End-user involvement in health technology assessment (HTA) development: A way to increase impact

Abstract

Objectives: A mechanism to increase the influence of Health Technology Assessments (HTAs) on hospital policy decisions was developed.Methods: We describe the process and results of an experiment in which a local in-hospital HTA unit was created to provide sound evidence on technology acquisition issues, and to formulate locally appropriate policy recommendations. The Unit consists of a small technical staff that accesses and synthesizes the evidence incorporating local health and economic data, and a Policy Committee that develops policy recommendations based on this evidence. It represents administration, health-care professionals, patients, and representatives of the clinical disciplines affected by each issue. The level of success of the Unit was independently evaluated.Results: To date, 16 reports have been completed, each within 2–4 months. Five recommended unrestricted use, seven recommended rejection, and four recommended very limited use of the technology in question. All have been incorporated into hospital policy. Budget impact is estimated at approximately $3 million of savings per year.Conclusions: This local in-house HTA agency has had a major impact on the adoption of new technology. Probable reasons for success are (i) relevance (selection of topics by administration with on-site production of HTAs allowing them to incorporate local data and reflect local needs), (ii) timeliness, and (iii) formulation of policy reflecting community values by a local representative committee. Because over one third of all health-care costs are incurred in the hospital, diffusion of this model could have a significant effect on the quantity and quality of health-care spending.

Innovation in hospitals: a survey of the literature

“…We will confine ourselves here to examining these last three targets and, in particular, the question of the impacts of innovation on health expenditure and externalities, which seem to figure prominently in the literature. One additional, cross-cutting theme is evaluation (of medical technologies), the aim of which is both to verify the performance of the technologies in their practical applications and to assess their positive or negative consequences for individuals and the wider society [19,[25][26][27].…”

Hospital-Based Health Technology Assessment: Developments to Date

“…This model represents the highest degree of structure for hospital-based HTA [7,18]. The HTA unit is a formal organizational structure, with dedicated HTA personnel working on a full-time basis.…”

“…In Canada, the Technology Assessment Unit (TAU) of McGill University Health Centre (MUHC) in Montreal was the first hospitalbased unit to be established in the province of Quebec in 2001. The TAU-MUHC is composed of two entities: professional staff and a policy committee [7]. The former is made up of staff with expertise in HTA and is in charge of gathering, analysing and synthesizing scientific evidence.…”

“…Nevertheless, one of the main disadvantages of the HTA unit is the financial and time investments it requires. The experience of implementing HTA units in Quebec university hospitals demonstrated that it can take several years for these units to reach their goal and create a culture of evaluation [7]. Experts have reported that the role of HTA units is not always well understood, but that once the HTA unit is established, its recommendations can have a major impact on hospital decisions [22].…”

“…HTA logic has been adopted at the hospital level to provide answers to health authorities with respect to improving the quality and efficiency of care delivery in a context of limited budgets. According to McGregor and Brophy [7], hospital-based HTA could be seen as a means to improve the rationality of the decision-making process.…”