HEALTH TECHNOLOGY REASSESSMENT OF NON-DRUG TECHNOLOGIES: CURRENT PRACTICES

2012 ◽  
Vol 28 (3) ◽  
pp. 220-227 ◽  
Author(s):  
Laura Leggett ◽  
Tom W. Noseworthy ◽  
Mahmood Zarrabi ◽  
Diane Lorenzetti ◽  
Lloyd R. Sutherland ◽  
...  
Keyword(s):  
Health Technology ◽  
Economic Effects ◽  
Text Documents ◽  
Health Technologies ◽  
Work Related ◽  
Program Budgeting ◽  
Obsolete Technology ◽  
Future Work ◽  
Health Technology Reassessment ◽  
Current Practices

Objectives: Obsolescence is a natural phase of the lifecycle of health technologies. Given increasing cost of health expenditures worldwide, health organizations have little choice but to engage in health technology reassessment (HTR); a structured, evidence-based assessment of the medical, social, ethical, and economic effects of a technology, currently used within the healthcare system, to inform optimal use of that technology in comparison to its alternatives. This research was completed to identify and summarize international HTR initiatives for non-drug technologies.Methods: A systematic review was performed using the terms disinvestment, obsolescence, obsolete technology, ineffective, reassessment, reinvestment, reallocation, program budgeting, and marginal analysis to search PubMED, MEDLINE, EMBASE, and CINAHL until November 2011. Websites of organizations listed as members of INAHTA and HTAi were hand-searched for gray literature. Documents were excluded if they were unavailable in English, if the title/abstract was irrelevant to HTR, and/or if the document made no mention of current practices. All citations were screened in duplicate with disagreements resolved by consensus.Results: Sixty full-text documents were reviewed and forty were included. One model for reassessment was identified; however, it has never been put into practice. Eight countries have some evidence of past or current work related to reassessment; seven have shown evidence of continued work in HTR. There is negligible focus on monitoring and implementation.Conclusions: HTR is in its infancy. Although health technology reassessments are being conducted, there is no standardized approach. Future work should focus on developing and piloting a comprehensive methodology for completing HTR.

scholarly journals HEALTH TECHNOLOGY REASSESSMENT: THE ART OF THE POSSIBLE

2013 ◽  
Vol 29 (4) ◽  
pp. 418-423 ◽  
Author(s):  
Gail MacKean ◽  
Tom Noseworthy ◽  
Adam G. Elshaug ◽  
Laura Leggett ◽  
Peter Littlejohns ◽  
...  
Keyword(s):  
Monitoring And Evaluation ◽  
Health Technology ◽  
Economic Effects ◽  
Policy And Practice ◽  
Political Will ◽  
Multiple Levels ◽  
Methodological Approaches ◽  
Context Specific ◽  
Constant Comparative Analysis ◽  
Health Technology Reassessment

Background:Health technology reassessment (HTR) is “a structured, evidence-based assessment of the clinical, social, ethical, and economic effects of a technology currently used in the healthcare system, to inform optimal use of that technology in comparison to its alternatives.” The purpose of this study is to describe the key themes in the context of current HTR activities and propose a way forward for this newly emerging field.Methods:Data were gathered from a workshop held as part of the 2012 Canadian Agency for Drugs and Technology in Health (CADTH) symposium. The workshop consisted of two panel presentations followed by discussion; data gathered, including presentations and rich audience discussion transcripts, were analyzed for key themes emerging in the field of HTR using constant comparative analysis.Results:The language chosen to describe HTR will set the tone for engagement. The identification of champions at multiple levels and political will are essential. Key lessons from international experience are: disinvestment is difficult, focus on clinical areas not specific technologies, identify clear goals of the HTR agenda. Six key themes were identified to move the HTR agenda forward: emphasize integration over segregation, focus on development of HTR methods and processes, processes are context-specific but lessons must be shared, build capacity in synergistic interdisciplinary fields, develop meaningful stakeholder engagement, strengthen postimplementation monitoring and evaluation.Conclusions:To move this field forward, we must continue to build on international experiences with a focus on developing novel methodological approaches to generating, incorporating, and implementing evidence into policy and practice.

