Prof' Mike Drummond

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Prof. Mike Drummond

• University of York

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Ensuring value for money in healthcare The role
of HTA in the European Union
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(No Transcript)
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Innovation and the Financing of
HealthcareManaging the Tensions The Role of
Health Technology Assessment (HTA)

• Corinna Sorenson, LSE Health and Social Care
• Michael Drummond, Centre for Health Economics,
  University of York
• Panos Kanavos, LSE Health and Social Care

Please do not quote or use material without
permission from the authors.
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Outline of Presentation

• Brief overview of health technology in EU health
  care systems
• Role of health technology assessment (HTA) in
  health care innovation and financing
• Overview of study
• Study methods
• Key findings
• Conclusions and recommendations

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Role of Health Technology in EU Health Care
Systems

• Health technology plays an integral role in EU
  health care systems.
• Almost all Member States have experienced
  exponential growth in the introduction and uptake
  of health technologies (e.g., new medicines,
  diagnostic tools, telemedicine).
• New technologies provide enormous opportunity for
  governments, providers, and patients to realise
  improved health care services and outcomes.
• As a result of rapid diffusion, governments have
  faced unprecedented challenges in balancing high
  quality and innovative care with other dual
  concerns.
• Managing health care budgets and scarce
  resources.
• Safeguarding basic principles of access, equity,
  and choice.

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Role of HTA in HC Innovation and Financing

• Consequently, governments are increasingly
  required to strategically manage scarce resources
  by investing in services that deliver the best
  value for money.
• To help meet this challenge, various Member
  States have developed HTA systems.
• Overall, HTA systems seek to systematically
  evaluate the relative properties, effects, and/or
  other impacts of health technology.
• Helps to identify both cost-effective and
  cost-ineffective or obsolete technologies and
  health services.
• HTA provides a range of stakeholders with
  evidence-based information for decision-making
  (e.g., reimbursement, pricing) and
  priority-setting.
• Serves as a bridge between science and
  decision-making.

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Overview of Study

• While HTA systems increasingly play a role in
  supporting decision-making, they are not without
  controversy.
• Questions abound surrounding the following
  issues
• Role of HTA in decision-making and
  priority-setting
• Methods employed during the assessment process
• Impact on innovation and access
• Role of stakeholders

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Study Methods

• To meet these objectives, the study employed both
  primary and secondary research.
• Current literature related to HTA was
  systematically reviewed.
• Evidence base included both peer-reviewed
  journals and grey literature sources.
• Where needed, reports and other information
  sources were translated to English.
• To supplement the secondary data collection and
  address any information gaps, HTA experts were
  consulted.

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Key Findings (1)

• Governance of HTA
• Varied, reflecting local circumstances.
• Responsibility and membership of HTA entities
• Can have advisory, regulatory, or coordinating
  role.
• Conduct reviews in-house or contract them
  outside.
• Role of stakeholders
• Many HTA bodies involve professional groups,
  industry, and patient organisations.
• More involvement encourages transparency.

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Key Findings (2)

• Topic selection
• Priorities for HTA need to be set.
• Range of approaches and criteria (e.g., disease
  burden, capacity to deliver health benefit,
  feasibility of assessment).
• Evidence/data requirements
• Typically, the manufacturer submits a dossier,
  according to agreed guidelines.
• Sometimes a systematic review is carried out by
  an independent group.

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Key Findings (3)

• Design of studies
• All HTA bodies consider therapeutic benefit, or
  clinical effectiveness.
• Cost-effectiveness, quality of life, and
  budgetary impact are often considered.
• Economic assessment methods
• Cost-effectiveness analysis (or its variant,
  cost-utility analysis) is the most favoured
  approach.
• Differences of opinion on perspectives for
  costing and the relative roles of RCTs and models.

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Key Findings (4)

• Application of HTA evidence to decision-making
• Therapeutic benefit is the most important
  consideration.
• In most countries, no explicit cost-effectiveness
  threshold.
• Dissemination and implementation of HTA findings
• HTA needs to be timely, in relation to the
  decision.
• Active dissemination of findings in most
  countries.
• Many barriers to implementation, which need to be
  addressed.

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Conclusions (1)

• HTA can play a valuable role in health care
  decision-making, but the process must be
  transparent, timely, relevant, and useable.
• Assessments must also employ robust methods and
  engage a variety of stakeholders.
• A greater level of transparency is needed for an
  open, systematic, and unbiased decision-making
  process.
• Increased attention should be placed on
  identifying topics for potential disinvestment.
• Additional investments (financial and human
  capital) are need to address methodological
  hurdles.

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Conclusions (2)

• More attention needs to be paid to mechanisms to
  encourage adoption of HTA findings.
• Effective use of HTA can be enhanced by
  international collaboration, re-evaluation, and
  congruence with decision-maker needs and health
  system dynamics.
• By maximizing the potential of HTA,
  decision-makers will better be able to implement
  decisions that capture the benefits of
  innovation, within the constraints of the health
  care system.