scholarly journals Considering and communicating uncertainty in health technology assessment

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Rebecca Trowman ◽  
Alicia Powers ◽  
Daniel A. Ollendorf
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Critical Factor ◽  
Health Technology ◽  
Management Approach ◽  
Output Stage ◽  
Challenges And Opportunities ◽  
Stakeholder Input ◽  
Generation Mechanisms ◽  
Context Specific

Abstract As health technology assessment (HTA) seeks to combine complex sets of evidence, values, and perspectives to support open, accountable, and transparent decision making, uncertainty is inherent. Uncertainty is present in the clinical and economic inputs that inform HTA and is a critical factor during context-specific deliberations where the evidence is weighed and decisions are made, taking uncertainty into account through either financial or evidence-generation mechanisms. The presence and impact of uncertainty must also be communicated to all relevant stakeholders during the HTA output stage. This article summarizes the 2021 HTAi Global Policy Forum discussion on “Considering and Communicating Uncertainty in HTA” that debated some of the key challenges and opportunities regarding uncertainty in HTA. Through a combination of small and large group discussions, core themes related to the topic of uncertainty in HTA were identified. These discussions revealed that: utilization of a life cycle/HTA management approach helps manage uncertainty; genuine stakeholder input and engagement (and not just consultation) can clarify uncertainty; tolerance of risk, the relationship of risk to uncertainty, and the context in which uncertainty is considered is critical; transparent and early dialogues could be increased to further reduce the uncertainty during HTA; and communicating uncertainty in HTA outputs is critical. The paper ends with suggested next steps that HTA agencies and stakeholders (such as industry, patients, regulators, payers, and others) might take to move the field forward. The paper promotes further discussion on aspects of uncertainty that should be more openly discussed, debated, and addressed.

scholarly journals An Integrated Framework to Measure the Performance of Inter-Organizational Programme on Health Technology Assessment

2021 ◽  
Vol 13 (7) ◽  
pp. 3873
Author(s):  
Milena Vainieri ◽  
Francesca Ferrè ◽  
Stefania Manetti
Keyword(s):  
Health Technology Assessment ◽  
Performance Management ◽  
Technology Assessment ◽  
Collaborative Governance ◽  
Health Technology ◽  
Policy Makers ◽  
Integrated Framework ◽  
Language And Culture ◽  
Health Authorities ◽  
Context Specific

Combining insights from collaborative governance, performance management, and health technology assessment (HTA) literature, this study develops an integrated framework to systematically measure and monitor the performance of HTA network programmes. This framework is validated throughout an action research carried out in the Italian HTA network programme for medical devices. We found that when building up collaborative performance management systems, some elements such as the participation in the design and the use of context specific performance assessment framework, facilitate their acceptance by managers and policy makers especially in high professionalized and sector-specific organizations because it reflects their distinctive language and culture. The hybrid framework may help health authorities and policymakers to understand the HTA network, monitor its performance, and ensure network sustainability over time.

PP151 Establishing Health Technology Assessment Impact Evaluation With Stakeholder Input From Day One

2019 ◽  
Vol 35 (S1) ◽  
pp. 66-66
Author(s):  
Ruth Louise Poole ◽  
Sophie Hughes ◽  
Lauren Elston ◽  
Susan Myles
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Impact Evaluation ◽  
Health Technology ◽  
Support Staff ◽  
Evaluation Plan ◽  
Individual Interviews ◽  
The Core ◽  
Stakeholder Input ◽  
Written Materials

IntroductionHealth Technology Wales (HTW) is a relatively new Health Technology Assessment (HTA) agency which focuses on non-medicines. In common with other HTA organizations, it identifies and appraises a range of technologies. However, HTW is also looking beyond the publication of guidance, to assess the adoption of advice and its eventual impact.MethodsHTW commissioned development of an Evaluation Plan from independent experts (Matter of Focus). A literature review was carried out to inform an options appraisal of methods for assessing impact. The selected approach was Contribution Analysis, which estimates the counterfactual through engagement of stakeholders.ResultsWhilst it is too early to report the full impact of HTW's guidance, a number of activities have taken place to prepare for evaluation. The core HTW team developed a series of logic models to describe the anticipated impact, the mechanisms by which it would be achieved, and key assumptions. Stakeholders were consulted for insight from a range of perspectives, and to manage expectations. This was achieved through individual interviews, presentation and discussion at committee meetings, and the sharing of written materials for feedback. This information was collated to populate bespoke software (OutNav). The collection of data relating to processes, outputs and outcomes is already an ongoing routine task of researchers and support staff.ConclusionsHTW has an opportunity to build impact evaluation into its culture from the beginning. This will facilitate the future reporting of HTW's influence using a well-designed, evidence-based approach. Furthermore, this pioneering work will clearly demonstrate the value of HTA to funders, commissioners, governments, and other decision-making bodies.

