Basic concepts and fundamental issues in technology assessment

Evidence-Based Decision Making 3: Health Technology Assessment

This chapter begins with a brief introduction to health technology assessment (HTA). HTA is concerned with the systematic evaluation of the consequences of the adoption and use of new health technologies and to improve the evidence on existing technologies. The objective of mainstream HTA is to support evidence-based decision- and policy-making that encourage the uptake of efficient and effective health-care technologies. This chapter provides a basic framework for conducting an HTA, as well as some fundamental concepts and challenges in assessing health technologies. Whether HTA is beneficial-supporting timely access to needed technologies-or detrimental depends on three critical issues: when the assessment is performed; how it is performed; and how the findings are used.

Evidence-based decision-making 3: Health technology assessment

This chapter begins with a brief introduction to health technology assessment (HTA). HTA is concerned with the systematic evaluation of the consequences of the adoption and use of new health technologies and improving the evidence on existing technologies. The objective of mainstream HTA is to support evidence-based decision- and policy-making that encourage the uptake of efficient and effective health care technologies. This chapter provides a basic framework for conducting an HTA as well as some fundamental concepts and challenges in assessing health technologies. A case study of the assessment of drug eluting stents in Ontario is presented to illustrate the HTA process. Whether HTA is beneficial-supporting timely access to needed technologies-or detrimental depends on three critical issues: when the assessment is performed; how it is performed; and how the findings are used.

Conditionally funded field evaluations and practical trial design within a health technology assessment framework

Randomized controlled trials may lack generalizability and cannot always provide sufficient information for policymakers to make decisions regarding the use of new technologies entering into a health care system. Information related to other aspects of health technologies, in addition to clinical endpoints, such as economic, patient-related, and organizational issues, may be needed before making policy decisions. To address generalizability issues related to a health care technology, primary data collection conducted within a health care system may be required. A process for primary data collection to inform health policy in Ontario regarding health care technologies was initiated in 2003. Following recommendations from the Ontario Health Technology Advisory Committee, conditionally funded field evaluations for promising technologies with insufficient information are initiated. The conduct of these field evaluations occurs in 3 stages. The translation of the policy problem to research questions that can be answered through the design of a practical clinical trial is the first stage, followed by implementation, data collection, quality control, and quality assurance activities. After the completion of the field evaluation data collection and analysis, the results of the study are presented to the committee to respond to its request. Technologies evaluated by this process include drug-eluting stents, the endovascular repair of abdominal aortic aneurysms, and multifaceted interventions in diabetes care. This process, developed in Ontario for the evaluation of health technologies, has been a successful collaborative effort between practitioners, academia, government, health policymakers, and industry that has permitted an evidence-based framework for the approval and funding of technologies within the health care system.

Basics of health technology assessment

This chapter begins with a brief introduction to health technology assessment (HTA). HTA is concerned with the systematic evaluation of the consequences of the adoption and use of new health technologies and improving the evidence on existing technologies. The objective of mainstream HTA is to support evidence-based decision and policy making that encourage the uptake of efficient and effective health care technologies. This chapter provides a basic framework for conducting an HTA, as well as some fundamental concepts and challenges in assessing health technologies. A case study of the assessment of drug-eluting stents in Ontario is presented to illustrate the HTA process. Whether HTA is beneficial (supporting timely access to needed technologies) or detrimental depends on three critical issues: when the assessment is performed, how it is performed, and how the findings are used.

When is the 'right' time to initiate an assessment of a health technology?

There is currently no generally accepted formula for the optimal timing of health technology assessments (HTAs). This paper presents some of the relevant issues and then reviews the existing literature on timing of HTAs. It finds that the literature that specifically addresses these issues is limited. There is a consensus that HTAs should be initiated at an early stage of the development of a new health technology, and repeated during the life cycle of the technology. However, the questions of reliably identifying new technologies at an early stage in their development and of deciding on a detectable critical point for starting evaluation are not resolved. It is proposed that a system of categorization and prioritization of health technologies should be developed to allow decisions to be made as to when a strongly precautionary approach is required and how the limited resources available for HTA could be optimally deployed.

Where Does Ultrasound Stand in Technology Assessment and Outcomes Research

Although diagnostic ultrasound has been widely applied for various clinical conditions and diseases, its clinical effectiveness remains less well defined. Technology assessment can be applied to ultrasound and includes several criteria such as techologic capability, range of possible uses, diagnostic accuracy, impact on health care providers, therapeutic impact, and patient outcome. A review of each of these criteria is provided to raise sonographer awareness as to the need for further reserch in this area.

Testing prototype products in the operating room

Historically, the discussion of which products to use in a hospital has centered around disposable versus reusable products; however, new technology has produced a line of products that are not only disposable but degradable. Perioperative staff members at Redmond Regional Medical Center, Rome, Ga, participated in the testing, evaluation, and use of these prototype products during their development.