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Non-drug health technology assessment in Ontario, Canada. HTA: Health technology assessment; MOHLTC: Ministry of Health and Long-Term Care.
Source publication
Health technology assessment (HTA) adopts a multidisciplinary approach to comprehensively assess safety, efficacy, effectiveness, economic and organizational impact, and any potential social and ethical implications associated with adoption and diffusion of a technology in a healthcare system. Canada was one of the first pioneers in using HTA as a...
Context in source publication
Context 1
... policy recommendations following an HTA for non-drug technologies in the province are made by OHTAC. OHTAC was formed in 2003 to provide a single point of entry for requests for funding health technologies from across the provincial health system (which is primarily publically funded), including requests from hospitals, community health services and from within MOHLTC [18]. The recommendations made by OHTAC gen- erally provide advice to the Minister of Health concerning the uptake and diffusion (as well as removal) of medical technologies within the Ontario health system. As shown in Figure 3, any stakeholder from Ontario's health- care system can submit a request for funding a non-drug health technology to MAS. The evidence related to the technology is gathered by MAS and presented to OHTAC in the form of health technology policy assessments, which include structured reviews of the clinical and economic evidence, including dis cussion of provincial health system implications associated with the techno- logy [19]. Following the review of the health technology policy assessments, if evidence is sufficient, OHTAC can directly make a recommendation (i.e., either accept or reject the request). If the evidence is insufficient, OHTAC may request that further primary data collection is required in order for the committee to make recommendations regarding the use of the technology in the province and may request that a field evaluation be completed to obtain this information [20]. A process related to the devel- opment of conditionally funded field evaluation protocols and implementation has previously been described [21]. Briefly, follow- ing the recommendation to collect further data, academic centers are assigned responsibility to design a pragmatic clinical study to collect further outcome data related to the clinical, economic, patient-related and/or organizational impli cations associated with the technology. For these studies or 'field evaluations', a multi- disciplinary team is recruited from clinical and academic centers from across the province to develop and implement a clinical study protocol. Upon study completion and analysis, the results of the field evaluation studies are presented back to OHTAC to help inform their policy decisions [19]. The authors have com- pleted field evaluations regarding drug -eluting stents [22,23], endo vascular aortic aneurysm repair [24,25] and multidetector computed tomographic coronary angiography [26]. The field evaluations completed by other academic research groups have been outlined by Levin et al. ...
Similar publications
The Institute for Quality and Efficiency in Health Care (IQWiG) was established in 2003 by the German parliament. Its legislative responsibilities are health technology assessment, mostly to support policy making and reimbursement decisions. It also has a mandate to serve patients' interests directly, by assessing and communicating evidence for the...
Citations
... Interest in using MCDA to support complex cancer drug funding decisions is evolving and generating great interest in Canada and internationally. MCDA is being considered and, in many cases, implemented within international HTA agencies as a mechanism to support transparent, robust, and equitable decision-making as well as in various other decision contexts (e.g., priority setting, clinical decision-making, etc.) [10,15,[19][20][21][22][23]. In Canada, value assessment frameworks have been developed to assess the value of oncology therapeutics being funded through public drug programs [24,25]. ...
Citation: Takhar, P.; Geirnaert, M.; Gavura, S.; Beca, J.; Mercer, R.E.; Denburg, A.; Muñoz, C.; Tadrous, M.; Parmar, A.; Dionne, F.; et al. Abstract: Multi-criteria decision analysis (MCDA) is a value assessment tool designed to help support complex decision-making by incorporating multiple factors and perspectives in a transparent, structured approach. We developed an MCDA rating tool, consisting of seven criteria evaluating the importance and feasibility of conducting potential real-world evidence (RWE) studies aimed at addressing uncertainties stemming from initial cancer drug funding recommendations. In collaboration with the Canadian Agency for Drugs and Technologies in Health's Provincial Advisory Group, a validation exercise was conducted to further evaluate the application of the rating tool using RWE proposals varying in complexity. Through this exercise, we aimed to gain insight into consensus building and deliberation processes and to identify efficiencies in the application of the rating tool. An experienced facilitator led a multidisciplinary committee, consisting of 11 Canadian experts, through consensus building, deliberation, and prioritization. A total of nine RWE proposals were evaluated and prioritized as low (n = 4), medium (n = 3), or high (n = 2) priority. Through an iterative process, efficiencies and recommendations to improve the rating tool and associated procedures were identified. The refined MCDA rating tool can help decision-makers prioritize important and feasible RWE studies for research and can enable the use of RWE for the life-cycle evaluation of cancer drugs.
