health technology assessment : interpreting a hta report

HEALTH HEALTH TECHNOLOGY TECHNOLOGY ASSESSMENT ASSESSMENT (HTA): (HTA): INTERPRETING INTERPRETING A HTA REPORTA HTA REPORT

DR JUNAINAH SABIRIN

DATIN DR RUGAYAH BAKRI

OUTLINEOUTLINE

IntroductionMaHTAS HTA productsChecklist for HTA reports

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INTRODUCTIONINTRODUCTION Proponent to the MOH’s vision for health: “A NATION WORKING TOGETHER FOR BETTER HEALTH”

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MaHTAS

Health Technology Assessment Unit established under Medical

Dev. Div., Ministry of Health (MOH) in keeping with the

Ministry’s policy of ensuring that safe, effective and cost-effective health technologies are being used in the MOH

facilities

HTA Unit upgraded to HTA Section, and

development of evidence-based CPG

put under HTA Section’s purview

- to reduce variation in practice in improving

quality of care

HTA Section designated as WHO Collaborating Centre for Evidence-Based in Health-Care Practice for Asia Pacific region

INTERNATIONAL INTERNATIONAL NETWORKINGNETWORKING

oMember of international organization/network: INAHTAHTAiG-I-N ISPORHTA AsiaLink EVIP Net Asia

INAHTA : International Network of Agencies for Health Technology Assessment

HTAi : Health Technology Assessment International

G-I-N : Guidelines International Network

ISPOR : International Society for Pharmacoeconomics and Outcome Research

HTA AsiaLink : Collaboration between HTA agencies in Asia : Singapore, Thailand,

Korea, Japan, Taiwan & China

EVIP Net Asia : Evidence-based Informed Policy Network

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MAHTAS FUNCTIONMAHTAS FUNCTION Conduct health technology assessment or

rapid assessment Coordinate formulation and implementation

of evidence-based CPGs Provide training Conduct horizon scanning (New activity)

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HTA ….HTA …. HTA is the systematic evaluation of

properties, effects, and / or impacts of health care technology. May address the direct, intended consequences of technologies as well as their indirect, unintended consequences.

Main purpose is to inform technology-related policy making in health care:

Acquisition / Adoption / Implementation of new health technology

Continued use of existing technology Disengage the use of obsolete technology Advertisement related to health technology Reimbursement

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MAHTAS HTA PRODUCTS MAHTAS HTA PRODUCTS InformationBrief (Rapid Review)

Very rapid information response- Urgent information need or decision problem-Look for high level of evidence, may restrict the literature search to 1 or 2 database-Preparation time: 2 weeks

Technology review report (Mini HTA)

Reacting to an existing decision problem -Less comprehensive report-Smaller scope of assessment (evaluate safety, effectiveness issues, costs/financial impact)-May be externally reviewed-Preparation time: 2-4 months

Health Technology Assessment (HTA) reports

Traditional assessments (Comprehensive report)-Anticipating a future decision problem-Decision can wait (to some extent) based on evidence-Evaluate safety, effectiveness issues, cost-effectiveness/financial impact, organizational considerations. may also address ethical, social and legal implications-Expert committee and externally reviewed-Preparation time: 8-18 months after approval by HTA CPG Council

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9

OUTPUT

6

3

6

1

5

34

6

2 21

43 3

43

2

78

12

46

37

22

2728

3130

20

28

0

3

13

10

64 4

8

67

8

65

0

5

10

15

20

25

30

35

40

Number

Year

No. of HTA, TR, CPG dan IB (1997 - 2013)

HTA

TR

CPG

Info brief

TOTAL NO. OF PRODUCTS (as of 2013)TOTAL NO. OF PRODUCTS (as of 2013) Health Technology Assessment (HTA) reports = 58 58 (1997-2013) Technology Review (Rapid assessment) reports = 260 260 (1997-2013) Clinical Practice Guidelines (CPGs) = 8080 (2001-2013) Information Brief = 5858 (2009-2013)

MaHTAS

HTA (1998-2013) TR (2001-2013)

HTA & TR OUTPUT BY TYPES OF HEALTH HTA & TR OUTPUT BY TYPES OF HEALTH TECHNOLOGIES :1997-2013 TECHNOLOGIES :1997-2013

HTA REPORTSHTA REPORTS

MaHTAS

ONLINE ONLINE ACCESSIBILITYACCESSIBILITY

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Click

e.g. search CPG/HTA by category or title

MAHTAS MOBILE APP MAHTAS MOBILE APP (MYMAHTAS)(MYMAHTAS)

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CHECKLIST FOR HTA REPORTSCHECKLIST FOR HTA REPORTS

Prepared by INAHTA Aid to ensure consistent and transparent approach to

HTA Clear identification in an HTA report of what has been

done in an assessment and any significant limitation in the analysis

Help reader of HTA report to easily obtain information on purpose, method used, assumptions made and conclusion reached

15GLOBAL NETWORKING FOR EFFECTIVE HEALTHCARE

INTENDED AUDIENCEINTENDED AUDIENCE

oUSER• Gives guidance on what to look for in an HTA

report and assess the reliability of the information

oPRODUCER• Gives points that should be considered during

the planning, conducting and reporting of the assessment

• Improve the quality of HTA products

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CHARACTERISTICS OF CHARACTERISTICS OF HTA REPORTHTA REPORT

A clear formulation of the problem An explicit methods A wide scope of the technology• Assessments will vary considerably in their depth and

scope of analysis, given differences in the types of problem being addressed, policy requirements and the time and resources available for assessment

o Strength relies on transparency in the assessment process and in the reporting

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HTA REPORTSHTA REPORTS Variations in the content of HTA reports Main content: - Policy question / issues - Objective - Research questions - Background information - Methods - Results - Conclusions

