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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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Greaves R, Kricka L, Gruson D, Ferrari M, Martin H, Loh TP, Bernardini S. Toolkit for emerging technologies in laboratory medicine. Clin Chem Lab Med 2023; 61:2102-2114. [PMID: 37314970 DOI: 10.1515/cclm-2023-0571] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/16/2023]
Abstract
An emerging technology (ET) for laboratory medicine can be defined as an analytical method (including biomarkers) or device (software, applications, and algorithms) that by its stage of development, translation into broad routine clinical practice, or geographical adoption and implementation has the potential to add value to clinical diagnostics. Considering the laboratory medicine-specific definition, this document examines eight key tools, encompassing clinical, analytical, operational, and financial aspects, used throughout the life cycle of ET implementation. The tools provide a systematic approach starting with identifying the unmet need or identifying opportunities for improvement (Tool 1), forecasting (Tool 2), technology readiness assessment (Tool 3), health technology assessment (Tool 4), organizational impact map (Tool 5), change management (Tool 6), total pathway to method evaluation checklist (Tool 7), and green procurement (Tool 8). Whilst there are differences in clinical priorities between different settings, the use of this set of tools will help support the overall quality and sustainability of the emerging technology implementation.
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Affiliation(s)
- Ronda Greaves
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Larry Kricka
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Damien Gruson
- Cliniques Universitaires Saint Luc, Département des Laboratoires Cliniques, Biochimie Médicale, Brussels, Belgium
| | | | | | - Tze Ping Loh
- National University Hospital, Singapore, Singapore
| | - Sergio Bernardini
- Department of Experimental Medicine, University Tor Vergata, Rome, Italy
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Shalev L, Helfrich CD, Ellen M, Avirame K, Eitan R, Rose AJ. Bridging language barriers in developing valid health policy research tools: insights from the translation and validation process of the SHEMESH questionnaire. Isr J Health Policy Res 2023; 12:36. [PMID: 38008722 PMCID: PMC10680279 DOI: 10.1186/s13584-023-00583-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/12/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND The use of research tools developed and validated in one cultural and linguistic context to another often faces challenges. One major challenge is poor performance of the tool in the new context. This potentially impact the legitimacy of health policy research conducted with informal adaptations of existing tools which have not been subjected to formal validation. Best practices exist to guide researchers in adapting and validating research tools effectively. We present here, as an extended example, our validation of the SHEMESH questionnaire ('Organizational Readiness to Change Assessment'; In Hebrew: 'SHE'elon Muchanut Ergunit le'SHinuy'), a Hebrew-language version of the Organizational Readiness to Change Assessment (ORCA). SHEMESH is tailored to support implementation science projects, whose aim is to promote a more rapid and complete adoption of evidence-based health policies and practices. METHODS The SHEMESH included originally eleven questions from the Evidence (item 1-4) and Context (items 5-11) domains. We validated SHEMESH through the following steps: 1. Professional translation to Hebrew and discussion of the translation by multidisciplinary committee; 2. Back-translation into English by a different translator to detect discrepancies; 3. Eleven cognitive interviews with psychiatric emergency department physicians and nurses; and 4. Pilot testing and psychometric analyses, including Cronbach's alpha for subscales and factor analyses. RESULTS Following translation and cognitive interviews, SHEMESH was administered to 222 psychiatrists and nurses. Pearson correlation showed significant and strong correlations of items 1-4 to the Evidence construct and items 6-11 to the Context construct. Item 5 did not correlate with the other items, and therefore was removed from the other psychometric procedures and eventually from the SHEMESH. Factor analysis with the remaining 10 items yielded two factors, which together explained a total of 69.7% of variance. Cronbach's Alpha scores for the two subscales were high (Evidence, 0.887, and Context, 0.852). CONCLUSIONS This multi-step validation process of the SHEMESH questionnaire may serve as a comprehensive guideline for others who are willing to adapt research tools that were developed in other languages. Practically, SHEMESH has been validated for use in implementation science research projects in Israel.
