David Hailey

THE USE AND IMPACT OF RAPID HEALTH TECHNOLOGY ASSESSMENTS

OBJECTIVESnTo consider the impact of rapid health technology assessments undertaken as part of a program in a provincial healthcare system in response to urgent requests for advice.nnnMETHODSnReview of the development and preparation of 20 rapid assessment reports, communication with decision makers within the healthcare system, and appraisal of data subsequent to preparation of the reports.nnnRESULTSnFourteen of the assessments were judged to have had an influence on policy and other decisions, as judged by responses from those who had requested advice. Another four were considered to have provided guidance, while having less immediate influence on decisions, and two others had no apparent impact. Quality of the assessments was considered acceptable, on the basis of literature that subsequently became available and from comments received.nnnCONCLUSIONSnThese brief reports are considered to be a useful component of a health technology assessment program. However, they should be regarded as provisional appraisals and followed up with more detailed evaluation where possible.

TOWARD TRANSPARENCY IN HEALTH TECHNOLOGY ASSESSMENT A Checklist for HTA Reports

OBJECTIVESnAs an initiative of the International Network of Agencies for Health Technology Assessment (INAHTA), a checklist for assessment reports was developed as a means of improving transparency and consistency in HTA.nnnMETHODSnPreparation of a summary of key elements in HTA reports, drawing on experience in preparation of such documents, information from guidelines for HTA, and individual assessments. Review by INAHTA agencies and modification of the summary to reflect the consensus.nnnRESULTSnThe resulting checklist includes 17 questions, with supporting detail. General areas covered include preliminary information, why and how the assessment has been prepared, the results of the assessment, implications of the results, and conclusions.nnnCONCLUSIONSnThe checklist is intended to be considered by those preparing or using an HTA report. It reflects the views of INAHTA members and is seen as a mechanism to improve the standard of HTA reports, being complementary to the more detailed guidelines on how to conduct assessments.

Elements for assessment of telemedicine applications.

OBJECTIVESnAs an initiative of the International Network of Agencies for Health Technology Assessment, an approach to assessment of telemedicine applications was prepared to assist decision makers who are considering introduction and use of this technology.nnnMETHODSnReview and commentary drawing on published assessment frameworks and reports of primary evaluations of telemedicine, with particular reference to experience in Finland and Canada.nnnRESULTSnElements of the approach included development of a business case (considering population and services, personnel and consumers, delivery arrangements, specifications and costs); subsequent evaluation of the telemedicine application; and follow-up (covering the domains of technical assessment, effectiveness, user assessment of the technology, costs of telemedicine, trials, economic evaluation methods, and sensitivity analysis).nnnCONCLUSIONSnDecision makers should link introduction of new and often costly technology to appraisal of its feasibility, followed by evaluation of the application, including longer term consideration of its sustainability and impact on the healthcare system. As the effectiveness and efficiency of telemedicine applications will often be strongly influenced by local issues, results of assessments may not be generalizable.

An assessment of gait analysis in the rehabilitation of children with walking difficulties.

Purpose: To assess the current status of computerized gait analysis techniques in the management of children with cerebral palsy or spina bifida who have significant walking disorders. Method: Synthesis of available data from a review of the literature, drawing on MEDLINE, EMBASE, PRE-MEDLINE, HealthStar and PsychInfo. Other information was obtained from persons with expertise in computerized gait analysis. Cost data were obtained from Canadian rehabilitation centres and the provincial health ministry. Results: This technology seems helpful in detecting gait changes. However, available evidence is insufficient to draw conclusions about the influence of computerized gait analysis on treatment outcomes. Part of the rationale for use of the technology is that costs of gait analysis (of the order of

Linking evidence from health technology assessments to policy and decision making: The Alberta Model

CAN 2,000 per examination) would be offset by a decrease in followup surgical procedures and associated hospital care. There could also be a major influence on childrens independence and quality of life. However, there are as yet no convincing data to support these propositions. Conclusions: Computerized gait analysis is a potentially useful technology in the management of children with walking disabilities, but its efficacy is not established. It should be regarded as a developing technology and its clinical application linked to systematic collection and assessment of outcomes data.