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CONTEXT OF CONTEXT OF MATERIAL IN MATERIAL IN CHECKLISTCHECKLIST Checklist contains only brief details of a number

of important points relating to HTA reports (14 questions)

HTA report may be a valid and useful source of information even if it does not include a number of elements in the checklist

Not essential for an HTA report to include all the attributes given in the checklist

The significance of any omissions in an HTA report will depend on how it is to be used by the reader 19

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Copyright INAHTA Secretariat 2007

A checklist for HTA reports This summary form is intended as an aid for those who wish to make a record of the extent to which a health technology assessment report meets the 14 questions given in the checklist.

It is NOT intended as a scorecard to rate the standard of HTA reports — reports may be valid and useful without meeting all the criteria that have been listed.

Item Yes Partly

No

Preliminary

1. Appropriate contact details for further information?

2. Authors identified?

3. Statement regarding conflict of interest?

4. Statement on whether report externally reviewed?

5. Short summary in non-technical language?

Why?

6. Reference to the policy question that is addressed?

7. Reference to the research question(s) that is/are addressed?

8. Scope of the assessment specified?

9. Description of the assessed health technology?

How? 10. Details on sources of information and literature search strategies provided?

Search strategy

Databases Year range Language restriction

Primary data Other kind of information resources

O O O O O O

Complete reference

list of included studies List of excluded

studies Inclusion criteria Exclusion criteria

O O O O

11. Information on basis for the assessment and interpretation of selected data and information?

Method of data extraction described?

Critical appraisal method (for quality assessment of the

literature) described?

Method of data synthesis described?

Results of the assessment clearly

presented, e.g. in the form of evidence

tables? O O O O

Context? (may or may not apply to each HTA)

(Medico-) legal implications considered?

Economic analysis

provided?

Ethical implications considered?

Social implications considered?

Other perspectives (stakeholders,

patients, consumers) considered?

O O O O O

What then? Yes Partly No

12. Findings of the assessment discussed?

13. Conclusions from assessment clearly stated?

14. Suggestions for further action?

PRELIMINARY INFORMATIONPRELIMINARY INFORMATION

1. Appropriate contact details for further information?

Contact person or position with appropriate address

1. Authors identified? Clear indication of persons who were involved

in preparing the report and their roles Authors/Committee members

1. Statement regarding conflict of interest? Statement of “no conflict of interest” Funding Non-financial matters

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Yes / Partly /No

PRELIMINARY INFORMATIONPRELIMINARY INFORMATION

4. Statement on whether report externally reviewed?o Measure to improve its quality and credibilityo Names and affiliations of persons who have

provided comment or information during preparation of report

5. Short summary in non-technical language?o Executive summary/Abstract – addressed for

policy-makerso Focused on conclusion and recommendation

22Yes / Partly /No

WHY THE ASSESSMENT WHY THE ASSESSMENT HAS BEEN HAS BEEN UNDERTAKENUNDERTAKEN

6. Reference to the policy question that is addressed?o Why the assessment has been undertaken? o Who requested?

6. Reference to the research question that is / are addressed?o Define the research questions

23Yes / Partly /No

WHY THE ASSESSMENT HAS WHY THE ASSESSMENT HAS BEEN UNDERTAKENBEEN UNDERTAKEN8. Scope of the assessment specified?

o Indicate the attributes of the technology addressed and areas that are not included in the assessment

8. Description of the assessed health technology?

o Short description of technology – what, how it works?

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Yes / Partly /No

HOW THE ASSESSMENT HAS HOW THE ASSESSMENT HAS BEEN UNDERTAKENBEEN UNDERTAKEN

10. Sources of information used?o Search strategyo Databaseso Yearo Language restrictiono Use of primary data, other kind of informationo Complete reference list of included studieso List of excluded studieso Inclusion criteriao Exclusion criteria

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√ where appropriate

HOW THE ASSESSMENT HAS HOW THE ASSESSMENT HAS BEEN UNDERTAKENBEEN UNDERTAKEN

11. Information on basis for the assessment and the interpretation of selected data and information?o Method of data extraction describedo Critical appraisal method (quality assessment)o Method of data synthesis describedo Results of the assessment clearly presented (e.g

evidence table)

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√ where appropriate

CONTEXTCONTEXTInformation on context (may or may not apply to each HTA)

Medico-legal implications Economic analysis Ethical implications Social implications Wider perspectives (stakeholders, patients,

consumers)

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√ where appropriate

IMPLICATIONS OF THE IMPLICATIONS OF THE ASSESSMENT ASSESSMENT RESULTS AND CONCLUSIONSRESULTS AND CONCLUSIONS

12. Findings of the assessment discussed? Discussion should include:o Relationship of the results obtained to the question

being addressed by the assessmento Comment on missing or uncertain informationo Basis for the opinion and conclusions in the report

13. Conclusions from the assessment clearly stated? Clear conclusion with reference to the policy and

research questions13. Suggestion for further action?

Research, information gaps

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Yes / Partly /No

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THANK YOU