Health Technology Assessment (HTA): A Primer for Procurement Professionals Dr. Tammy Clifford, Chief Scien+st & Vice President, Canadian Agency for Drugs and Technologies in Health (CADTH) Dr. Fiona A Miller, Associate Professor, Ins+tute of Health Policy, Management and Evalua+on (IHPME), University of Toronto.
HTA & Procurement AN INTRODUCTION TO HTA 2
What is HTA? (Health) technology assessment is a mul+disciplinary field of policy analysis. It studies the medical, social, ethical, and economic implica+ons of development, diffusion, and use of health technology. From INAHTA (Interna+onal Network of Agencies for Health Technology Assessment); www.inahta.org
What is HTA (2)? systema+c evalua+on of proper+es, effects, and/or impacts of health care technology. It addresses the direct, indirect, intended and unintended consequences Its main purpose is to inform technology-related decision-making in health care. HTA is conducted by interdisciplinary groups drawing from a variety of methods. HTAi (www.htai.org)
The Role of HTA Provide basis for informed decisions about: Adop+on/acquisi+on, diffusion, appropriate use, disinvestment/obsolescence HTA is not, in and of itself, the decision Reliable and +mely provision of (synthesized, appraised) evidence: Is it safe? For whom does it work and when? Is it be[er than what we already have/do? Does it provide value for money? Can we afford it? Can we afford not to? What else needs to be considered?
HTA supports evidence-informed decisions Across the lifecycle of a technology Innovation and R&D Adoption Ongoing assessment Appropriate Use Obsolescence
For Whom? Government policy and decision makers Public drug plan managers Regional health authori+es Hospitals and other health care facili+es Health professionals Pa+ents
Mul+ple Factors in Decision Making While HTA incorporates evidence on many facets of a decision (e.g., clinical, economic, ethical, legal, social) Evidence is but one input into a decision And even what is defined as evidence can differ Desire is to reduce uncertainty Not realis+c to eliminate it
The HTA Landscape: Canada
The HTA Landscape: Interna+onal
To be useful to decision makers, HTA must be tailored to the decision nodes of the health-care system and the needs and interests of decision makers at each of these nodes. The OECD Health Project. Health Technology and Decision Making. Paris, France: OECD. 2005.
HTA one size does not fit all Agency/organiza+on Mandate/remit Governance Linkages to other groups/programs Report Processes Who s involved, at what point(s) and to what extent Decision making framework(s)
What s the HTA Process? 1. Priority Setting/Topic Selection 2. Research Question Formulation 3. Identifying the Relevant Primary Research 4. Collect and Appraise the Clinical Evidence 5. Economic Analyses: comparative cost effectiveness, impact on current budget and health systems (VALUE) 6. Evaluation of ELSIs 7. Summarize/disseminate 3 natural pockets of knowledge Systematic Review & Meta-analysis Economic Evaluation Additional aspects
HTA & Procurement TWO SOLITUDES? 14
Same, same HTA & Healthcare Procurement share Roles in adop+on and appropriate u+liza+on The front doors of healthcare systems Public policy a[en+on Fiscal pressure; value for money Principle missions High quality health systems, pa+ent outcomes
but different HTA Scope For clinical technologies At point of adop+on Mostly drugs (outpa+ent) Procurement Scope For clinical & non-clinical products & services Most adop+on, All diffusion
quite different HTA Soc regulatory regime Limited regulatory direc+ves Community of prac+ce Provides guidance to policy Procurement Strict regulatory regime Trade agreements/ statute Finance/ Treasury Board policy Ensures compliance in prac,ce
really, quite different HTA Touchstones Evidence-based medicine Value for money Pa+ent & social values Procurement Touchstones Compe++on, Fairness & Transparency Fraud & Corrup+on Waste
really, quite different HTA Adjudicate compara+ve clinical & cost effec+veness Evidence-based medicine Cri+cal appraisal of relevant clinical evidence Value for money Cost per QALY Pa+ent & social values Pa+ent preferences Ci+zen values Accountability for Reasonableness Procurement Adjudicate transparent, fair & compe++ve process Request for proposals Pre-specified criteria Mandatory requirements Envelope 1: Technical/ Quality requirements (Clinical, Service Level, Device and Product Performance Requirements) Envelope 2: Business/Financial requirements
Working together? (1) For adop+on HTA to evaluate high cost technologies prior to broad use Procurement to follow. Informa+on to flow Business case to be built Recommenda+ons to be usable Relevant issues evaluated Different value proposi+ons of different products iden+fied Comprehensive, not selec+ve, product review
Working together? (2) For op+mal use Procurement to specify need for assessments Planned spend HTA to follow Iden+fy whether products are clinically equivalent within product class Inform business case for technology variants Ex.: Rela+ve value of different colours of intraocular lens implants? Inform decisions about technology use for different pa+ent subgroups Ex.: Pay more for joint replacement technologies for younger pa+ents?
Working together? (3) For shared exper+se and capacity HTA as source of exper+se for procurement For apprecia+ng value, challenging business as usual Procurement as source of exper+se for HTA To understand u+liza+on, for real world outcomes
Two solitudes? HTA & Procurement Share goals, but Operate in very different ways Many ways to work together & value for each Requires strong connec+ons Requires transla+on across significant differences 23
HTA & Procurement OPPORTUNITIES TO CONNECT 24
What does CADTH consider to be a health technology? Pharmaceu+cals (includes blood and vaccines); Diagnos+cs; and Medical, dental, surgical devices and procedures.
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Opportuni+es to Connect Make a request! Rapid Response Service Evidence reviews tailored to your specific informa+on needs and +meline All reports posted to cadth.ca Suggest a topic For larger assessments (HTA) For technologies that are new/emerging (horizon scan) To find out who s doing what (environmental scan) Connect with your Liaison Officer h[ps://cadth.ca/submit-a-request Check out our website/subscribe 29
Thanks!