What is Health Technology Assessment

The first in a series on the topic of HTA in which we will look at the following questions. What is Health Technology Assessment? What are the issues with HTA as it relates to developing countries? What determines whether a HTA report is generalisable?

Technology assessment in health care is a multidisciplinary field of policy analysis. It studies the medical, social, ethical, and economic implications of development, diffusion, and use of health technology. (INHTA. 2002) ‘Technology’ is not necessarily referring to expensive pieces of equipment.Technology is the practical application of scientific knowledge. (Szczepura 1996) Initially Health Technology meant “drugs, equipment and medical devices, medical and surgical procedures along with the organisation and support systems” needed for their use in looking after patients. The term now includes all technologies in personal health care (of ill and healthy) and makes explicit the knowledge and skills needed for the use of those technologies. (PAHO 1998)
Most health care technologies can be thought of as belonging to one of the following categories: drugs, devices or equipment, medical and surgical procedures, support systems, and organisational and managerial systems. (Goodman 1998)Is Health Technology Assessment Research?Although there is occasionally the need to commission research to support the HTA process generally it does not seek to generate new knowledge or new solutions and therefore is not research (PAHO 1998)

Purpose of HTA

According Banta the goal of technology assessment is to provide policy makers with information on policy alternatives (Banta and Luce, 1993). Stevens and Milne are more specific in saying that the purpose of HTA is to help services that have an impact on health meet the objectives of the decision makers. (Stevens 2001). There are several ways that HTA can be used to support decisions including: Advising a regulatory body about whether to allow commercial use of a drug, device or other technology. Assisting health care financiers and providers in determining which technologies should be funded and / if how much they should pay. Providing useful information for patients, clinicians and health care providers on appropriate use of various health interventions. Guiding managers of health care institutions in their acquisition and management of health technologiesAdvising health officials contemplating public health programmes (Goodman 1998)

Do we need HTA?

It is becoming more and more apparent that not all health interventions make large contributions to health at reasonable cost but rather many new technologies make minimal impact on health at vast cost. (Gray 2001, Pencheon 2001, Panerai 1989)To control costs without negatively affecting health we have to make a concerted effort to obtain reliable and relevant information. Some of the major reasons cited for the interest and increase in use of HTA are: The acknowledgement that there are variations in clinical practice that is not entirely accounted for by clinical/ epidemiological, uncertainty, acceptability and diversity. Significant uncertainty about the real impact on health of many widely used health technologies.The fact that new interventions are being introduced more rapidly that in the past along with pressure from industry to adopt them. (Szcepura, 1996) Over the past few years we have seen significant world-wide increases in resource implications of providing health care (attributed to various factors: ageing population, business savvy of drug and medical device manufacturers among others) combined with an awareness of the limitations of resources. (PAHO 1998) It is also useful to bear in mind that the aims of individual patients, groups of patients with the same problem and the elected representatives may be in conflict. This is likely to be so because: each individual or group of individuals with a common health problem will tend to try to maximise the allocation of resources to their problems, while the representative of the public at large will be expected to allocate resources in ways that are transparent and that maximise equity of access. (Gray 2001)

Types of HTA

One of the issues with HTA is that it is despite the fact that it was originally intended for assessments to be comprehensive this is seldom done. These “partial” technology assessments tend to look at impacts that are of particular interest and their scope is influenced by resource constraints. (Goodman 1998) It is generally accepted that there are three perspectives from with a HTA can be done. The orientations are not always distinct; they may overlap and complement each other. It is suggested that a good HTA should contain elements of all three. (Goodman 1998, Szczepura 1996) Technology-Oriented Assessments are intended to determine the characteristics or impacts of a particular technology. Problem-Oriented Assessments are intended to assess how best to manage a particular type of problem for which there are alternative and/or complementary technologies as possible solutions Project-oriented Assessments focus on the need for or use of an intervention in a institution, programme or other designated project.

What do we assess in HTA?

Where as the traditional technology assessment may have focused on the social impact, health technology assessments zero in on safety, cost and effectiveness. This is so because of the fact that healthcare technologies tend to be insulated from the rules of the market economy. Typically products in other areas survive only as they are competitive in terms of price and performance. In health care it tends to be the health care professional or institution that determines what is provided (PAHO 1989) The following characteristics have been taken from Goodman’s discussion of the Properties and Impacts assessed in HTA. (Goodman 1998)Technical qualities- these include performance, conformity with design specifications, reliability, ease of use and related measures. Clinical safety- this is a judgement of the acceptability of risk in specific clinical situations. Efficacy and /or effectiveness- how well the technology will contribute to the improvement of patient health outcomes in idealised study settings (efficacy) and in everyday practice (effectiveness) Economic attributes or impacts- microeconomic attributes include costs, prices, charges and payment levels accompanying individual technologies they may also include comparison of resource use and benefits for alternative technologies. The macroeconomic concerns involve the impacts of technologies on national or state wide health care costs, effects on the spending between different health programmes or between health and other areas, or the impact on the delivery mechanisms for health care.Social, legal, ethical and/ or political impacts. Some technologies as a direct result of their being used in life threatening situations, being reproduction related or the need to allocate scarce resource intensive technologies. (Szczepura 1996, Goodman 1998)

References

Banta, H. D Luce, B. Health Care Technology and its Assessment: An International Perspective, Oxford University Press, Oxford, 1993Drummond, M. et al Methods for the Economic Evaluation of Health Care Programmes, 2nd ed. Oxford University Press, London, 1997

Gold, M. Et al (eds.) Cost- Effectiveness in Health and in Medicine . Oxford University Press, New York, 1996

Goodman, C., TA 101 Introduction to Health Care Technology Assessment, National Library of Medicine, 1998Available from national library medicine: http://www.nlm.nih.gov/nichsr/outreach.html#ta101 (Accessed: 4/12/02)

Muir Grey, J. Evidence-based health care. How to make policy and management decisions. 2 ed. Harcourt publishers, London, 2001

Stevens, A. and Miline, R. Evaluating Health Care Technologies. Chapter 5.3 p 300-308 in Pencheon et al ed. Oxford Handbook of Public Health Practice, Oxford University Press, Oxford, 2001

Szczepura, A and Kankaanpaa (eds.) Assessment of Health Care Technologies: Case Studies, Key Concepts and Strategic Issues, John Wiley and Sons limited, West Sussex, 1996

Resources

International Journal of Technology Assessment in Health

Web Resources

Center for Reviews and Dissemination- Health Technology Assessment (HTA) Database http://www.york.ac.uk/inst/crd/htahp.htm

The NHS Health Technology Assessment Programme http://www.ncchta.org/HowToOrderHTAMonos.htm

Canadian Coordinating Office for Health Technology Assessment http://www.ccohta.ca/entry_e.html

Health Technology on the Web www.ahfmr.ab.ca/hta/hta-publications/ infopapers/Internet_sources_of_information.pdf

The University of Birmingham in the UK offers a MSc in HTA http://www.bham.ac.uk/PublicHealth/htamasters/

INTERNATIONAL MASTER'S PROGRAM IN HTA & Management? Offered by universities of McGill, Montreal and Ottawa in Canada , Barcelona in Italy and Cattolica del Sacro Cuore in Italyhttp://www.hta-master.com/en/intro.html