HEALTH TECHNOLOGY ASSESSMENT IN DENMARK

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.

2019 ◽  
Vol 11 (4) ◽  
Author(s):  
Jari Haverinen ◽  
Niina Keränen ◽  
Petra Falkenbach ◽  
Anna Maijala ◽  
Timo Kolehmainen ◽  
...  

Health technology assessment (HTA) refers to the systematic evaluation of the properties, effects, and/or impacts of health technology. The main purpose of the assessment is to inform decisionmakers in order to better support the introduction of new health technologies. New digital healthcare solutions like mHealth, artificial intelligence (AI), and robotics have brought with them a great potential to further develop healthcare services, but their introduction should follow the same criteria as that of other healthcare methods. They must provide evidence-based benefits and be safe to use, and their impacts on patients and organizations need to be clarified. The first objective of this study was to describe the state-of-the-art HTA methods for mHealth, AI, and robotics. The second objective of this study was to evaluate the domains needed in the assessment. The final aim was to develop an HTA framework for digital healthcare services to support the introduction of novel technologies into Finnish healthcare. In this study, the state-of-the-art HTA methods were evaluated using a literature review and interviews. It was noted that some good practices already existed, but the overall picture showed that further development is still needed, especially in the AI and robotics fields. With the cooperation of professionals, key aspects and domains that should be taken into account to make fast but comprehensive assessments were identified. Based on this information, we created a new framework which supports the HTA process for digital healthcare services. The framework was named Digi-HTA.


1997 ◽  
Vol 13 (2) ◽  
pp. 186-219 ◽  
Author(s):  
Alessandro Liberati ◽  
Trevor A. Sheldon ◽  
H. David Banta

Health technology assessment (HTA) is primarily concerned with the consequences (benefits and costs) of health care and health policy decisions. Because decision making is complex and outcomes are often uncertain, it is helpful to attempt to assess the consequences. The quality of decisions can be improved by a process that provides a consistent framework for identifying and assessing health technologies.


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):  
Steven Simoens

This chapter introduces health technology assessment and health economics as tools for decision makers to allocate scarce resources in the healthcare sector. It argues that information about the safety, efficacy and effectiveness, organizational implications, social and ethical consequences, legal considerations, and health economic aspects of the application of a health technology needs to be taken into account with a view to informing decisions about the registration and reimbursement of a health technology. Also, the author hopes that understanding the methodology and use of health technology assessment and health economics will persuade the reader of the added value of such studies and promote the application of health technologies that support further health improvements, whilst containing health expenditure.


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.


2017 ◽  
Vol 41 (1) ◽  
pp. 19 ◽  
Author(s):  
Anna Mae Scott

Objective Health technology assessment (HTA) is a process of assessing evidence to inform policy decisions about public subsidy of new drugs and medical procedures. Where evidence is uncertain but the technology itself is promising, funders may recommend funding on an interim basis. It is unknown whether evidence from clinical registries is used to resolve uncertainties identified in interim-funded decisions made by Australian HTA bodies. Therefore, the present study evaluated the role of evidence from clinical registries in resolving evidence uncertainties identified by the Medical Services Advisory Committee (MSAC). Methods All HTAs considered by MSAC between 1998 and 2015 were reviewed and assessments that recommended interim funding were identified. The MSAC website was searched to identify reassessments of these recommendations and sources of evidence used to resolve the uncertainties were identified. Results Of 173 HTA reports considered by MSAC, 17 (10%) contained an interim funding recommendation. Eight recommendations cited uncertainty around safety, 15 cited uncertainty around clinical effectiveness and 13 cited uncertainty around economics (cost-effectiveness and/or budget impact). Of the 17 interim funding recommendations, 11 (65%) have been reassessed. Only two reassessments relied on clinical registry evidence to resolve evidence gaps identified at the time of the interim funding recommendation. Conclusions Clinical registries are underused as a source of evidence for resolving uncertainties around promising new health technologies in Australia. An open dialogue between stakeholders on the role of registries in this context is needed. What is known about the topic? HTA is a process of assessing the evidence to inform policy decisions about public subsidy of new health technologies (e.g. pharmaceuticals, diagnostic tests, medical procedures). Where evidence is uncertain but the technology under evaluation is promising, funders may recommend the funding of the technology on a temporary basis while additional evidence is collected. Clinical registries have been suggested as a means of collecting additional evidence in these situations. What is does this paper add? It is currently unknown whether evidence from clinical registries is used to resolve uncertainties identified at the time that temporary (interim) funding decisions are made by Australia’s HTA bodies, in particular MSAC. The present study found that MSAC rarely relies on the interim funding mechanism (17/173 assessments). Of the 11 subsequent reassessments of interim recommendations, two relied on registry evidence to provide Australian-specific data for addressing uncertainties around long-term safety, effectiveness and cost-effectiveness. These findings suggest that clinical registries, although a feasible source of evidence for HTAs, are rarely used for this purpose. What are the implications for practitioners? Given the registries’ ability to resolve both a wider range of questions than those typically addressed by randomised control trials and applicability to a wider group of patients (and, hence, providing estimates of outcomes that are more generalisable), the potential of clinical registries to resolve HTA issues needs more attention from both researchers and decision makers. Stakeholder collaboration to define the evidence requirements for new technologies early in their development phase would be valuable to determine the potential role for clinical registries.