scholarly journals Why do health technology assessment drug reimbursement recommendations differ between countries? A parallel convergent mixed methods study

2019 ◽  
Vol 15 (3) ◽  
pp. 386-402 ◽  
Author(s):  
Elena Nicod ◽  
Laia Maynou ◽  
Erica Visintin ◽  
John Cairns
Keyword(s):  
Mixed Methods ◽  
Health Technology Assessment ◽  
Conceptual Framework ◽  
Technology Assessment ◽  
Health Technology ◽  
Deliberative Process ◽  
Drug Reimbursement ◽  
Quantitative And Qualitative Research ◽  
Research Designs ◽  
Stakeholder Input

AbstractUsing quantitative and qualitative research designs, respectively, two studies investigated why countries make different health technology assessment (HTA) drug reimbursement recommendations. Building on these, the objective of this study was to (a) develop a conceptual framework integrating the factors explaining these decisions, (b) explore their relationship and (c) assess if they are congruent, complementary or discrepant. A parallel convergent mixed methods design was used. Countries included in both previous studies were selected (England, Sweden, Scotland and France). A conceptual framework that integrated and organised the factors explaining the decisions from the two studies was developed. Relationships between factors were explored and illustrated through case studies. The framework distinguishes macro-level factors from micro-level ones. Only two of the factors common to both studies were congruent, while two others reached discrepant conclusions (stakeholder input and external review of the evidence processes). The remaining factors identified within one or both studies were complementary. Bringing together these findings contributed to generating a more complete picture of why countries make different HTA recommendations. Results were mostly complementary, explaining and enhancing each other. We conclude that differences often result from a combination of factors, with an important component relating to what occurs during the deliberative process.

HEALTH TECHNOLOGY ASSESSMENT FOR THE NHS IN ENGLAND AND WALES

2002 ◽  
Vol 18 (2) ◽  
pp. 161-165 ◽  
Author(s):  
Kent Woods
Keyword(s):  
Decision Making ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Clinical Excellence ◽  
Health Technology ◽  
Relevant Evidence ◽  
Healthcare Decision Making ◽  
Wide Range ◽  
Scientific Task ◽  
Context Specific

In healthcare decision making, there is an important functional separation between assessment and appraisal. In the U.K. National Health Service (NHS), this distinction is illustrated by the separation of roles between the Health Technology Assessment Programme and the National Institute for Clinical Excellence. However, it can be seen at every level within the healthcare system. Assessment of a technology is a scientific task that synthesizes all relevant evidence on effectiveness and cost-effectiveness; its results are therefore generalizable. Appraisal of the technology is informed by the assessment but adds context-specific judgments on the applicability of the evidence, the feasibility and impact of alternative options, relative priorities, and wider social and ethical aspects. An explicit distinction between assessment and appraisal is helpful in achieving clarity, consistency, and consensus. It also makes clear the need for a wide range of assessment reviews to support decision making by commissioners, providers, and users of health services. Increasingly, the secondary research supported by the NHS R&D Programme is being distributed electronically. It is also being used to identify areas in which further primary research should be commissioned.