Cost-Effectiveness Analysis and the Value for Money of Health Technologies

2012 ◽  
pp. 92-109
Author(s):  
Steven Simoens
Keyword(s):  
Cost Effectiveness ◽  
Health Technology ◽  
Cost Effectiveness Analysis ◽  
Value For Money ◽  
Health Technologies ◽  
Effectiveness Analysis ◽  
Ratio Approach ◽  
Alternative Approaches ◽  
Program Budgeting ◽  
Care Decision

Cost-effectiveness analysis serves as a tool to assess the value for money of a health technology. This chapter aims to review different approaches to assessing value for money of health technologies. First, the chapter discusses the methodological basis of the incremental cost-effectiveness ratio approach. Second, the chapter reviews alternative approaches such as the replacement approach, program budgeting and marginal analysis, the generalised optimisation framework, and multi-criteria decision analysis. This information will aid health care decision makers and researchers to interpret cost-effectiveness analyses and their results for the purpose of decision making.

UNTANGLING, UNBUNDLING, AND MOVING FORWARD: FRAMING HEALTH TECHNOLOGY REASSESSMENT IN THE CHANGING CONCEPTUAL LANDSCAPE

2018 ◽  
Vol 34 (2) ◽  
pp. 212-217 ◽  
Author(s):  
Lesley J.J. Soril ◽  
Daniel J. Niven ◽  
Rosmin Esmail ◽  
Tom W. Noseworthy ◽  
Fiona M. Clement
Keyword(s):  
Healthcare System ◽  
Policy Process ◽  
Health Technology ◽  
Health Technologies ◽  
Inductive Synthesis ◽  
The Common ◽  
Current Utilization ◽  
Common Understanding ◽  
Synthesis Approach ◽  
Health Technology Reassessment

Objectives:Health technology reassessment (HTR) is a policy process to manage health technologies throughout their lifecycle and ensure their ongoing optimal use. However, within an ever-evolving field, HTR is only one of many concepts associated with the optimization of health technologies. There is limited understanding of how other concepts and processes might differ and/or be interrelated. This study aims to describe the concepts underlying the various technology optimization processes and to reconcile their relationships within the HTR process.Methods:A synthesis of the literature on approaches to HTR was completed. An inductive synthesis approach was completed to catalogue common concepts and themes. Expert stakeholders were consulted to develop a schematic to diagrammatically depict the relationships among concepts and frame them within the HTR process.Results:A practical schematic was developed. Common concepts and themes were organized under six major domains that address the following discussion questions: (i) what is the value of the existing technology?; (ii) what is the current utilization gap?; (iii) what are the available tools and resources?; (iv) what are the levers for change?; (v) what is the desired outcome?; and (vi) who are the foundational actors?Conclusions:Using these six questions to frame the issues faced by HTR will advance the common understanding of HTR, as well as improve implementation of HTR initiatives. These questions will clearly identify the process required to move forward within a complex healthcare system.

scholarly journals Early Detection Methods for Silicosis in Australia and Internationally: A Review of the Literature

2021 ◽  
Vol 18 (15) ◽  
pp. 8123
Author(s):  
Emma K. Austin ◽  
Carole James ◽  
John Tessier
Keyword(s):  
Early Detection ◽  
Literature Review ◽  
Detection Method ◽  
Detection Methods ◽  
X Rays ◽  
Review Of The Literature ◽  
Occupational Lung Disease ◽  
Work Related ◽  
Growing Body ◽  
Future Work

Pneumoconiosis, or occupational lung disease, is one of the world’s most prevalent work-related diseases. Silicosis, a type of pneumoconiosis, is caused by inhaling respirable crystalline silica (RCS) dust. Although silicosis can be fatal, it is completely preventable. Hundreds of thousands of workers globally are at risk of being exposed to RCS at the workplace from various activities in many industries. Currently, in Australia and internationally, there are a range of methods used for the respiratory surveillance of workers exposed to RCS. These methods include health and exposure questionnaires, spirometry, chest X-rays, and HRCT. However, these methods predominantly do not detect the disease until it has significantly progressed. For this reason, there is a growing body of research investigating early detection methods for silicosis, particularly biomarkers. This literature review summarises the research to date on early detection methods for silicosis and makes recommendations for future work in this area. Findings from this review conclude that there is a critical need for an early detection method for silicosis, however, further laboratory- and field-based research is required.

scholarly journals Estimating an EQ-5D-3L Value Set for Romania Using Time Trade-Off

2021 ◽  
Vol 18 (14) ◽  
pp. 7415
Author(s):  
Marian Sorin Paveliu ◽  
Elena Olariu ◽  
Raluca Caplescu ◽  
Yemi Oluboyede ◽  
Ileana-Gabriela Niculescu-Aron ◽  
...  
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Assessment Process ◽  
Computer Assisted ◽  
Health State ◽  
Health States ◽  
Value Set ◽  
Health Technologies ◽  
Related Quality