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Affiliation(s)
- Ligat Shalev
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Ein Kerem Campus, 91120, Jerusalem, Israel.
| | - Christian D Helfrich
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA
| | - Moriah Ellen
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, 84105, Beer-Sheva, Israel
| | - Keren Avirame
- Psychiatric Division, Sourasky Medical Center, 14 Weizmann Street, Tel Aviv-Yafo, Israel
| | - Renana Eitan
- Psychiatric Division, Sourasky Medical Center, 14 Weizmann Street, Tel Aviv-Yafo, Israel
| | - Adam J Rose
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Ein Kerem Campus, 91120, Jerusalem, Israel
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Tang M, Zhang X, Ye Z, Feng L, Yang Y, Hou Z, Bai F, Lin X, Liu X, Yang H, Hu S, Song P, He J. The initiation, exploration, and development of hospital-based health technology assessment in China: 2005 ‒ 2022. Biosci Trends 2023; 17:1-13. [PMID: 36775343 DOI: 10.5582/bst.2023.01013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
A hospital-based health technology assessment (HB-HTA) can provide the evidence needed to inform clinical decisions at the administrative level. With the implementation of a new round of medical and health care system reforms in China, such as the abolition of medical mark-ups, adoption of modern hospital management systems, reform of diagnosis related groups (DRGs) payment, and performance evaluations for public hospitals, medical institutions increasingly need HB-HTA. The development of HB-HTA in China can be divided into three phases: An initiation phase (2005-2014), a preliminary exploratory phase (2015-2017), and a rapid development phase (2018-present). HB-HTA has been used to manage medical consumables, medical devices, and medicines, but there are still problems and challenges in terms of concept recognition, the mode of development, and limited professionals and data. To promote and use HB-HTA in developing countries, we have identifies the development paths and recommendations for implementation based on a case study in China, which can be summarized as follows: enhancing the top-level design of HB-HTA, formulating HB-HTA guidelines, further promoting the main ideas of HB-HTA, concentrating on the training of evaluation personnel, establishing an HB-HTA network and paying attention to the flexibility of HB-HTA in the application process, and multi- stakeholder participation.
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Affiliation(s)
- Mi Tang
- Shanghai Health Development Research Center, Shanghai, China
| | - Xueyan Zhang
- Shanghai Municipal Center for Health Promotion, Shanghai, China
| | - Ziping Ye
- School of Public Administration, Hainan University, Hainan, China
| | - Lvfan Feng
- Shanghai Health Development Research Center, Shanghai, China
| | - Yan Yang
- Shanghai Health Development Research Center, Shanghai, China
| | - Zhiying Hou
- Shanghai Health Development Research Center, Shanghai, China
| | - Fei Bai
- National Center for Medical Service Administration, National Health Commission of the People's Republic of China, Beijing, China
| | - Xia Lin
- National Center for Medical Service Administration, National Health Commission of the People's Republic of China, Beijing, China
| | - Xinyu Liu
- Shenzhen Municipal Health Commission, Shenzhen, China
| | - Hai Yang
- Shanghai Sixth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shanlian Hu
- School of Public Health, Fudan University, Shanghai, China
| | - Peipei Song
- Center for Clinical Sciences, National Center for Global Health and Medicine of Japan, Tokyo, Japan
| | - Jiangjiang He
- Shanghai Health Development Research Center, Shanghai, China
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Multiple Criteria Decision Analysis (MCDA) for evaluating cancer treatments in hospital-based health technology assessment: The Paraconsistent Value Framework. PLoS One 2022; 17:e0268584. [PMID: 35613115 PMCID: PMC9132343 DOI: 10.1371/journal.pone.0268584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 05/02/2022] [Indexed: 11/19/2022] Open
Abstract
