HTA – Lecture 1 – Introduction to HTA and
economic evaluation
Two key questions
- How much to be spend on healthcare versus other social priorities
- Given our healthcare budget which treatments should we provide
Opportunity cost; next best alternative costs
• Money spent on health care cannot be spent on education, infrastructure
etc.
• Money spent on technology A cannot be spent on technology B
To reimburse or not to reimburse
- Resources in healthcare are limited
- Decisions need to be made
- Decisions have real and large impacts on spending and health
- A formal process for decision making is required
What is HTA?
Formal definition (WHO)
HTA is the systematic evaluation of properties, effects and/or impacts of health
technologies and interventions. It covers both the direct, intended
consequences (improvement duration of life and adverse events) of
technologies and interventions and their indirect, unintended consequences
In other words
Formal process for assessing the value of medical technologies.
Other information
Pre-requisite for reimbursement of new technologies in many countries but
systems differ significantly
- Clinical effectiveness and safety vs. cost effectiveness core sources
of decision making in HTA
o If you improve quality of life impact on complications, reduces costs
go hand in hand therefore
6 Steps of performing HTA
,Step 1 – A) trial based and model based economic evaluation
Trial based
- Directly observe the costs and benefits of the intervention
Advantages:
- Don’t have to make assumptions about the effect
- More certain because of the potential in the randomization
Challenges
- Shorter follow up; shorter than period we are interested in
- Limited data collection due to missing data given the time frame
Model based
- Gather all the information we can gather, extract data beyond and answer
policy questions
Advantages
• Direct analysis to policy questions
• Synthesise all available evidence
Challenges
• Indirect evidence, question of relevance; not observing things directly,
abstract model framework
• Integration of evidence challenging;
• Outcomes not directly observe
,What perspective to we focus on?
Health care perspective; NHS only looking at the healthcare budget
Societal perspective: also tax revenue from being able to work Netherlands
What is the most appropriate comparator?
• Most efficient alternative
• Standard treatment
• Consider “no treatment
Discussion
• Ozempic has been approved for weight loss in patients with obesity by the
regulators
• The Zorginstituut want to understand the cost-effectiveness of Ozempic in
the Netherlands
• GLI
Type of analysis
Only costs
- Cost minimization analysis (CMA)
- effects are equal, focus on costs
Cost and effects in monetary terms
- Cost benefit analysis (CBA)
- Weigh cost and benefits in the same units
Costs in monetary terms, effects in natural units
- Cost-effectiveness analysis (CEA) other units than QALY for example
Costs in monetary terms, effects in QALYs
- Cost-utility analysis (CUA) outcome as QALY
, Time horizon
- Long enough o caputure all consequences to be taken in account, for
example overall survival must be long. Focus on the life time horizon
o More mild as colds can take a smaller time frame
- How to do so?
o RCT
o Observational study
o Modelling (trial and extent beyond this)
o Combination
Perform the first step for the comparison!!!!
• Perspective – Who is going to pay?
• Comparator
• Type of analysis
• Time horizon
Step 2; measuring and valuing costs
• Identify all relevant cost items- resources
• Measure resource use
• Value resource use
• Which costs are relevant depends on the perspective!
What kinds of resources are to measure in proton therapy Capital costs,
medical staff,
economic evaluation
Two key questions
- How much to be spend on healthcare versus other social priorities
- Given our healthcare budget which treatments should we provide
Opportunity cost; next best alternative costs
• Money spent on health care cannot be spent on education, infrastructure
etc.
• Money spent on technology A cannot be spent on technology B
To reimburse or not to reimburse
- Resources in healthcare are limited
- Decisions need to be made
- Decisions have real and large impacts on spending and health
- A formal process for decision making is required
What is HTA?
Formal definition (WHO)
HTA is the systematic evaluation of properties, effects and/or impacts of health
technologies and interventions. It covers both the direct, intended
consequences (improvement duration of life and adverse events) of
technologies and interventions and their indirect, unintended consequences
In other words
Formal process for assessing the value of medical technologies.
Other information
Pre-requisite for reimbursement of new technologies in many countries but
systems differ significantly
- Clinical effectiveness and safety vs. cost effectiveness core sources
of decision making in HTA
o If you improve quality of life impact on complications, reduces costs
go hand in hand therefore
6 Steps of performing HTA
,Step 1 – A) trial based and model based economic evaluation
Trial based
- Directly observe the costs and benefits of the intervention
Advantages:
- Don’t have to make assumptions about the effect
- More certain because of the potential in the randomization
Challenges
- Shorter follow up; shorter than period we are interested in
- Limited data collection due to missing data given the time frame
Model based
- Gather all the information we can gather, extract data beyond and answer
policy questions
Advantages
• Direct analysis to policy questions
• Synthesise all available evidence
Challenges
• Indirect evidence, question of relevance; not observing things directly,
abstract model framework
• Integration of evidence challenging;
• Outcomes not directly observe
,What perspective to we focus on?
Health care perspective; NHS only looking at the healthcare budget
Societal perspective: also tax revenue from being able to work Netherlands
What is the most appropriate comparator?
• Most efficient alternative
• Standard treatment
• Consider “no treatment
Discussion
• Ozempic has been approved for weight loss in patients with obesity by the
regulators
• The Zorginstituut want to understand the cost-effectiveness of Ozempic in
the Netherlands
• GLI
Type of analysis
Only costs
- Cost minimization analysis (CMA)
- effects are equal, focus on costs
Cost and effects in monetary terms
- Cost benefit analysis (CBA)
- Weigh cost and benefits in the same units
Costs in monetary terms, effects in natural units
- Cost-effectiveness analysis (CEA) other units than QALY for example
Costs in monetary terms, effects in QALYs
- Cost-utility analysis (CUA) outcome as QALY
, Time horizon
- Long enough o caputure all consequences to be taken in account, for
example overall survival must be long. Focus on the life time horizon
o More mild as colds can take a smaller time frame
- How to do so?
o RCT
o Observational study
o Modelling (trial and extent beyond this)
o Combination
Perform the first step for the comparison!!!!
• Perspective – Who is going to pay?
• Comparator
• Type of analysis
• Time horizon
Step 2; measuring and valuing costs
• Identify all relevant cost items- resources
• Measure resource use
• Value resource use
• Which costs are relevant depends on the perspective!
What kinds of resources are to measure in proton therapy Capital costs,
medical staff,
