Health Technology Assessment of Public Health Interventions: A Synthesis of Methodological Guidance

Mathes, Tim; Antoine, Sunya-Lee; Prengel, Peggy; Bühn, Stefanie; Pieper, Dawid

doi:10.1017/s0266462317000228

Cited by 15 publications

(24 citation statements)

References 24 publications

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“…The inadequacy of HTA from an overall PH perspective is also reported in literature (12,(25)(26)(27). One of the underlying reasons probably lays in the multi-dimensional character of PH, a field which is increasingly affected by a full range of extra-clinical circumstances (28,29), including demographic transitions (30) and modifiable risk factors of disease development associated with unhealthy lifestyle habits in the general population (31)(32)(33)(34)(35).…”

Section: Discussionmentioning

confidence: 93%

“…The key issue with building the evidence base for initiatives such as social prescribing as well as PH interventions in general lies in the fact that applying the golden standard of evidence (i.e., double-blinded randomized controlled trials) might not be adapted. Pragmatic trials, as a more naturalistic approach, might provide a better picture of effectiveness, while evidence summaries may include a realist synthesis as opposed to standard systematic review approaches (12,(18)(19)(20). This being said, it should be kept in mind that good evidence does not necessarily lead to good policy (21).…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review about HTAs of PH interventions reported a limited number of guidelines in this field. The authors also observed numerous, and often unjustified, changes to recommendations such as adaptations in the processes of quality evaluation, assessment of applicability, and integration of qualitative and quantitative evidence (12,13). These methodological tweaks were mainly linked to the fact that complex PH interventions implement diverse methodologies that often fall outside a controlled experimental setup such as those processed in randomized controlled trials.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating Public Health Interventions: A Neglected Area in Health Technology Assessment

Stojanovic

Wübbeler

Geis

et al. 2020

Front. Public Health

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Introduction: Public health (PH) interventions are crucial for ensuring sustainable healthcare services. Nevertheless, they represent a neglected area in the field of health technology assessment (HTA) due to various methodological issues and their complex design that goes beyond clinical setting. The present study provides an environmental scan of HTA initiatives related to the assessment of PH technologies on a global level.Methods: We conducted a cross-sectional survey among 85 HTA-related European and international societies, health bodies, and networks from September 2018 to January 2019. The questionnaire contained four sections and 18 questions regarding activities related to the evaluation of PH technologies, information on existing PH technologies, and methodologies of assessment as well as barriers and facilitators to reaching a decision and implementing a PH technology.Results: Among 52 survey responses, the majority of the respondents came from European countries (35%), followed by North American (27%), and South American (19%) countries. The main type of organizations covered by our survey included HTA agencies, public administrations, and research institutes. Seventy-one % of the institutions reported engagement in any aspect of HTA in the area of PH (N = 37). Among those, 81% evaluated less than 5 PH technologies from 2013 to 2018. The most common barriers for reaching a decision on PH technologies were lack of data, conflicting stakeholder priorities, and methodological issues. A total of 76 PH interventions were reported, and most cited initiatives were related to chronic disease screening, prevention of infectious diseases, and maternal, prenatal, and neonatal screening.Conclusion: Our survey reported a rather limited involvement of HTA in the evaluation of PH technologies. In particular, an evaluation of behavioral and lifestyle interventions remains extremely rare. The implementation of collaborative HTA approaches in the setting of PH practice and policy needs to be prioritized and further strengthened. Moreover, ensuring reliable data structures and consolidation of HTA methods for the evaluation of PH technologies will be crucial for tackling the enormous burden of non-communicable diseases in societies.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluating Public Health Interventions: A Neglected Area in Health Technology Assessment

Stojanovic

Wübbeler

Geis

et al. 2020

Front. Public Health

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“…Authors of primary and secondary research find context challenging to operationalise, research and evaluate 23. Primary studies are criticised for failing to characterise context,17 yet many guidance documents recommend that contextual factors are examined within systematic reviews and syntheses 24. Review teams face particular challenges resulting from (1) the lack of contextual detail in included studies and (2) unsophisticated approaches to handling context within existing review tools.…”

Section: How Is Context Defined and Understood?mentioning

confidence: 99%

Taking account of context in systematic reviews and guidelines considering a complexity perspective

et al. 2019

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Systematic review teams and guideline development groups face considerable challenges when considering context within the evidence production process. Many complex interventions are context-dependent and are frequently evaluated within considerable contextual variation and change. This paper considers the extent to which current tools used within systematic reviews and guideline development are suitable in meeting these challenges. The paper briefly reviews strengths and weaknesses of existing approaches to specifying context. Illustrative tools are mapped to corresponding stages of the systematic review process. Collectively, systematic review and guideline production reveals a rich diversity of frameworks and tools for handling context. However, current approaches address only specific elements of context, are derived from primary studies which lack information or have not been tested within systematic reviews. A hypothetical example is used to illustrate how context could be integrated throughout the guideline development process. Guideline developers and evidence synthesis organisations should select an appropriate level of contextual detail for their specific guideline that is parsimonious and yet sensitive to health systems contexts and the values, preferences and needs of their target populations.

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“…Although randomized controlled trials are considered the standard method for the evaluation of health interventions (Cochrane, 1989), they are not often available in the field of public health as they are usually difficult to conduct (Petticrew et al, 2012). Mathes et al (2017), reviewed the existing HTA guidelines for this type of technology, and concluded that methods to evaluate public health interventions are not sufficiently developed or have not been adequately evaluated.…”

Section: Introductionmentioning

confidence: 99%

The use of intervention analysis of the mortality rates from breast cancer in assessing the Brazilian screening programme

et al. 2018

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There is a need to develop methods to evaluate public health interventions. Therefore, this work proposed an intervention analysis on time series of breast cancer mortality rates to assess the effects of an action of the Brazilian Screening Programme. Methods: The analysed series was the monthly female breast cancer mortality rates from January 1996 to March 2016. The intervention was the establishment of the National Information System on Breast Cancer in June 2009. The Box-Tiao approach was used to build a Global Intervention Model (GIM) composed of a component that fits the series without the intervention, and a component that fits the effect with the intervention. The intervention's response time was estimated and used to define the length of the residual series to assess the predictive accuracy of the GIM, which was compared to a one-step-ahead forecasting approach. Results: The pre-intervention period was fitted to a SARIMA (0,1,2) (1,1,1)12 model and the intervention's effect to an ARIMA (1,1,0) model. The intervention led to an increase in the mortality rates, and its response time was 24 months. The forecast error (MAPE) for the GIM was 3.14%, and for the one-step-ahead forecast it was 2.15%. Conclusion: This work goes one step further in relation to the studies carried out to evaluate the Breast Cancer Screening Programme in Brazil, considering that it was possible to quantify the effects and the response time of the intervention, demonstrating the potential of the proposed method to be used to evaluate health interventions.

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Health Technology Assessment of Public Health Interventions: A Synthesis of Methodological Guidance

Cited by 15 publications

References 24 publications

Evaluating Public Health Interventions: A Neglected Area in Health Technology Assessment

Evaluating Public Health Interventions: A Neglected Area in Health Technology Assessment

Taking account of context in systematic reviews and guidelines considering a complexity perspective

The use of intervention analysis of the mortality rates from breast cancer in assessing the Brazilian screening programme

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