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Lipska I, Di Bidino R, Niewada M, Nemeth B, Bochenek T, Kukla M, Więckowska B, Sobczak A, Iłowiecka K, Zemplenyi A, Martelli N, Martin T, Filiniuk O, Kosyachenko K, Sucu R, Piniazhko O, Zaliska O, Avdeyev A, Shanazarov N, von Pinoci M, Hren R. Overcoming Barriers in Hospital-Based Health Technology Assessment (HB-HTA): International Expert Panel Consensus. Healthcare (Basel) 2024; 12:889. [PMID: 38727447 PMCID: PMC11083158 DOI: 10.3390/healthcare12090889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
The purpose of this article is to investigate the common facilitators and barriers associated with the implementation of hospital-based health technology assessment (HB-HTA) across diverse hospital settings in seven countries. Through a two-round Delphi study, insights were gathered from a panel of 15 HTA specialists from France, Hungary, Italy, Kazakhstan, Poland, Switzerland, and Ukraine. Experts initially conducted a comprehensive review of the HB-HTA implementation in their respective countries, identifying the barriers and facilitators through descriptive analysis. Subsequently, panel experts ranked these identified barriers and facilitators on a seven-point Likert scale. A median agreement score ≥ 6 and interquartile range (IQR) ≤ 1 was accepted as reaching a consensus. Out of the 12 statements categorized as external and internal barriers and facilitators, the expert panel reached consensus on six statements (two barriers and four facilitators). The external barrier, which achieved consensus, was the lack of the formal recognition of the role of HB-HTA in national or regional legislations. The internal barrier reaching consensus was the limited availability of human resources dedicated to HB-HTA. This qualitative study indicates that HB-HTA still has progress to make before being formally accepted and integrated across most countries, although by building on the facilitating factors we identified there may be an opportunity for the implementation of internationally developed strategies to strengthen HB-HTA practices.
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Affiliation(s)
- Iga Lipska
- Health Policy Institute, 00-819 Warsaw, Poland; (I.L.); (A.S.); (K.I.)
- Medical Department, Academy of Applied Medical and Social Sciences, 82-300 Elbląg, Poland
- Hospital-Based Health Technology Assessment Interest Group, Health Technology Assessment International, Edmonton, AB T6H 5P9, Canada; (M.K.); (R.S.)
| | - Rossella Di Bidino
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Health Graduate School of Health Economics and Management (ALTEMS), Università Cattolica Del Sacro Cuore, 00168 Rome, Italy
| | - Maciej Niewada
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Bertalan Nemeth
- Syreon Research Institute, 1142 Budapest, Hungary; (B.N.); (A.Z.)
| | - Tomasz Bochenek
- Department of Nutrition and Drug Research, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Krakow, Poland;
| | - Monika Kukla
- Hospital-Based Health Technology Assessment Interest Group, Health Technology Assessment International, Edmonton, AB T6H 5P9, Canada; (M.K.); (R.S.)
| | - Barbara Więckowska
- Social Insurance Department, Warsaw School of Economics, 02-554 Warsaw, Poland;
| | - Alicja Sobczak
- Health Policy Institute, 00-819 Warsaw, Poland; (I.L.); (A.S.); (K.I.)
| | | | - Antal Zemplenyi
- Syreon Research Institute, 1142 Budapest, Hungary; (B.N.); (A.Z.)
- Center for Health Technology Assessment and Pharmacoeconomics Research, Faculty of Pharmacy, University of Pécs, 7624 Pécs, Hungary
| | - Nicolas Martelli
- Pharmacy Department, Georges Pompidou European Hospital, 75015 Paris, France; (N.M.); (T.M.)
- Faculty of Pharmacy, Université Paris-Saclay, GRADES, 91190 Orsay, France
| | - Tess Martin
- Pharmacy Department, Georges Pompidou European Hospital, 75015 Paris, France; (N.M.); (T.M.)