... Health technology assessment (HTA) is a comprehensive method for evaluating 2 the technical performance and economic characteristics of medical equipment and 3 devices, diagnosis and treatment technologies, and drugs. It is an indispensable tool in 4 health technology decision-making and management (1)(2). In recent years, HTA policy 5 frameworks have been widely applied in Asian countries and regions (3). ...
... In this article we focus on seven cases from pilot hospitals: (1) ...
Objectives
This study aimed to introduce a pilot program for hospital-based health technology assessment (HB-HTA) in China and present the participants’ experiences based on seven case studies from seven tertiary hospitals.
Methods
One-year pilot projects were initiated at the beginning of 2018. Seven pilot hospitals were closely followed from the beginning until the completion of their pilot HTA project. Regular interviews were conducted with the hospital managers leading the HB-HTA projects and key members of the special HTA teams. Observations were made based on field trips and written HTA reports.
Results
Three pilot projects evaluated the use of medical consumables, three evaluated the use of surgical or medical interventions, and one evaluated an innovative management model for ventilators. Real-world data were collected from all the pilot projects to assist with the assessments. Most HB-HTA pilot projects achieved remarkable results such as improvements in economic efficiency; however, there were also obvious deficiencies such as the lack of a necessary cost-effectiveness analysis.
Conclusions
The results varied among the seven HB-HTA pilot projects. The HB-HTA pilot program was implemented to promote the use of HB-HTA in hospital decision making in China. At the same time, HB-HTA in China faces challenges. We have made some policy recommendations based on the findings of the pilot projects.
... The AHP proves to be an invaluable tool for translating subjective expert judgments regarding various evaluation factors into quantitative weights, especially in the context of intricate issues necessitating decomposition [29]. In this study, we leveraged the results from the second round of expert importance ratings to compute the indicator weights and determine their corresponding values [30]. ...
Background In the context of the smart city and aging trends, Internet + community home-based care offers a novel approach to elderly care in China. However, limited research has focused on developing a comprehensive indicator system to address the diverse needs of elderly individuals residing at home. Based on existence needs, relationship needs and growth needs abbreviated as "ERG" demand theory. In response, this study leverages the ERG demand theory as a functional framework to establish a demand-oriented Internet + community home-based elderly service indicator system. Methods In this study, we adopt the ERG demand theory as the conceptual framework and employ a combination of the Delphi method and Analytic Hierarchy Process (AHP), thereby integrating both qualitative and quantitative research techniques to develop and assign weightings to the demand-orientated indicator system for Internet-based community home healthcare services for the elderly. Our research methodology is based on comprehensive literature reviews and collaborative group meetings. Results The study developed a demand-orientated Internet + community home healthy elderly service indicator system, comprising three primary indicators, 10 secondary indicators, and 46 tertiary indicators. These top-level indicators, ranked in descending order of importance, are medical and nursing services (0.493), living care services (0.311), and psychosocial/spiritual support services (0.196). Conclusion The indicator system serves the purpose of comprehending the health status and care requirements of elderly individuals confined to their homes while offering personalized services. In addition to addressing the fundamental needs of homebound older people through individualized care and expert medical guidance, this program places a significant emphasis on the spiritual and psychological well-being of these individuals to ensure a holistic approach to their physical and mental needs. This research posits that the indicator system can aid community healthcare workers in discerning the demand distribution for elderly services and optimizing resource allocation. By continuously evaluating and monitoring the indicators, this approach facilitates the enhancement of service quality and the fine-tuning of strategies, ultimately delivering efficient, safe, and high-quality elderly care services.