Objective: To provide health-related quality of life (HRQoL) data to support health technology assessment (HTA) and reimbursement decisions in Romania, by developing a country-specific value set for the EQ-5D-3L questionnaire. Methods: We used the cTTO method to elicit health state values using a computer-assisted personal interviewing approach. Interviews were standardized following the most recent version of the EQ-VT protocol developed by the EuroQoL Foundation. Thirty EQ-5D-3L health states were randomly assigned to respondents in blocks of three. Econometric modeling was used to estimate values for all 243 states described by the EQ-5D-3L. Results: Data from 1556 non-institutionalized adults aged 18 years and older, selected from a national representative sample, were used to build the value set. All tested models were logically consistent; the final model chosen to generate the value set was an interval regression model. The predicted EQ-5D-3L values ranged from 0.969 to 0.399, and the relative importance of EQ-5D-3L dimensions was in the following order: mobility, pain/discomfort, self-care, anxiety/depression, and usual activities. Conclusions: These results can support reimbursement decisions and allow regional cross-country comparisons between health technologies. This study lays a stepping stone in the development of a health technology assessment process more driven by locally relevant data in Romania.

scholarly journals Extrapolating Parametric Survival Models in Health Technology Assessment Using Model Averaging: A Simulation Study

2021 ◽  
Vol 41 (4) ◽  
pp. 476-484
Author(s):  
Daniel Gallacher ◽  
Peter Kimani ◽  
Nigel Stallard
Keyword(s):  
Survival Time ◽  
Survival Data ◽  
Mean Squared Error ◽  
Model Averaging ◽  
Information Criterion ◽  
Health Technology ◽  
Weighted Averaging ◽  
Health Technologies ◽  
Mean Survival Time ◽  
Restricted Mean Survival Time

Previous work examined the suitability of relying on routine methods of model selection when extrapolating survival data in a health technology appraisal setting. Here we explore solutions to improve reliability of restricted mean survival time (RMST) estimates from trial data by assessing model plausibility and implementing model averaging. We compare our previous methods of selecting a model for extrapolation using the Akaike information criterion (AIC) and Bayesian information criterion (BIC). Our methods of model averaging include using equal weighting across models falling within established threshold ranges for AIC and BIC and using BIC-based weighted averages. We apply our plausibility assessment and implement model averaging to the output of our previous simulations, where 10,000 runs of 12 trial-based scenarios were examined. We demonstrate that removing implausible models from consideration reduces the mean squared error associated with the restricted mean survival time (RMST) estimate from each selection method and increases the percentage of RMST estimates that were within 10% of the RMST from the parameters of the sampling distribution. The methods of averaging were superior to selecting a single optimal extrapolation, aside from some of the exponential scenarios where BIC already selected the exponential model. The averaging methods with wide criterion-based thresholds outperformed BIC-weighted averaging in the majority of scenarios. We conclude that model averaging approaches should feature more widely in the appraisal of health technologies where extrapolation is influential and considerable uncertainty is present. Where data demonstrate complicated underlying hazard rates, funders should account for the additional uncertainty associated with these extrapolations in their decision making. Extended follow-up from trials should be encouraged and used to review prices of therapies to ensure a fair price is paid.

The Ethics of Mobile Health Technology

2017 ◽  
Vol 41 (S1) ◽  
pp. S39-S39
Author(s):  
S. Galderisi ◽  
F. Caputo
Keyword(s):  
Health Equity ◽  
Mobile Health ◽  
New Technologies ◽  
Ethical Issues ◽  
Professional Associations ◽  
Health Technology ◽  
Ethical Guidelines ◽  
High Quality ◽  
Quality Healthcare ◽  
Health Technologies

IntroductionMobile health (m-health) technology has been growing rapidly in the last decades. The use of this technology represents an advantage, especially for reaching patients who otherwise would have no access to healthcare. However, many ethical issues arise from the use of m-health. Health equity, privacy policies, adequate informed consent and a competent, safe and high quality healthcare need to be guaranteed; professional standards and quality of doctor-patient relationship in the digital setting should not be lower than those set for in-person practice.AimsTo assess advantages and threats that may arise from the wide use of m-health technologies, in order to guarantee the application of the best medical practices, resulting in the highest quality healthcare.MethodsA literature search has been conducted to highlight the most pressing ethical issues emerging from the spreading of m-health technologies.ResultsFew ethical guidelines on the appropriate use of m-health have been developed to help clinicians adopt a professional conduct within digital settings. They focus on the need for professional associations to define ethical guidelines and for physicians to take care of their education and online behavior when using m-health technologies.ConclusionsThe rapid spreading of m-health technologies urges us to evaluate all ethical issues related to its use. It would be advisable to produce an ethical code for the use of these new technologies, to guarantee health equity, privacy protection, high quality doctor-patient relationships and to ensure that m-health is not chosen over traditional care for merely economic purposes.Disclosure of interestSG received honoraria or Advisory board/consulting fees from the following companies: Lundbeck, Janssen Pharmaceuticals, Hoffman-La Roche, Angelini-Acraf, Otsuka, Pierre Fabre and Gedeon-Richter. All other authors have declared.

