gms | German Medical Science

53. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V. (GMDS)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie

15. bis 18.09.2008, Stuttgart

Methods, procedures, and contextual characteristics of HTA and health policy decision-making: Comparison of leading HTA agencies in Germany, UK, France and Sweden

Meeting Abstract

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  • Ruth Schwarzer - UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Österreich
  • Uwe Siebert - UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Österreich

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie. 53. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds). Stuttgart, 15.-19.09.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocP-12

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/gmds2008/08gmds043.shtml

Veröffentlicht: 10. September 2008

© 2008 Schwarzer et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction

In light of growing demands in health policy, adequate understanding of powerful instruments like health technology assessment (HTA) and of its potential usefulness in decision-making is needed. However, lack of knowledge and uncertainty on practice variations of a rising number of HTA performers drives misunderstandings questioning HTA quality, comparability, generalizability, applicability, and practical usefulness [1], [2], [3], [4]. Currently discussed topics include the lack of standardization or comparability for quality assurance, and need and limits for harmonization of HTA processes and methods to avoid a waste of resources [2], [4].

The aim of this study was (1) to develop a systematic framework that allows for describing and comparing the different features of HTA agencies in a formal and explicit manner, (2) to summarize and categorize the HTA methods, guidelines, processes and contextual factors issued in five leading agencies: in Germany the Institute for Quality and Efficiency in Health Care (IQWiG) and the German Agency for HTA at the German Institute for Medical Documentation and Information (DAHTA@DIMDI); in UK the National Institute for Health and Clinical Excellence (NICE); in France Haute Autorité de Santé (HAS); in Sweden the Swedish Council on Technology Assessment in Health Care (SBU), (3) to clarify similarities and differences between the agencies by comparison, (4) and, to draw conclusions on single characteristics as well as on the whole resulting picture for producers and users of HTA in research and policy.

Methods

We performed a systematic literature search in Medline, EMBASE, PreMedline, EconLit, Science Citation Index, Cochrane, HTA databases, the websites of the agencies and other relevant institutions, as well as additional primary data and information retrieval of HTA methods, processes, contextual, and subsequent issues. Based on this search, we developed a conceptual framework comprising eight main domains: (1) organization, (2) scope, (3) processes, (4) methods, (5) dissemination, (6) decision, (7) implementation, and (8) impact. We identified the relevant aspects covered by these domains, and grouped the information gathered in a table format for each agency.

We qualitatively compared these aspects both within and between agencies by demonstrating similarities and differences. Finally, based on all preceding steps, we identified possible reasons for these similarities and differences across all agencies to draw conclusions and implications for further steps by identifying relationships among domains and agencies.

Results

We developed a framework representing a comprehensive structure surrounding HTA and the stages through which a HTA is passing from science to policy and then to the population (Figure 1 [Fig. 1]). We identified 88 aspects as subunits of our eight main domains.

All agencies except the SBU are in varying degrees in transition. Regarding other organizational aspects, only legal status, regulations, relationship with health-related governmental institutions, governmental mandate, and membership in EUnetHTA were equal.

Currently on average, DAHTA@DIMDI, NICE and IQWiG provide a comparable preparation time of 15-16 months in full scale report production, HAS the fastest (6 months), and SBU the longest (up to 36 months). Between 2005 and 2007, by counting the reports on the websites of the agencies, DIMDI@DAHTA and NICE performed nearly 45, IQWiG 26, SBU 16, HAS 11 full scale assessments. But there are substantial differences in other aspects which have to be taken into account.

Regarding scope, agencies differs in mission, methodological principles, purpose, requester, commissioner, proponents of topics, primary audience/ target groups, and priorities/ reasons for assessment. Also processes are highly structured and elaborated at IQWIG and NICE. Agencies have different approaches for participation of third parties and only NICE has a structured appeal procedure. Regarding methods, the scale of reports differs amongst the agencies. Only NICE and IQWiG use confidential material, the HTA unit at HAS does not yet perform a comprehensive cost-effectiveness assessment, only NICE stated an explicit preference for QALYs, and complex modeling is yet only a matter of NICE, DAHTA@DIMDI, and SBU which also uses simpler modeling approaches. In principle, all agencies uniformly perform subgroup analyses. Regarding dissemination, SBU provides the most elaborated and wide-spread pattern among the included agencies. Regarding the binding character of the result of the HTA report for the decision process, the reports of IQWIG, HAS and NICE must be considered by the decision making bodies, whereas reports of DAHTA@DIMDI and SBU may be used in a less formal way by decision makers. Regarding implementation, NICE provides an elaborate way through the Evaluation and Review of NICE Implementation Evidence (ERNIE) database. NICE, HAS and SBU are interested in their impact on decision making and implementation and make attempts to evaluate this impact.

Discussion and Conclusions

Our study presents detailed information on five important HTA agencies. We found considerably more differences than similarities across agencies and countries. Differences must be considered within their legal and policy context and other aspects.

This elementary framework is not intended to add another “universal“ framework, but to provide both more disaggregated as well as more global comparative insight that may allow further progress in clarification on the need for action.

Our findings should be confirmed or extended by enlarging the number of agencies assessed. Our findings are also intended to foster the debate on how and how far HTA can be harmonized across countries and how HTA can better serve as knowledge communication between producers and users in an understandable, interpretable and transferable way.

Acknowledgement

The authors are grateful to all persons who provided information on the HTA agencies.


References

1.
Drummond M. Technology assessment in the German context [Editorial]. Eur J Health Econ. 2007 Jul 10.
2.
EUnetHTA.net. [homepage on the Internet] Copenhagen: European network for Health Technology Assessment (EUnetHTA), hosted by Danish Centre for Evaluation and HTA (DACEHTA); 2008 [updated 2008; cited 2008 March ]; Available from: http://www.eunethta.net. Externer Link
3.
Hivon M, Lehoux P, Denis JL, Tailliez S. Use of health technology assessment in decision making: coresponsibility of users and producers? Int J Technol Assess Health Care. 2005;21(2):268-75.
4.
Sorenson C, Kanavos P, Drummond M. Ensuring value for money in health care: The role of HTA in the European. Union In: Cox P, editor. Financing sustainable health care in Europe: New approaches for new outcomes. Report endorsed by Luxembourg's Ministry of Health and by Sitra, the Finnish Innovation Fund, partnered by Pfizer, Inc [Available at: http://www.sustainhealthcare.org/] [Accessed: 2007 April 28]. Pfizer Healthcare; 2007. p. 45-138. Externer Link