... Different systems have adopted different organizational arrangements of reimbursement process, and the HTA agencies organization may also very. Most countries have a "light" model, under which agencies assess the quality of the analyses (including their reliability, and objectivity) (Xie et al., 2011). Other countries have a "heavy" model-the agencies develop the analysis internally. ...
Introduction: Our objective was to analyze and compare systematically and structurally reimbursement systems in Poland and other countries.
Methods: The systems were selected based on recommendations issued by the Polish Agency for Health Technology Assessment and Tariffication (AHTAPol), which explicitly referred to other countries and agencies). Consequently, apart from Poland, the countries included in the analysis were England, Scotland, Wales, Ireland, France, Netherlands, Germany, Norway, Sweden, Canada, Australia and New Zealand. Relevant information and data were collected through a systematic search of PubMed (Medline), Embase and The Cochrane Library as well as competent authority websites and grey literature sources.
Results and discussion: In most of the countries, the submission of a reimbursement application is initiated by a pharmaceutical company, and only a few countries allow it before a product is approved for marketing. All of the agencies analyzed are independent and some have regulatory function of reimbursement decision making body. A key criterion differentiating the various agencies in terms of HTA is the cost-effectiveness threshold. Most of the countries have specific mechanisms to improve access to expensive specialty drugs, including cancer drugs and those used for rare diseases. Reimbursement systems often lack consistency in appreciating the same stages, leading to heterogeneous decision-making processes. The analysis of recommendations issued in different countries for the same medicinal product will allow a better understanding of the relations between the reimbursement system, HTA assessment, stakeholders involvement and decision on reimbursement of innovative drugs.
... Provincial governments then refer to reports like the Common Drug Review (CDR) which independently compiles evidence on comparators, costs and outcomes and makes subsidization recommendations to assist their decision making toward providing a provincial subsidy [11]. This process aligns with the health technology assessment model which encourages multifaceted decision-making in healthcare delivery [12]. The CDR was established to standardize the drug approval process across the country, but inquiries have shown variable levels of agreements between CDR recommendations and provincial formulary listings [13][14][15][16]. ...
Background
In Canada, cost prohibits access to emergency contraception (EC) which may assist to prevent unintended pregnancy. The drug, ulipristal acetate (UPA-EC), is more clinically effective and cost-effective than the prior standard levonorgestrel (LNG-EC). We analyzed provincial EC subsidization policies and examined underlying decision-making processes.
Methods
We undertook documentary analysis of provincial EC subsidization policies in publicly available drug formularies. We conducted semi-structured interviews with key informants to explore the processes underlying current policies.
Results
Quebec is the only province to subsidize UPA-EC, whilst all ten provinces subsidize LNG-EC. As such, provincial EC subsidization policies do not align with the latest UPA-EC evidence. Interviews revealed that evidence was valued in the policymaking process and formulary decisions were made through interdisciplinary consensus.
Conclusions
We identify a gap between EC subsidization policies and the latest evidence. Institutional structures affect policies reflecting evolving evidence. Increasing interdisciplinary mechanisms may encourage evidence-based policies.
... Further, it will also enable the workforce to contribute in an evidence-based-monitoring and instrumentation of various public-health programmes, policies, and decision-making processes. [15,[48][49][50][51][52] In India, about 2 to 3% share from the GDP was apportioned for the education sector, which needs to be increased for development and promotion of educational endeavors in HTA curriculum. [40] Further, keeping in view the major healthcare concerns among the LMICs, there is a need for the promotion of HTA as a regular discipline by highlighting its progressive effects on public health practices and quality of care among the community. ...