- Faculty of Pharmacy, Université Paris-Saclay, GRADES, 91190 Orsay, France
| | - Olena Filiniuk
- Safe, Affordable, and Effective Medicines for Ukrainians (SAFEMed) Activity, Management Sciences for Health, 02000 Kyiv, Ukraine;
| | - Kostyantyn Kosyachenko
- Department of Management and Economy of Pharmacy, Bogomolets National Medical University, 01601 Kyiv, Ukraine;
| | - Rabia Sucu
- Hospital-Based Health Technology Assessment Interest Group, Health Technology Assessment International, Edmonton, AB T6H 5P9, Canada; (M.K.); (R.S.)
| | - Oresta Piniazhko
- Department of Health Technology Assessment, State Expert Center, Ministry of Health of Ukraine, 01021 Kyiv, Ukraine;
- Department of Management and Economy of Pharmacy, Medicine Technology and Pharmacoeconomics, Faculty of Postgraduate Education, Danylo Halytsky Lviv National Medical University, 79010 Lviv, Ukraine;
| | - Olha Zaliska
- Department of Management and Economy of Pharmacy, Medicine Technology and Pharmacoeconomics, Faculty of Postgraduate Education, Danylo Halytsky Lviv National Medical University, 79010 Lviv, Ukraine;
| | - Andrey Avdeyev
- Medical Center Hospital of the President’s Affairs Administration of the Republic of Kazakhstan, Astana 010000, Kazakhstan; (A.A.); (N.S.)
| | - Nasrulla Shanazarov
- Medical Center Hospital of the President’s Affairs Administration of the Republic of Kazakhstan, Astana 010000, Kazakhstan; (A.A.); (N.S.)
| | - Marina von Pinoci
- Care Quality Division, Hôpitaux Universitaires de Genève, 1211 Geneva, Switzerland;
| | - Rok Hren
- Syreon Research Institute, 1142 Budapest, Hungary; (B.N.); (A.Z.)
- Institute of Mathematics, Physics, and Mechanics, 1000 Ljubljana, Slovenia
- Faculty of Mathematics and Physics, University of Ljubljana, 1000 Ljubljana, Slovenia
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Falkowski A, Ciminata G, Manca F, Bouttell J, Jaiswal N, Farhana Binti Kamaruzaman H, Hollingworth S, Al-Adwan M, Heggie R, Putri S, Rana D, Mukelabai Simangolwa W, Grieve E. How Least Developed to Lower-Middle Income Countries Use Health Technology Assessment: A Scoping Review. Pathog Glob Health 2023; 117:104-119. [PMID: 35950264 PMCID: PMC9970250 DOI: 10.1080/20477724.2022.2106108] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Health Technology Assessment (HTA) is a multidisciplinary tool to inform healthcare decision-making. HTA has been implemented in high-income countries (HIC) for several decades but has only recently seen a growing investment in low- and middle-income countries. A scoping review was undertaken to define and compare the role of HTA in least developed and lower middle-income countries (LLMIC). MEDLINE and EMBASE databases were searched from January 2015 to August 2021. A matrix comprising categories on HTA objectives, methods, geographies, and partnerships was used for data extraction and synthesis to present our findings. The review identified 50 relevant articles. The matrix was populated and sub-divided into further categories as appropriate. We highlight topical aspects of HTA, including initiatives to overcome well-documented challenges around data and capacity development, and identify gaps in the research for consideration. Those areas we found to be under-studied or under-utilized included disinvestment, early HTA/implementation, system-level interventions, and cross-sectoral partnerships. We consider broad practical implications for decision-makers and researchers aiming to achieve greater interconnectedness between HTA and health systems and generate recommendations that LLMIC can use for HTA implementation. Whilst HIC may have led the way, LLMIC are increasingly beginning to develop HTA processes to assist in their healthcare decision-making. This review provides a forward-looking model that LLMIC can point to as a reference for their own implementation. We hope this can be seen as timely and useful contributions to optimize the impact of HTA in an era of investment and expansion and to encourage debate and implementation.