2020 ◽  
Vol 36 (S1) ◽  
pp. 44-44
Author(s):  
Oresta Piniazhko ◽  
Kachveci Rabia ◽  
Dumenko Tetyana ◽  
Mariya Leleka ◽  
Alona Masheiko ◽  
...  

IntroductionThe Health Technology Assessment (HTA) Department of the “State Expert Center of the Ministry of Health of Ukraine” was established in 2019 for conducting assessments and development of recommendations for informing decisions of the Ukrainian Ministry of Health regarding financing of the health technologies. Since 2015, procurement of medicines by the state budget in Ukraine was carried out through international specialized organizations. The central procurement program covers forty-one programs for different disease areas. The list of medicines and medical devices purchased were based of procurement agreements with specialized organizations approved by Cabinet of Ministers Decree of Ukraine № 255 of 13 March 2019.MethodsDescriptive analysis of methodological processes around rapid review methods in HTA used for the procedure of central procurements of medicines. In the process of conducting rapid assessment we use a modern tool based on the HTA Core Model® for Rapid Relative Effectiveness Assessments version (V3.0). HTA Guidance in Ukraine was developed in 2017.ResultsThe list of government programs, for which rapid review methods in HTAhave been conducted, included following diseases: adult and pediatric oncology, juvenile rheumatoid arthritis, hemophilia, and orphan diseases. Reports include an overview of comparative efficacy, effectiveness and safety, as well as analysis of reports from HTA agencies and thresholds, budget impact for informing decisions for development of the central procurement programs in 2019. The HTA Department conducted more than forty reviews in less than 6 months.ConclusionsUse of rapid review methods in HTA in Ukraine for informing decisions for the central procurement programs of medicines is the perspective for rational resource allocation and spending. This increases and improves patients’ access to effective, safe and cost-effective medicines.


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.


2020 ◽  
pp. 12-25 ◽  
Author(s):  
V. N. Nаzаrkinа

In order to support the development of a Health Technology Assessment (НTA) in Ukraine, it is necessary to create a professional environment. The organization of training specialists in НTA is relevant for all countries of the world, including Ukraine. The aim of the work is to summarize the experience of training specialists of health technologies assessment and related branches of knowledge in different countries of the world, to analyze the curricula and courses for the development of this educational area in Ukraine. The subject of the study were scientific publications of domestic and foreign scientists, official sites of educational institutions, national agencies on the НTA and international organizations, as well as educational portals and training centers. The studies were conducted using methods of analysis, systematization and generalization. The structure and content of different training programs for health technologies assessment and related branches of knowledge used to meet the information needs of various target audiences (HTA experts, policy makers, healthcare managers, medical and pharmaceutical workers) were analyzed. The most common forms of training are courses, trainings and seminars, which are considered as a means of professional development. Academic programs (master degree, master of science, PhD) in Health Technology Assessment have 13 countries in Europe. To increase awareness of Health Technology Assessment distance learning is widely implemented within Massive Open Online Courses (MOOC). Flexible adaptation to the needs of students allows to obtain, as a result of training, a certificate/diploma of a graduate, a master's degree/master of science or Ph.D. Online courses are also considered as refresher training, non-assessment training for self-improvement and professional development audit. Taking into account the foreign experience of training specialists in НTA, the qualification characteristic of a specialist in health technology assessment and the author's educational program have been developed. For the first time in Ukraine in 2019 at the National University of Pharmacy, training of specialists on the evaluation of health technologies was started. The educational direction of НTA expert training requires development and support from the state and professional institutions.


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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