Demographic transitions accompanied with epidemiological shifts are affecting many countries around the globe. These apprehensions have raised the concern for constructing and sustaining healthcare systems especially among resource-constrained low- and middle-income-countries (LMICs) such as India. Introducing Health-Technology-Assessment (HTA) in the educational initiatives could support planners and policy-makers in formulating evidence-based-decision-making along with tackling inequalities/inefficiencies and promoting cost-effectiveness in resource allocation. A mapping exercise has been undertaken for examining the feasibility and implementation of HTA curriculum in the existing courses in India. To gain best possible insight on HTA curriculum, a situational analysis was conducted using systematic search strategy through search engines such as Google, Google Scholar, ProQuest and PubMed. Currently, seventy-one institutes in India are offering one or more courses through regular mode at undergraduate/postgraduate/diploma-certificate/doctorate-level pertaining to Medical-technology (MT), Biostatistics (BS), and Health-economics (HE). MT was offered in 37 institutes (52.12%), followed by BS in 23 (32.39%), and HE in nine (12.67%). Only two institutes (2.81%) are offering certificate-courses on HTA, mainly confined in virtual modules. This review reveals noticeable gaps in the existing curriculum in India and necessitates a novel academic initiative by introducing HTA in a full-fledged manner. Reforms in the research and educational initiatives need to be brought for promoting awareness regarding HTA. The application of domain needs to be widened from the field of health-policy formulators to research and teaching. This should be further strengthened with the strong academic collaborations to generate replicable findings, address challenges, and offer solutions for existing threats to HTA.
... Regarding the relevance of using MCDA in HTA, studies, first, discussed the use of MCDA methods to overcome barriers in priority setting, particularly by accounting for the views of healthcare stakeholders [106]; second, they recommended MCDA for dealing with stroke interventions requirements [107]; third, they discussed MCDA usefulness in the context of personalized healthcare by dealing with nuanced and context-specific information that decisionmakers would typically require [108]; fourth, they suggested MCDA as a comprehensive tool for dealing with distinct criteria in priority setting or for designing healthcare coverage packages [109]; fifth, they suggested MCDA to value pharmaceuticals [110], arguing for its specific suitability in the rare diseases context [111,112]; sixth, they discussed the potential role of MCDA to implement a hedonic-pricing approach by bringing together multiple perspectives on the benefits (and potential harms) of medical technologies [113]; seventh, they suggested MCDA to operationalise valuebased pricing and aggregate elements of value that are not well represented by weighted quality adjusted life years in a pragmatic way [25]; eighth, they discussed the relevance of including evidence on patient preferences in MCDA [114]; ninth, they suggested MCDA as a tool to include all the relevant criteria that impact on decision-making within transparent processes in Canada [115] and analysed the benefits and challenges regarding its use in that context [116]; tenth, they suggested MCDA to explicitly model non-economic criteria in pricing and reimbursement decisions in Central and Eastern Europe [117]; and, finally, they suggested MCDA as a methodological approach to increase efficiency, rationality and legitimacy in resource allocation decisions [118]. ...
Background
Multi-criteria decision analysis (MCDA) concepts, models and tools have been used increasingly in health technology assessment (HTA), with several studies pointing out practical and theoretical issues related to its use. This study provides a critical review of published studies on MCDA in the context of HTA by assessing their methodological quality and summarising methodological challenges.
Methods
A systematic review was conducted to identify studies discussing, developing or reviewing the use of MCDA in HTA using aggregation approaches. Studies were classified according to publication time and type, country of study, technology type and study type. The PROACTIVE-S approach was constructed and used to analyse methodological quality. Challenges and limitations reported in eligible studies were collected and summarised; this was followed by a critical discussion on research requirements to address the identified challenges.
Results
129 journal articles were eligible for review, 56% of which were published in 2015–2017; 42% focused on pharmaceuticals; 36, 26 and 18% reported model applications, issues regarding MCDA implementation analyses, and proposing frameworks, respectively. Poor compliance with good methodological practice (< 25% complying studies) was found regarding behavioural analyses, discussion of model assumptions and uncertainties, modelling of value functions, and dealing with judgment inconsistencies. The five most reported challenges related to evidence and data synthesis; value system differences and participant selection issues; participant difficulties; methodological complexity and resource balance; and criteria and attributes modelling. A critical discussion on ways to address these challenges ensues.
