Generalisability of HTA Reports

The following information was gathered from a review of the literature conducted in 2003 on generalisability of effectiveness, cost effectiveness, full economic evaluations; multinational clinical trials, economic evaluations, international cost comparisons and papers on methodology among others. Healthcare has become more effective and more ambitious and in many cases significantly more expensive.There has been an increased awareness of the fact that resources are limited and that there should be a responsibility to make sure that they are well used. In order to ensure we make the best use of the resources we need to evaluate health interventions.B ecause of the abundance of health impacting interventions available it is likely to be challenging for all except the most wealthy contexts to do all of their own assessments. This is likely to be a particular challenge for developing countries. As a result it may be important to be able to have a way of transferring, adapting or reinterpreting the findings of health technology assessments done by developed countries in developing countries. There aught to be a simple way of adapting HTAs from one country to another. Or at least assessing which HTA's are transferable. Several factors were found in guidelines of the generalisability of HTAs. The most important of these were detailed reporting of unit prices and discount rates; and reporting costs and resources separately; clear information on what was done; similarity between study and target population (in terms of definitions; costs; perspective; patient characteristics and preferences common or;) minimal sensitivity of result to reasonable change in key parameters and standard method. Therefore it may be useful to have guidelines based on these as a means of assessing the best available evidence on whether HTAs are generalisable. Further work needs to be done to determine the special issues that may be of relevance when generalising from developed to developing countries.Michael Drummond's book (Oxford University Press 2001)Economic Evaluation in Health Care: Merging Theory with Practice has a chapter on transferablity of economic evaluation results. Assessing Generalisability by Location in Trial-Based. Cost-Effectiveness Analysis: the Use of Multilevel Models. Andrea Manca Scupher and othershttp://www.herc.ox.ac.uk/DEEM/Bristol/Manca.pdf See page 61 in the GUIDELINES FOR ECONOMIC EVALUATION OF PHARMACEUTICALS: CANADA 2nd Edition November 1997 http://www.farmacoeconomia.com/articulos/canada.pdf I find this to be a very facinating subject and am certainly interested in hearing your coments.