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Affiliation(s)
- Anna Falkowski
- Division of Communicable Disease, Michigan Department of Health and Human Services, State of Michigan, USA
| | - Giorgio Ciminata
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Francesco Manca
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Janet Bouttell
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Nishant Jaiswal
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Hanin Farhana Binti Kamaruzaman
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow.,Malaysian Health Technology Assessment Section (MaHTAS), Ministry of Health Malaysia, Putrajaya
| | | | - Mariana Al-Adwan
- F. Hoffman-La Roche Ltd, Amman, Jordan and Jordan ISPOR Chapter, Amman, Jordan
| | - Robert Heggie
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Septiara Putri
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow.,Health Policy and Administration Department, Faculty of Public Health, University of Indonesia, Depok, West Java, Indonesia
| | - Dikshyanta Rana
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
| | - Warren Mukelabai Simangolwa
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa and Patient and Citizen Involvement in Health, Lusaka, Zambia
| | - Eleanor Grieve
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Health Economics and Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow
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Furman M, Gałązka-Sobotka M, Marciniak D, Kowalska-Bobko I. Possibilities of Implementing Hospital-Based Health Technology Assessment (HB-HTA) at the Level of Voivodeship Offices in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11235. [PMID: 36141507 PMCID: PMC9517551 DOI: 10.3390/ijerph191811235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 06/16/2023]
Abstract
The Health Technology Assessment is based on the evaluation of the characteristics and effects of health technologies to properly spend resources in healthcare. For the needs of hospitals, a special HTA department, Hospital-Based Health Technology Assessment (HB-HTA), has been established. The objective of the article is to assess the possibility of implementing a functional model with the coordinating role of Health Departments of the Voivodeship Offices with the support of the National Health Fund and the HTA Agency in Poland. Ten semi-structured interviews were conducted with representatives from eight Voivodeship Offices. The interviews consisted of nine questions related to the possibility of introducing a functional model with the participation of the Voivodeship Office. The material was divided into seven codes relating to the questions included in the topic guide. From the perspective of Voivodeship Offices, HB-HTA could contribute to the improvement of the methodology used in the Evaluation Instrument of Investment Motions in Health. The lack of personnel in the Voivodeship Offices was identified as one of the greatest barriers to the implementation of HB-HTA. These public administration units should not be involved in the hospital health technology assessment process.
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Affiliation(s)
- Maciej Furman
- Department of Health Policy and Management, Faculty of Health Sciences, Institute of Public Health, Jagiellonian University Medical College, 31-066 Cracow, Poland
| | | | - Damian Marciniak
- Institute of Healthcare Management, Lazarski University, 02-662 Warsaw, Poland
| | - Iwona Kowalska-Bobko
- Department of Health Policy and Management, Faculty of Health Sciences, Institute of Public Health, Jagiellonian University Medical College, 31-066 Cracow, Poland
- Institute of Healthcare Management, Lazarski University, 02-662 Warsaw, Poland
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Using the Dynamic SWOT Analysis to Assess Options for Implementing the HB-HTA Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127281. [PMID: 35742532 PMCID: PMC9224318 DOI: 10.3390/ijerph19127281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/05/2022] [Accepted: 06/11/2022] [Indexed: 02/04/2023]
Abstract
This paper is aimed at exploring the role of the HB-HTA ecosystem as an important pathway for popularizing the implementation of innovations in healthcare organizations. The scientific debate has largely been focused on the rising importance of HB-HTA and the principles guiding the process. Solutions implemented by individual countries differ, which may be rooted in historical, cultural, and institutional differences. Our understanding of the impact of individual countries’ healthcare systems on HB-HTA solutions and infrastructure still lacks a basis in interpretative studies. A conceptual framework is proposed to assess the aptness of the HB-HTA model designed for hospitals operating in a country or region, focused on the concepts of adaptiveness and responsiveness to features of the healthcare system present there. A tool is proposed for investigating factors that are likely to assist the successful implementation of the HB-HTA ecosystem. A dynamic SWOT analysis on the case of the HB-HTA model designed for Poland provides interesting insights into the building of the conceptual framework. The results of this study help explain how to create an HB-HTA model that is best adapted to the regional or national healthcare system, including potential risks and opportunities.
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Gałązka-Sobotka M, Kowalska-Bobko I, Lach K, Mela A, Furman M, Lipska I. Recommendations for the Implementation of Hospital Based HTA in Poland: Lessons Learned From International Experience. Front Pharmacol 2021; 11:594644. [PMID: 34054508 PMCID: PMC8155722 DOI: 10.3389/fphar.2020.594644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/29/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction: The main challenge of modern hospitals is purchasing medical technologies. Hospital-based health technology assessments (HB-HTAs) are used in healthcare facilities around the world to support management boards in providing relevant technologies for patients. Aim: This study was undertaken to update the existing body of knowledge on the characteristics of HB-HTA systems/models in the selected European countries. Insights gained from this study were used to provide an optimal approach for implementing HB-HTA in Poland. Materials and methods: Firstly, we carried out a systematic review in PubMed and embase. Secondly, we searched for gray literature via the AdHopHTA online handbook and the design book of the AdHopHTA project, as well as literature describing healthcare systems provided by the WHO. Then, we conducted in-depth interviews with HB-HTA experts from four countries. Finally, we selected ten countries from Europe and prepared frameworks for data collection and analyses. Results: The selected countries (Switzerland, Spain, France, Italy, Denmark, Finland, Sweden, the Netherlands, and Austria) are examples of decentralized or deconcentrated healthcare systems. In terms of HB-HTA, differences in organisational models (independent group, stand-alone, integrated-essential, integrated-specialised), type of financing (internally vs. externally), collaboration with an HTA National Agency and other stakeholders (e.g., Patients' Associations) were identified. HB-HTA engages multi-skilled staff with various academic backgrounds and operates mainly on a voluntary basis. Conclusion: Strengths and weaknesses associated with various organisational models must be carefully considered in the context of support for decentralized or centralized models of implementation while embarking on HTA activities in Polish hospitals.