scholarly journals Toward economic evaluation of the value of vaccines and other health technologies in addressing AMR

2018 ◽  
Vol 115 (51) ◽  
pp. 12911-12919 ◽  
Author(s):  
J. P. Sevilla ◽  
David E. Bloom ◽  
Daniel Cadarette ◽  
Mark Jit ◽  
Marc Lipsitch
Keyword(s):  
Economic Value ◽  
Decision Rules ◽  
Health Sector ◽  
Economic Evaluations ◽  
General Point ◽  
Value For Money ◽  
Mortality And Morbidity ◽  
Health Technologies ◽  
General Terms ◽  
Future Work

We discuss the need to make economic evaluations of vaccines antimicrobial resistance (AMR)-sensitive and ways to do so. Such AMR-sensitive evaluations can play a role in value-for-money comparisons of different vaccines within a national immunization program, or in comparisons of vaccine-centric and non-vaccine-centric technologies within an anti-AMR program. In general terms, incremental cost-effectiveness ratios and rates of return and their associated decision rules are unaltered by consideration of AMR-related value. The decision metrics need to have their various health, cost, and socioeconomic terms disaggregated into resistance-related subcategories, which in turn have to be measured carefully before they are reaggregated. The fundamental scientific challenges lie primarily in quantifying the causal impact of health technologies on resistance-related health outcomes, and secondarily in ascertaining the economic value of those outcomes. We emphasize the importance of evaluating vaccines in the context of other potentially complementary and substitutable nonvaccine technologies. Complementarity implies that optimal spending on each set of interventions is positive, and substitutability implies that the ratio of spending will depend on relative value for money. We exemplify this general point through a qualitative discussion of the complementarities and (especially the) substitutability between pneumococcal conjugate vaccines and antimicrobial stewardship and between research and development (R&D) of a gonorrhea vaccine versus R&D of a gonorrhea antibiotic. We propose a roadmap for future work, which includes quantifying the causal effects of vaccination and other health technologies on short-term and long-term resistance-related outcomes, measuring the health-sector costs and broader socioeconomic consequences of resistance-related mortality and morbidity, and evaluating vaccines in the context of nonvaccine complements and substitutes.

Key principles for the improved conduct of health technology assessments for resource allocation decisions

2008 ◽  
Vol 24 (03) ◽  
pp. 244-258 ◽  
Author(s):  
Michael F. Drummond ◽  
J. Sanford Schwartz ◽  
Bengt Jönsson ◽  
Bryan R. Luce ◽  
Peter J. Neumann ◽  
...  
Keyword(s):  
Resource Allocation ◽  
Health Technology ◽  
Resource Allocation Decision ◽  
Decision Makers ◽  
Costs And Benefits ◽  
Allocation Decision ◽  
Health Technologies ◽  
System A ◽  
Different Types ◽  
Allocation Decisions

Health technology assessment (HTA) is a dynamic, rapidly evolving process, embracing different types of assessments that inform real-world decisions about the value (i.e., benefits, risks, and costs) of new and existing technologies. Historically, most HTA agencies have focused on producing high quality assessment reports that can be used by a range of decision makers. However, increasingly organizations are undertaking or commissioning HTAs to inform a particular resource allocation decision, such as listing a drug on a national or local formulary, defining the range of coverage under insurance plans, or issuing mandatory guidance on the use of health technologies in a particular healthcare system. A set of fifteen principles that can be used in assessing existing or establishing new HTA activities is proposed, providing examples from existing HTA programs. The principal focus is on those HTA activities that are linked to, or include, a particular resource allocation decision. In these HTAs, the consideration of both costs and benefits, in an economic evaluation, is critical. It is also important to consider the link between the HTA and the decision that will follow. The principles are organized into four sections: (i) “Structure” of HTA programs; (ii) “Methods” of HTA; (iii) “Processes for Conduct” of HTA; and (iv) “Use of HTAs in Decision Making.”

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