Paula Corabian

1
Development of Health TechnologyAssessment in
Romania

• Paula Corabian
• Bucharest, September 21st, 2006

2
My agenda today

• Introduction to Health Technology Assessment
  (HTA)
• HTArelated activities in Romania
• Current efforts
• Next steps

3
Context

• Decisions on health technologies need timely,
• reliable comparative information on benefits
• and costs
• Continuing rapid growth in medical knowledge
• Global production of evidence and information
  overload
• Rapid diffusion and adoption of healthcare
  technologies
• Great variation in clinical practice
• Population aging
• Changes in health professionals and patients
  expectations
• Fiscal constraints are tighter than ever before
• Many technologies are ineffective, inefficient or
  unevaluated

4
Health Technology Assessment (HTA)
Is this a good technology? Good for doing
what, to whom, compared to what,
and at what price?

• HTA is not an on-site inspection of the safety
  and technical aspects of health devices and
  equipment.

5
Adopted definitions

• Health Technologies do not include only
• machines
• medical devices, and
• equipment
• Health Technology is defined broadly
• as prevention and rehabilitation, vaccines,
  pharmaceuticals and devices, medical and surgical
  procedures, and the systems within which health
  is protected and maintained

6
Adopted definitions

• Health Technology Assessment (HTA)
• is a multidisciplinary field of policy analysis
• studies the medical (clinical), social, ethical,
  and economic implications of development,
  diffusion, and use of health technology
• Primary purpose
• is to provide objective information to support
  health care decisions and policy making at the
  local, regional, national, and international
  levels.

7
Questions which may be asked

• Should we pay for people to receive this new
  intervention?
• Should it be used by certain types of health
  professionals?
• How much of the technology do we need?
• What will be the impact on population health?
• Do patients consider they obtain significant
  benefit?

8
Who uses HTA

• Within the health system

Outside the health system Patients/Families

General public

Interest groups
Manufacturing
industry
Media
9
Why HTA?
10
HTA in the world

• 1970s Formal HTA started in the United States
• Since 1980s Numerous HTA agencies were created
• International collaboration
• International Society of Technology Assessment in
  Health Care (ISTAHC)
• Health Technology Assessment International (HTAi)
• International Network of Agencies for Health
  Technology Assessment (INAHTA)
• World Health Organization (WHO)
• In Europe
• European Commission recognizes the value of HTA
• -- European Network for Health Technology
  Assessment (EUnetHTA)
• Health Evidence Network (Regional Office for
  Europe of WHO)

11
HTA in Romania a history

• 1992 identified the need for developing HTA in
  Romania
• 1998 start initiative to assist development of
  HTA in Romania
• Involved Department of Public Health and
  Management, University of Medicine and Pharmacy
  Carol Davila Bucharest and the HTA Unit,
  Alberta Heritage Foundation for Medical Research,
  Edmonton, Canada
• Main objective to raise awareness and
  understanding of HTA and of its necessity and
  utility in Romania
• 2002 European Union Twinning Project (Consensus
  III)
• Involved National Health Insurance Fund and the
  Federal Association of Regional Health Insurance
  Funds in Germany (AOK Bundesverband)
• Main objective to create an organizational model
  to facilitate the implementation of Evidence
  Based Medicine (EBM) and HTA activities in
  Romania.
• 2002 Memorandum concerning institutionalized HTA
  in
• Romania
• 2006 Institutionalized HTA in Romania has yet to
  happen

12
HTA in Romania a history

• Acknowledgements
• In Romania
• Dr Daniela Bartos,
• Dr Vasile Cepoi,
• Prof Mircea Cinteza,
• Prof Dan Enachescu,
• Dr Florin Lunguleac,
• Dr Sorin Oprescu,
• Dr Tiberiu Stania ,
• Dr Emanuil Stoicescu,
• Dr Eugeniu Turlea.
• International
• Dr David Banta
• Ms Liza Chan
• Dr David Hailey
• Dr Jorg Lauterberg
• Dr Devidas Menon
• Dr Matthias Perleth
• Ms Leigh-Ann Topfer

• More information on HTA-related
• activities in two published articles
• Developing Health Technology
• Assessment in Romania"
• - article published in the Eurohealth Journal
• (WHO), Vol 9, Nr.3, Fall 2003
• "Mentoring a developing health
• technology assessment initiative in
• Romania An example for countries with
• limited experience of assessing health
• technology"
• - article published in the International
• Journal of Technology Assessment in
• Health Care, Vol. 21, Fall 2005, No.4.

13
HTA in Romania Current efforts

• Project initiated by World Bank in 2006
• Main objective to support the institutional
  set-up of a Romanian HTA Commission including an
  HTA Office
• Estimated duration 12 months
• The winners have to
• - continue the activity started within the
  Twinning project
• - build up a HTA Commission with highly qualified
  scientific staff
• A National HTA Commission will be functioning at
  the Ministry of Health.
• An evidence-based medicine (EBM) and HTA unit
  will be functioning within the National School of
  Public Health and Health Services Management
  (NSPHHS)

14
HTA in Romania Current efforts

• International collaboration started in 2006
• Initiated by the Alberta HTA Program
• Brought together
• - Main decision makers and stakeholders from
  Romania
• (The National College of Physicians, National
  Health Insurance House,
• National School of Public Health and Health
  Services Management,
• Institute of Public Health in Bucharest, and
  University of Medicine and
• Pharmacy Carol Davila)
• - Representatives from international
  organizations
• (HTAi, INAHTA, WHO, EUnetHTA, and the AOK
  Bundesverband)
• Teleconference (May 30th, 2006)
• Face-to-face meetings (August 28-29, 2006)
• - NSPHHSM (Bucharest)
• - Alberta HTA Program, Institute of Health
  Economics (Edmonton)

15
HTA in Romania Next steps

• Initiate training of a core group in HTA methods
• Initiate HTA studies
• Continue to raise awareness about and increase
  interest in HTA
• Join international agencies and networks
• - HTAi
• - INAHTA
• - Work Package 8 Group of EUnetHTA project
• Create a national network

16
HTA in Romania
EBM and HTA Unit at NSPHHSM

• Next actionable steps Sept-Dec 2006
• set-up online access to journals databases
• set-up core HTA library
• development of a draft of a Romanian HTA handbook
• first HTA research project (issue pre-operative
  routine testing) in collaboration with Alberta
  HTA Program
• Resources support help are needed!

17
Summary

• HTA is here to stay
• Success of future actions depend on political,
  financial, and educational support
• Your participation is important
• Continue to build on past accomplishments

18
Ingredients for Success
19
Thank you very much!AcknowledgementsDr.
Carmen Moga Dr. Don Juzwishin Prof. Egon
Jonsson Ms. Christa Harstall Dr. Catalin
Tufanaru
Questions?