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Affiliation(s)
| | - Iwona Kowalska-Bobko
- Institute of Public Health, Faculty of Health Science, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Lach
- National Institute of Cardiology (Poland), Warsaw, Poland
| | - Aneta Mela
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Furman
- Institute of Public Health, Faculty of Health Science, Jagiellonian University Medical College, Krakow, Poland
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Mela A, Poniatowski ŁA, Drop B, Furtak-Niczyporuk M, Jaroszyński J, Wrona W, Staniszewska A, Dąbrowski J, Czajka A, Jagielska B, Wojciechowska M, Niewada M. Overview and Analysis of the Cost of Drug Programs in Poland: Public Payer Expenditures and Coverage of Cancer and Non-Neoplastic Diseases Related Drug Therapies from 2015-2018 Years. Front Pharmacol 2020; 11:1123. [PMID: 32922285 PMCID: PMC7456857 DOI: 10.3389/fphar.2020.01123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background In Poland drug programmes developed by the Minister of Health and financed by the National Health Fund are special reimbursement frameworks of innovative, expensive, and mostly hospital based medical products used for a small number of patients. Research Design The research presented in this paper is based on data analysis published by the National Health Fund in Poland. The analysis focused on estimating public payer expenditure on drugs available within drug programmes from 2015 to 2018. Results In subsequent years, reimbursement of drugs used within drug programmes was associated with the National Health Fund budget expenditure of 635 mln USD, 755 mln USD, 854 mln USD, and 921 mln USD, respectively. Reimbursement of oncology drug programmes constituted 48.1%, 42.5%, 47.1%, and 52.4% and were approximately 305, 312, 402, 483 mln USD, whereas values of non-oncology drug programmes were approximately 330, 434, 452, and 438 mln USD which constituted 51.9%, 57.5%, 52.9%, and 47.6% respectively. Conclusion Despite the fact that the expenditure on drug programs in Poland are increasing every year, they undoubtedly improve the patient’s access to the most innovative oncological and nononcological therapies in the Polish healthcare system.
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Affiliation(s)
- Aneta Mela
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland
| | - Łukasz A Poniatowski
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland.,Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Bartłomiej Drop
- Department of Information Technology and Medical Statistics, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | | | - Janusz Jaroszyński
- Chair of Administrative Procedure, Faculty of Law and Administration, Maria Curie-Skłodowska University of Lublin, Lublin, Poland
| | | | - Anna Staniszewska
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland
| | - Jan Dąbrowski
- Department of Pharmacology, National Medicines Institute, Warsaw, Poland
| | - Anna Czajka
- Department of Neurology, Czerniakowski Hospital, Warsaw, Poland
| | - Beata Jagielska
- Department of Oncological Diagnostics, Cardiooncology and Palliative Medicine, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Monika Wojciechowska
- Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | - Maciej Niewada
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland
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Németh B, Goettsch W, Kristensen FB, Piniazhko O, Huić M, Tesař T, Atanasijevic D, Lipska I, Kaló Z. The transferability of health technology assessment: the European perspective with focus on central and Eastern European countries. Expert Rev Pharmacoecon Outcomes Res 2020; 20:321-330. [PMID: 32500749 DOI: 10.1080/14737167.2020.1779061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Lower-income European countries have a worse health status and less funds for health care compared to Western Europe. Despite their limited human and financial capacities for conducting Health Technology Assessment (HTA), the need for evidence-based decision-making is growing. Two main approaches emerged as potential solutions: joint clinical assessments on the European level, and simplified procedures relying on the judgments of well-established HTA agencies of Western countries. AREAS COVERED Based on considerations of transferability, the European Network for Health Technology Assessment (EUnetHTA) was built up to harmonize HTA methodologies across the European Union, and to develop an HTA Core Model by focusing on joint production of relative effectiveness assessment, which can be used as a basis for national value assessments. The second approach has been suggested in various forms without considering transferability issues. EXPERT OPINION Joint clinical assessments reduce duplication of efforts based on appropriate scientific rationale. On the other hand, recent examples show that relying on judgments of HTA agencies from wealthier countries with potentially different health-care priorities can lead to suboptimal allocation decisions. In the short term, some stakeholders may benefit from ignoring transferability, but it will ultimately lead to limited access in other disease areas.