Discussion
Results highlight the need for advancement in robust methodologies, procedures and tools to improve methodological quality of MCDA in HTA studies. Research pathways include developing new model features, good practice guidelines, technologies to enable participation and behavioural research.
... In the second round of the survey, experts were asked to assign weights to each level of indicators according to their experience and expertise, and the matrix was built in the principle of analytical hierarchy process. [13] In this period, experts were supposed to make comparisons of specific indicators in each judgment matrix, and Saaty 1-9 scale relative materiality table was applied in the grading the importance of the indicators between one and another, the matrix was completed based on the value of relative importance of each subject. [14] Calculate the primary and secondary index weight coefficient by the survey results of the matrix, and the index weight coefficient was used in judging the importance of the indicators. ...
... [22] The degree of development, structure, and scale of medical institutions might all have a direct impact on indicators. [13] Since the research was performed within a regional medical institution and all the experts we surveyed are from medical fields in Beijing, considering the different situation in various regions, as well as the limitation of the data and material, the generalization of the results should be more careful in other circumstances. [23] In conclusions, though a two-round questionnaire survey of experts and statistical analysis, along with the verification on the credibility of the results through consistency evaluation test, the study established a quantitative medical technology evaluation system model and assessment indicators within medical institutions based on the Delphi method and analytical hierarchy process. ...
Background: The development and application of medical technologies reflect the medical quality and clinical capacity of a hospital. It is also an effective approach in upgrading medical service and core competitiveness among medical institutions. This study aimed to build a quantitative medical technology evaluation system through questionnaire survey within medical institutions to perform an assessment to medical technologies more objectively and accurately, and promote the management of medical quality technologies and ensure the medical safety of various operations among the hospitals.
Methods: A two-leveled quantitative medical technology evaluation system was built through a two-round questionnaire survey of chosen experts. The Delphi method was applied in identifying the structure of evaluation system and indicators. The judgment of the experts on the indicators was adopted in building the matrix so that the weight coefficient and maximum eigenvalue (λ max), consistency index (CI), and random consistency ratio (CR) could be obtained and collected. The results were verified through consistency tests, and the index weight coefficient of each indicator was conducted and calculated through analytical hierarchy process.
Results: Twenty-six experts of different medical fields were involved in the questionnaire survey, 25 of whom successfully responded to the two-round research. Altogether, 4 primary indicators (safety, effectiveness, innovativeness, and benefits), as well as 13 secondary indicators, were included in the evaluation system. The matrix is built to conduct the λ max, CI, and CR of each expert in the survey, and the index weight coefficients of primary indicators were 0.33, 0.28, 0.27, and 0.12, respectively, and the index weight coefficients of secondary indicators were conducted and calculated accordingly.
Conclusions: As the two-round questionnaire survey of experts and statistical analysis were performed and credibility of the results was verified through consistency evaluation test, the study established a quantitative medical technology evaluation system model and assessment indicators within medical institutions based on the Delphi method and analytical hierarchy process. Moreover, further verifications, adjustments, and optimizations of the system and indicators will be performed in follow-up studies.
... The assessment of new technology in healthcare generally involves evaluating its safety, clinical effectiveness, economic impact, as well as effects on a local organizational level [1]. In order to fully capitalize on the introduction of a new technology in a hospital setting, changes in organizational processes and work flow need to also be measured and adapted accordingly [2]. ...
... [16] Second, enhancing the construction of medical technology assessment systems, procedures as well as standards, and developing industry guidance that are suitable and operable. [17] To achieve this goal, it is suggested to establish close cooperation ties with foreign medical technology assessment agencies so that we are able to absorb the experiences in combining with the actual situation in the industry. Last but not the least, promoting personnel training to build a team of professionals. ...
