderinger, og dermed unngå dobbeltarbeid. En metodevurdering oppsummerer utelukkende forskningsresultatene om en metode, og inneholder ingen anbefaling om hvorvidt metoden bør innføres i helsetjenesten. Fure B, Lauvrak V, Arentz-Hansen H, Skår Å, Ormstad SS, Vang VS, Frønsdal KB. Health Technology Assessment: Knowledge-based decision support at the superior level in the health services. Nor J Epidemiol 2013; 23 (2): 165-169. ENGLISH SUMMARY In Norway, Health Technology Assessment (HTA) has existed since the late 1990s as support for decision makers in the health services. Until 2004, HTA was performed at the Norwegian Centre for Health Technology Assessment and later at the Norwegian Knowledge Centre for the Health Services which is, today, the national HTA-organization in Norway. HTA may be used as decision support at all levels in the health services. However, in practice, HTA is mainly used as part of evidence-based decisions by politicians or health leaders. The main purpose of HTA is to contribute to rapid introduction of useful health technologies, for the benefit of the patients. HTA may be used for all types of health technologies, including pharmaceuticals, medical devices, diagnostic and therapeutic procedures, screening and organizational measures. In HTA-reports, the evidence regarding effect and safety of a technology is summarized, and, in most cases, also include a health economic evaluation. A strict and transparent methodology, developed by well-established international HTA-agencies, is used. Other aspects such as ethical, social, organizational or legal consequences of the technology may be evaluated, depending on the technology. In order to make HTA clinically relevant, clinical experts are usually invited to participate in the work. HTA-organizations, increasingly, collaborate with HTA-organizations in other countries, not only in order to develop the methodology of HTA, but also to share the results of HTA-reports, and, thus, avoid double work. An HTA-report summarizes the research results on a technology, and gives no advice regarding the decision that should be made about the introduction of the new technology.


2002 ◽  
Vol 18 (2) ◽  
pp. 171-183 ◽  
Author(s):  
Egon Jonsson

Health technology assessment (HTA) grew from a need recognized by researchers concerned about the effectiveness of health services. They were later joined by policy makers in search of valid information about the costs and benefits of investments in health care. The history of HTA shows that this need appeared in many countries at nearly the same time.


2000 ◽  
Vol 16 (2) ◽  
pp. 347-381 ◽  
Author(s):  
Torben Jørgensen ◽  
Anne Hvenegaard ◽  
Finn Børlum Kristensen

The Danish healthcare services are mainly provided by public sector institutions. The system is highly decentralized. The state has little direct influence on the provision of healthcare services. State influence is exercised through legislation and budget allocations. The main task of the state is to initiate, co-ordinate, and advise. Counties, which run the hospitals, also decide on the placement of services. The hospital sector is controlled within the framework of legislation and global budgets. General practitioners occupy a central position in the Danish healthcare sector, acting as gatekeepers to the rest of the system. The system works well, and its structure has resulted in steady costs of health care for a long period. There is no regulatory mechanism in the Danish health services requiring use of health technology assessment (HTA) as a basis for policy decisions, planning, or administrative procedures. However, since the late 1970s a number of comprehensive assessments of health technology have formed the basis for national health policy decisions. In 1997, after years of public criticism of the quality of hospital care and health technologies, and on the basis of a previously developed national HTA strategy, a national institute for HTA (DIHTA) was established. There seems to be a growing awareness of evidence-based healthcare among health professionals and a general acceptance of health economic analyses as a basis for health policy decision making. This progress is coupled with growing regional HTA activity in the health services. HTA seems to have a bright future in Denmark.


2007 ◽  
Vol 23 (2) ◽  
pp. 155-161 ◽  
Author(s):  
Henry Z. Borowski ◽  
Jon Brehaut ◽  
David Hailey

Objectives: The objective of this study was to develop and implement a decision-making process for public funding of health services that links policy areas with health technology assessment and input from interested parties.Methods: Health authorities, assessment organizations, and healthcare professionals were consulted as a follow-up to recommendations of an expert panel established by the Alberta government. The methods involved formulation of an eight-stage, collaborative process that incorporates identification through the health ministry of health technologies requiring review, assessment of the technologies using expert groups in Alberta, and consultation and formulation of advice within the ministry to inform ministerial funding decisions.Results: All components of the decision process have been put in place and have collaborated to provide advice to inform policy on provincial health services. Of nineteen technologies selected for review, five have been completed and decisions made: laparoscopic adjustable gastric banding, fetal fibronectin assay for premature labor, newborn screening for cystic fibrosis, newborn screening for inborn errors of metabolism, and gastric electrical stimulation. A further six reviews are in progress, and reviews of the remaining technologies are planned for 2007.Conclusions: Bridging the evidence-to-policy gap is more likely to succeed when the policy community is actively engaged and an explicit model is used to put health technology assessment into practice.


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