The Effectiveness of Bone Density Measurement and Associated Treatments for Prevention of Fractures: An International Collaborative Review

OBJECTIVESnThe objective of this study was to develop and implement a decision-making process for public funding of health services that links policy areas with health technology assessment and input from interested parties.nnnMETHODSnHealth authorities, assessment organizations, and healthcare professionals were consulted as a follow-up to recommendations of an expert panel established by the Alberta government. The methods involved formulation of an eight-stage, collaborative process that incorporates identification through the health ministry of health technologies requiring review, assessment of the technologies using expert groups in Alberta, and consultation and formulation of advice within the ministry to inform ministerial funding decisions.nnnRESULTSnAll components of the decision process have been put in place and have collaborated to provide advice to inform policy on provincial health services. Of nineteen technologies selected for review, five have been completed and decisions made: laparoscopic adjustable gastric banding, fetal fibronectin assay for premature labor, newborn screening for cystic fibrosis, newborn screening for inborn errors of metabolism, and gastric electrical stimulation. A further six reviews are in progress, and reviews of the remaining technologies are planned for 2007.nnnCONCLUSIONSnBridging the evidence-to-policy gap is more likely to succeed when the policy community is actively engaged and an explicit model is used to put health technology assessment into practice.

A SHORT HISTORY OF INAHTA

This review assesses the evidence regarding the effectiveness of bone density measurement (BDM) screening and related interventions--hormone replacement therapy (HRT) and intranasal salmon calcitonin (SCT[N])--in menopausal women to prevent fractures in later life. Data sources included systematic reviews of evidence and relevant primary studies identified through literature searches on MEDLINE and EMBASE. Study selection included trials of BDM screening programs, prospective studies examining the predictive value of BDM, randomized controlled trials, cohort studies, and case-control studies of HRT and SCT (N). The evidence was evaluated using a classification system incorporating study design and quality. Outcomes were measured in terms of relative risk of fracture for a 1 SD decrease in bone mineral density below the age-adjusted mean, relative risks or odds ratios for fractures associated with treatments, and proportion of hip fractures potentially prevented by BDM screening linked to treatments. Fair evidence from prospective cohort studies suggests that BDM can predict the risk of fractures, but not with high accuracy. Fair evidence from low-quality randomized controlled trials and observational studies suggests that HRT and SCT(N) are efficacious in preventing fractures. Good evidence supports the efficacy of these treatments in preserving bone mass, but there is fair evidence that the effect wears off after cessation of therapy. There is little evidence on the impact of screening menopausal women with BDM in association with HRT or SCT(N) treatment. Estimates based on combining existing evidence regarding the predictive value of BDM and efficacy of HRT suggests that 1-7% of hip fractures might be prevented.

A preliminary survey on the influence of rapid health technology assessments.

The need for better communication and collaboration between health technology assessment agencies led to the formation of an International Network of Agencies for Health Technology Assessment (INAHTA). The network now comprises 27 agencies and has been successful in improving exchange of information and in undertaking joint health technology assessment projects. Issues for the future include possible changes to criteria for membership and identification of resources for more extensive programs.

Providing information on emerging health technologies to provincial decision makers: a pilot project

OBJECTIVESnThe aim of this study was to obtain information on rapid health technology assessments (HTAs) prepared by members of the International Network of Agencies for Health Technology Assessment (INAHTA).nnnMETHODSnA questionnaire was prepared, drawing on earlier INAHTA documents for recording HTA impact. A request for responses was sent to member agencies, seeking information on rapid HTA reports prepared during 2006.nnnRESULTSnResponses were provided on fifteen rapid HTAs, which covered both new and widely distributed technologies. The most common purpose for the HTAs (n = 8) was to inform coverage decisions, but other reasons included capital funding, formulary decisions, referral for treatment, program operation, guideline formulation, influence on routine practice, and indications for further research. All the rapid HTAs were considered by the agencies to have had some influence. The most common indications of influence were consideration by the decision maker, use of the HTA as reference material (both n = 10), and acceptance of recommendations or conclusions (n = 8).nnnCONCLUSIONSnRapid HTAs are used for a broad range of technologies, to inform several types of decision, and are effective in informing the decision-making process. Supplementation of their findings by further assessments will be appropriate in some cases.

Allogeneic stem cell transplantation. An economic comparison of bone marrow, peripheral blood, and cord blood technologies.

A pilot project to provide advice on new and emerging medical technologies to decision makers in a provincial health care system was undertaken by a health technology assessment (HTA) program. Briefs were prepared on technologies which were not yet available in the province and which might have a significant impact on health care. These were sent to the ministry of health and regional health authorities and made available through the agencys website. Reaction to the briefs was sought from decision makers. Decision makers in the health ministry and health authorities found the briefs helpful, and wished to continue receiving them. They had made limited use of them for planning purposes, but the briefs provided useful input to further consideration of technologies in several cases. Within the HTA program, the briefs and the process that produced them were valuable in increasing awareness of new health technologies that might require assessment in future. This pilot project demonstrated the feasibility of providing timely advice on emerging health technologies within a provincial health system. However, while decision makers found the information provided to be useful, this had not yet been integrated with provincial health care planning. Necessary machinery within policy areas and communication with the HTA process appear to be in need of development.