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Affiliation(s)
| | - Wim Goettsch
- WHO CollaboratingUtrecht Centre for Pharmaceutical Policy, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University , Utrecht, The Netherlands.,National Health Care Institute , Diemen, The Netherlands
| | - Finn Børlum Kristensen
- Faculty of Health Sciences, Department of Public Health, Research Unit of User Perspectives, University of Southern Denmark , Odense, Denmark.,Department of Strategy and Innovation, Copenhagen Business School , Copenhagen, Denmark
| | - Oresta Piniazhko
- Health Technology Assessment Department, State Expert Centre of Ministry of Health of Ukraine , Kyiv, Ukraine
| | | | - Tomáš Tesař
- Department of Organisation and Management in Pharmacy, Faculty of Pharmacy, Comenius University , Bratislava, Slovakia
| | | | - Iga Lipska
- Departament of Health Care Services, National Health Fund HQ , Warsaw, Poland
| | - Zoltán Kaló
- Syreon Research Institute , Budapest, Hungary.,Centre for Health Technology Assessment, Semmelweis University , Budapest, Hungary
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Health Technology Assessment Implementation in Ukraine: Current Status and Future Perspectives. Int J Technol Assess Health Care 2019; 35:393-400. [PMID: 31583985 DOI: 10.1017/s0266462319000679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The need for improving healthcare decision making by implementing health technology assessment (HTA) has been a top priority in Ukraine since 2016. This study sought to provide a tailor-made HTA implementation roadmap, drawing on insights from national stakeholders. METHODS We conducted a survey using a questionnaire already applied in previous HTA research. We assessed the status of HTA when reforms were initiated in 2016 and examined perspectives on possible future developments among policy makers and representatives of pharmaceutical companies and patient organizations. RESULTS Thirty-two respondents answered the survey. Forty-eight percent of respondents were not aware of HTA training in Ukraine, but 91 percent preferred having either a graduate or postgraduate training. Experts stated that funding for HTA research and for critical appraisal of HTA submissions was limited, but in the future, they would increase funding mainly from public sources. A public HTA agency with academic support was the most preferred organizational structure. Eighty-eight percent of respondents opted for full transparency, making the HTA agency's recommendations and the related appraisal reports publicly available. A great majority of participants preferred mandating the use of local data in certain categories and indicated the importance of evaluating the transferability of international evidence. Healthcare priority and cost-effectiveness were the most important criteria for decisions, applied with a soft explicit threshold. CONCLUSIONS Ukraine is in the early phase of implementing HTA and our study provides a clear vision of national stakeholders about the future directions. In addition, learning from the experiences of other countries may help the implementation process.
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Shedding light on the HTA consultancy market: Insights from Poland. Health Policy 2019; 123:1237-1243. [PMID: 31466804 DOI: 10.1016/j.healthpol.2019.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/26/2019] [Accepted: 08/12/2019] [Indexed: 11/22/2022]
Abstract
Research on health technology assessment (HTA) from a policy perspective typically examines public HTA bodies, with little attention devoted to how manufacturers develop their evidence submissions. Taking Poland as a crucial case, we explored the market of HTA consultancy firms which assist drug manufacturers in developing these submissions, called HTA reports. We reviewed 318 HTA reports from 2012 to 2015, data from the Polish National Company Registry, the content of HTA consulting firms' websites, and appraisal reports developed by the Polish HTA body. We identified HTA consultancy firms which developed 96-98% HTA reports. We found that the transparency of information about the authors of HTA reports provided by the HTA body had improved between 2012 and 2015. Six companies with market shares from 10 to 30% dominated the market. The market size was estimated to be 5-6 million EUR annually. HTA consultancies had a broad service portfolio related to preparation of HTA reports. Over 90% of HTA reports did not meet the official minimum quality requirements, and only half of the resubmissions took into account remarks made by the HTA body. Our study provides insights into the structure, evolution and role of the for-profit HTA consultancy market as a crucial part of the public HTA system. This raises important policy points about transparency and regulation at the intersection of public and private sectors in HTA.
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