Background In recent years, the potential of multi-criteria decision analysis (MCDA) in the health field has been discussed widely. However, most MCDA methodologies have given little attention to the aggregation of different stakeholder individual perspectives. Objective To illustrate how a paraconsistent theory-based MCDA reusable framework, designed to aid hospital-based Health Technology Assessment (HTA), could be used to aggregate individual expert perspectives when valuing cancer treatments. Methods An MCDA methodological process was adopted based on paraconsistent theory and following ISPOR recommended steps in conducting an MCDA study. A proof-of-concept exercise focusing on identifying and assessing the global value of first-line treatments for metastatic colorectal cancer (mCRC) was conducted to foster the development of the MCDA framework. Results On consultation with hospital-based HTA committee members, 11 perspectives were considered in an expert panel: medical oncology, oncologic surgery, radiotherapy, palliative care, pharmacist, health economist, epidemiologist, public health expert, health media expert, pharmaceutical industry, and patient advocate. The highest weights were assigned to the criteria “overall survival” (mean 0.22), “burden of disease” (mean 0.21) and “adverse events” (mean 0.20), and the lowest weights were given to “progression-free survival” and “cost of treatment” (mean 0.18 for both). FOLFIRI and mFlox scored the highest global value score of 0.75, followed by mFOLFOX6 with a global value score of 0.71. mIFL was ranked last with a global value score of 0.62. The paraconsistent analysis (para-analysis) of 6 first-line treatments for mCRC indicated that FOLFIRI and mFlox were the appropriate options for reimbursement in the context of this study. Conclusion The Paraconsistent Value Framework is proposed as a step beyond the current MCDA practices, in order to improve means of dealing with individual expert perspectives in hospital-based HTA of cancer treatments.
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Galdino JPDS, Camargo EB, Elias FTS. Sedimentation of health technology assessment in hospitals: a scoping review. CAD SAUDE PUBLICA 2021; 37:e00352520. [PMID: 34586173 DOI: 10.1590/0102-311x00352520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 05/28/2021] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to analyze the level of sedimentation of hospital-based health technology assessment (HTA) in diverse contexts. A scoping review was conducted according to the methodology of the Joanna Briggs Institute, whose data analysis model consisted of the combination of Donabedian's structure, process, and outcome categories and the dimensions of the project Adopting Hospital Based Health Technology Assessment in European Union (AdHopHTA). We identified 270 studies, and after removing duplicates and reading full texts, 36 references met the eligibility criteria. Thirty-six hospitals were identified, of which there were 24 large-scale hospitals with extra bed capacity. Twenty-three hospitals were affiliated with universities. Canada stood out with five university hospitals, four of which with public funding. Half of the identified hospitals had hospital-based HTA units (18/36). Hospitals with sedimented levels of HTA corresponded to 75% of the sample (27/36), and the remainder had partially sedimented HTA, or 25% of the hospitals in the review (9/36). There were no hospitals with incipient sedimentation. Measuring the level of HTA sedimentation in the hospitals contributed to understanding how their participation has occurred in the field of hospital-based HTA. This study revealed the importance of identifying factors such as sustainability, growth, and evolution of hospital-based HTA in countries with and without a tradition in this field.
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Overview of information retrieval in a hospital-based health technology assessment center in a Swedish region. Int J Technol Assess Health Care 2021; 37:e52. [PMID: 33840394 DOI: 10.1017/s0266462321000106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This article aims to provide a brief review of information retrieval and hospital-based health technology assessment (HB-HTA) and describe library experiences and working methods at a regional HB-HTA center from the center's inception to the present day. METHODS For this brief literature review, searches in PubMed and LISTA were conducted to identify studies reporting on HB-HTA and information retrieval. The description of the library's involvement in the HTA center and its working methods is based on the authors' experience and internal and/or unpublished documents. RESULTS Region Västra Götaland is the second largest healthcare region in Sweden and has had a regional HB-HTA center since 2007 (HTA-centrum). Assessments are performed by clinicians supported by HTA methodologists. The medical library at Sahlgrenska University Hospital works closely with HTA-centrum, with one HTA librarian responsible for coordinating the work. CONCLUSION In the literature on HB-HTA, we found limited descriptions of the role librarians and information specialists play in different units. The librarians at HTA-centrum play an important role, not only in literature searching but also in abstract and full-text screening.
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