Health Technology Assessment
GW4585M
Lecture 1: Introduction to HTA
Health technologies = medicines, medical devices, screening programs, etc.
Health Technology Assessment (HTA) = the systematic evaluation of properties, effects and/or impacts
of health technologies and interventions (WHO definition)
a) Direct, intended consequences of technologies and interventions
b) Indirect, unintended consequences
- Important advisory tool to make transparent and unbiased decisions
- Necessary for deciding on reimbursement in many countries
- Assure value for money
HTA Core Model Domains
HTA Core Model = methodological framework for the production and sharing of HTA information.
Decision-making: “Should we reimburse this health technology?”
Core domains for Rapid Relative Effectiveness Assessment (REA):
• Cur: Current use of technology
• Tec: Technical characteristics
• Saf: Safety (adverse events, risks)
• Eff: Clinical effectiveness (outcomes compared to
standard)
National assessment and for Member States:
• Eco: Cost and economic evaluation
• Eth: Ethical analysis (equity, access, vulnerable groups)
• Org: Organisational aspects (implementation)
• Soc: Patient and social (patient preferences, QAL,
acceptability)
• Leg: Legal aspects (liability issues, data protection,
regulations, national law)
Example: Trodelvy medicine vs. Chemo (for breast cancer)
Scores:
o 5.7 vs. 12.1 = number of months, so in this case 6.4 additional months for the SG treatment.
o 46.4% vs. 64% = how many people in each group experienced severe side effects.
,Progression-free survival = period in which the disease does not progress (moderately symptom-free),
control of the disease, so a stable situation.
HTA process
Economic evaluations provide insights costs and effects: (new) interventions vs. existing interventions.
The 5 steps of performing an economic evaluations in healthcare:
,- Which costs depend in the perspective.
, Economic evaluations
• Rationalizing rationing decisions
o Not about cost-saving
o Efficiency in HC spending: value for money
The NICE Cost-Effectiveness Threshold
National Institute for Health and Clinical Excellence (NICE): uses a cost-effectiveness threshold range
between £20.000 and £30.000 per QALY.
• Represents the Opportunity Cost (= health that is lost when a new treatment is funded).
Threshold-searcher idea:
• The threshold should reflect the cost per QALY of the least efficient treatment currently
funded by the National Healthcare System (NHS)
o So which health would be displaced.
• NICE approximates the NHS productivity at the margin.
There is a concern that the NICE Threshold is too high relative to the actual NHS productivity.
Incremental Cost-Effectiveness Ratio →
If treatment has a large budget impact (takes away more of the total budget), it will displace more
services, so more health is lost elsewhere.
• Not only: “Is this treatment efficient per patient?”
• Also: “How much total health must be taken elsewhere to pay for this?”
So, treatment with large budget impact should be more cost-effective, lower acceptable ICER.
If NICE approves a treatment above the threshold, the total population health decreases (more health
is displaced than gained).
• Focus on investment decisions, but active disinvestment is also important.
Threshold should reflect:
a) NHS budget changes
b) Productivity changes
c) Efficiency improvements
GW4585M
Lecture 1: Introduction to HTA
Health technologies = medicines, medical devices, screening programs, etc.
Health Technology Assessment (HTA) = the systematic evaluation of properties, effects and/or impacts
of health technologies and interventions (WHO definition)
a) Direct, intended consequences of technologies and interventions
b) Indirect, unintended consequences
- Important advisory tool to make transparent and unbiased decisions
- Necessary for deciding on reimbursement in many countries
- Assure value for money
HTA Core Model Domains
HTA Core Model = methodological framework for the production and sharing of HTA information.
Decision-making: “Should we reimburse this health technology?”
Core domains for Rapid Relative Effectiveness Assessment (REA):
• Cur: Current use of technology
• Tec: Technical characteristics
• Saf: Safety (adverse events, risks)
• Eff: Clinical effectiveness (outcomes compared to
standard)
National assessment and for Member States:
• Eco: Cost and economic evaluation
• Eth: Ethical analysis (equity, access, vulnerable groups)
• Org: Organisational aspects (implementation)
• Soc: Patient and social (patient preferences, QAL,
acceptability)
• Leg: Legal aspects (liability issues, data protection,
regulations, national law)
Example: Trodelvy medicine vs. Chemo (for breast cancer)
Scores:
o 5.7 vs. 12.1 = number of months, so in this case 6.4 additional months for the SG treatment.
o 46.4% vs. 64% = how many people in each group experienced severe side effects.
,Progression-free survival = period in which the disease does not progress (moderately symptom-free),
control of the disease, so a stable situation.
HTA process
Economic evaluations provide insights costs and effects: (new) interventions vs. existing interventions.
The 5 steps of performing an economic evaluations in healthcare:
,- Which costs depend in the perspective.
, Economic evaluations
• Rationalizing rationing decisions
o Not about cost-saving
o Efficiency in HC spending: value for money
The NICE Cost-Effectiveness Threshold
National Institute for Health and Clinical Excellence (NICE): uses a cost-effectiveness threshold range
between £20.000 and £30.000 per QALY.
• Represents the Opportunity Cost (= health that is lost when a new treatment is funded).
Threshold-searcher idea:
• The threshold should reflect the cost per QALY of the least efficient treatment currently
funded by the National Healthcare System (NHS)
o So which health would be displaced.
• NICE approximates the NHS productivity at the margin.
There is a concern that the NICE Threshold is too high relative to the actual NHS productivity.
Incremental Cost-Effectiveness Ratio →
If treatment has a large budget impact (takes away more of the total budget), it will displace more
services, so more health is lost elsewhere.
• Not only: “Is this treatment efficient per patient?”
• Also: “How much total health must be taken elsewhere to pay for this?”
So, treatment with large budget impact should be more cost-effective, lower acceptable ICER.
If NICE approves a treatment above the threshold, the total population health decreases (more health
is displaced than gained).
• Focus on investment decisions, but active disinvestment is also important.
Threshold should reflect:
a) NHS budget changes
b) Productivity changes
c) Efficiency improvements
