Marianna Cavazza

Stakeholders involvement by HTA Organisations: Why is so different?

OBJECTIVE To investigate stakeholder involvement by Health Technology Assessment Organisations (HTAOs) in France, Spain, England and Wales, Germany, Sweden, and The Netherlands and to examine whether this involvement depends on (i) the administrative tradition and the relevant conception of the relationship between state and society (contractarian and corporative vs. organic), (ii) the general structure of the healthcare system (HCS) (Bismarckian vs. Beveridgian system), and (iii) the role of Health Technology Assessment (HTA) and HTAOs in the HCS. METHODS Given the exploratory nature of the study, we considered interviews based on semi-structured questionnaires the most appropriate data-gathering technique. The interviews were administered to 16 key personnel in the HTAOs concerned. We have also carried out a literature review on HTAOs and stakeholders (1999-2011) using PubMed, Ebsco, JSTOR and Wiley Science. RESULTS In contractarian and (to a lesser extent) Bismarckian models, stakeholders are more involved. The administrative tradition and the HCS appear less important when the HTA is binding and used for regulatory purposes. In such situations, stakeholders are more intensively involved because their participation provides an opportunity for HTAOs to achieve consensus and legitimacy in advance. CONCLUSIONS Despite the limitations of the research (we did not conduct multiple interviews for each HTAO, and key informants were not always available) and its exploratory nature, we can conclude that models of stakeholders involvement cannot easily be transferred from one country to another due to the importance of national administrative traditions and the characteristics of HCSs.

Health care costs of influenza-related episodes in high income countries: A systematic review

Introduction This study systematically reviews costing studies of seasonal influenza-like illness (ILI) in high-income countries. Existing reviews on the economic impact of ILI do not report information on drug consumption and its costs, nor do they provide data on the overall cost per episode. Methods The PRISMA-P checklist was used to design the research protocol. Studies included were cost of illness analysis (COI) and modeling studies that estimated the cost of ILI episodes. Records were searched from January 2000 to December 2016 in electronic bibliographic databases including Medline, Embase, Science Direct, the Cochrane Library, the Centre for Reviews and Disseminations of the University of York, and Google scholar. References from the included studies were hand-searched for completion. Abstract screening, full-text analysis and data extraction were performed by two reviewers independently and discrepancies were resolved by discussion with a third reviewer. A standardized, pre-piloted form was used for data extraction. All costs were converted to 2015 US

Istituti di Health Technology Assessment e portatori di interesse

Purchasing Power Parities. Results The literature search identified 5,104 records. After abstract and title screening, 76 studies were analyzed full-text and 27 studies were finally included in the review. Full estimates of the cost per episode range from US

Social/economic costs and health-related quality of life in patients with Duchenne muscular dystrophy in Europe.

19 in Korea to US

The social burden and quality of life of patients with haemophilia in Italy

323 in Germany. Particularly, the cost per episode of laboratory confirmed influenza cases was estimated between US

De innovatione: The concept of innovation for medical technologies and its implications for healthcare policy-making

64 and US

Social/economic costs and quality of life in patients with haemophilia in Europe

73. Inpatient and outpatient services account for the majority of the costs. Differences in the estimates may reflect country-specific characteristics, as well as other study-specific features including study design, identification strategy of ILI cases, study populations and types of costs included in the analysis. Children usually register higher costs, whereas evidence for the elderly is less conclusive. Patients risk-profile, co-morbidities and complications are the other important cost-drivers. None of the papers considered appropriateness in resource use (e.g. abuse of antibiotics). Despite cost of illness studies have ultimately a descriptive role, evidence on (in)appropriateness is useful for policy-makers.

Governing through Evidence: A Study of Technological Innovation in Health Care

BackgroundThe involvement of stakeholders (internal — third party payers, health care organisations and research centres, external — industry and patients, and clinicians) by HTA Organisations is hugely debated. On the one hand their participation may provide important information for the assessment process and could promote consensus over recommendations. On the other hand stakeholders’ involvement increases complexity in the decision-making process. The actual role of stakeholders and reasons for their different involvement in HTA organisations have not been deeply scrutinised so far. The aim of this paper is to investigate these two issues in six European countries, with a focus on those HTA organisations that assess medical devices (France, Germany, England, the Netherlands, Spain, and Sweden).MethodsWe carried out a literature review (1999–2009), using PubMed, Ebsco, JStore and Wiley Science. In addition, 16 semi-structured interviews were conducted with key personnel in the organisations concerned, consistently with the explorative nature of the study.ResultsWe found huge differences across countries and these differences seem to be due to the administrative tradition, the way the health care system is organised and (even if more doubtful) the role of HTA organisations. External stakeholders are much more involved when the national administrative system is contract-based (e.g. England), whereas an organic conception (e.g. Spain) is more closed to stakeholders’ participation. Internal stakeholders (expecially third party payers) participate more, when the health care system is modeled as social insurance. The impact of administrative tradition and the health care system seem to be less important when recommendations based on HTA are binding and used for policy purposes (reimbursement and, possibly, prices), thus providing for an organisation-specific (and not only country-specific) source of difference.ConclusionsIt may be concluded that stakeholders’ involvement may be strongly influenced by the general context where the HTA organisations operate. As a consequence, a stakeholders’ involvement model cannot be easily transferred from one country to another. Despite of this, it can be stated that external stakeholders’ involvement was generally increasing, expecially when recommendations are binding: this could provide an opportunity for HTA organisations to achieve consensus in advance, thereby facilitating the implementation of any recommendations made.