VP78 Cross-Country Variation In Health Technology Assessment Preferences: An International Survey

2017 ◽  
Vol 33 (S1) ◽  
pp. 185-186
Author(s):  
Olina Efthymiadou ◽  
Panos Kanavos
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Disease Burden ◽  
Impact Analysis ◽  
Unmet Need ◽  
Health Technology ◽  
Clinical Criteria ◽  
Clinical Endpoints ◽  
Cross Country ◽  
Stakeholder Input

INTRODUCTION:Several studies have explored how Health Technology Assessment (HTA) processes, HTA submission requirements, perception and handling of uncertainties vary across different jurisdictions (1-3). However, no study has elicited HTA stakeholders’ preferences/priorities on criteria that shape coverage decisions across countries. We aimed to identify the extent to which preferences on criteria, uncertainties and other factors that shape HTA recommendations differ across countries.METHODS:HTA stakeholders in Brazil, England, France, Italy, Netherlands, Spain and Sweden were invited via email to complete a web-survey. A number of clinical, economic and other criteria (that is, rarity/orphan status and stakeholder input, among others) considered in HTAs, along with additional factors related to clinical evidence uncertainties, unmet need and innovative nature of treatment were ranked in terms of their importance on a 7-point Likert-scale. Responses were anonymised and analyzed using descriptive statistics.RESULTS:Responses were received from Brazil (n = 9), England (n = 7), France (n = 10), Italy (n = 6), Netherlands (n = 3), Spain (n = 3) and Sweden (n = 3). “Achievement of/Concerns around clinical benefit” was the only clinical criterion/uncertainty scoring equally important across countries (100 percent of respondents in each country). The requirement for/uncertainty around “Appropriate comparators” scored high in importance overall but was not consistent across countries, nor was the “Acceptability of surrogate rather than clinical endpoints”. Variation was seen in all economic criteria, apart from “Budget impact analysis” (equally important for more than 80 percent of respondents in each country). Greater differences were observed in the level of priority that innovation, disease severity and stakeholder input have towards HTA coverage decisions across countries.CONCLUSIONS:Although agreement was seen in preferences mostly for some of the clinical criteria and/or evidentiary requirements ranked, there were notable differences on countries' priorities for economic evidence criteria/uncertainties and the extent to which unmet need, disease burden and innovation are considered important towards HTA decision-making, possibly explaining differences in HTA recommendations.

scholarly journals Health technology assessment in China: challenges and opportunities

2017 ◽  
Vol 1 (1) ◽  
pp. 11-20 ◽  
Author(s):  
Lizheng Shi ◽  
Yiwei Mao ◽  
Meng Tang ◽  
Wenbin Liu ◽  
Zude Guo ◽  
...  
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Challenges And Opportunities

scholarly journals Context-Specific Economic Evaluation for Molecular Pathology Tests: An Application in Colorectal Cancer in the West of Scotland

2019 ◽  
Vol 35 (4) ◽  
pp. 327-333
Author(s):  
Janet Bouttell ◽  
Yun Yi Tan ◽  
David Creed ◽  
Gillian McGaffin ◽  
Neil Hawkins ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Molecular Pathology ◽  
Cost Savings ◽  
Health Technology ◽  
The West ◽  
Treatment Pathways ◽  
Local Decision ◽  
Context Specific

AbstractObjectivesThe cost-effectiveness of molecular pathology testing is highly context dependent. The field is fast-moving, and national health technology assessment may not be relevant or timely for local decision makers. This study illustrates a method of context-specific economic evaluation that can be carried out in a limited timescale without extensive resources.MethodsWe established a multi-disciplinary group including an oncologist, pathologists and a health economist. We set out diagnostic and treatment pathways and costs using registry data, health technology assessments, guidelines, audit data, and estimates from the group. Sensitivity analysis varied input parameters across plausible ranges. The evaluation setting was the West of Scotland and UK NHS perspective was adopted. The evaluation was assessed against the AdHopHTA checklist for hospital-based health technology assessment.ResultsA context-specific economic evaluation could be carried out on a timely basis using limited resources. The evaluation met all relevant criteria in the AdHopHTA checklist. Health outcomes were expected to be at least equal to the current strategy. Annual cost savings of £637,000 were estimated resulting primarily from a reduction in the proportion of patients receiving intravenous infusional chemotherapy regimens. The result was not sensitive to any parameter. The data driving the main cost saving came from a small clinical audit. We recommended this finding was confirmed in a larger population.ConclusionsThe method could be used to evaluate testing changes elsewhere. The results of the case study may be transferable to other jurisdictions where the organization of cancer services is fragmented.

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