Recommendations for the Implementation of Hospital Based HTA in Poland: Lessons Learned From International Experience

Overcoming Barriers in Hospital-Based Health Technology Assessment (HB-HTA): International Expert Panel Consensus

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.

Hospital-based health technology assessment of innovative medical devices: insights from a nationwide survey in France

OBJECTIVES

To better understand the process of hospital acquisition of innovative medical devices (MDs) and the hospital-based health technology assessment (HB-HTA) pathways in France, an in-depth study based on a quantitative approach is needed. The aim of the present study was to assess through a national survey how HB-HTA is currently implemented in French hospitals and to identify its level of formalization.

METHODS

A quantitative online survey was conducted among hospitals performing HB-HTA in France, with a focus on the acquisition of innovative MDs for individual use. The survey, conducted between March and June 2022, was developed by a scientific board composed of members of the French-speaking Society for HB-HTA.

RESULTS

Sixty-seven out of 131 surveyed hospitals with HB-HTA activities responded, including 29 university hospitals, 24 nonprofit private hospitals, and 14 local hospitals. Sixty-one respondents (91 percent) reported the existence of a process dedicated to evaluating innovative MDs; of these, 16 declared that their hospitals had a formalized unit with HB-HTA activity. These units were more frequently found in larger hospitals with more than 500 inpatient beds (n = 16, p = 0.0160) and in university hospitals (n = 12, p = 0.0158). No hospital reported any collaboration with HAS, the French national HTA agency.

CONCLUSION

A diverse range of HB-HTA organizations with different structural levels exist in France for MD procurement linked to the category of hospitals. The study highlights the need for recognition of HB-HTA activity at the regulatory level in France and for direct collaboration between HTA activities performed at local and national levels.

Possibilities of Implementing Hospital-Based Health Technology Assessment (HB-HTA) at the Level of Voivodeship Offices in Poland

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.

Using the Dynamic SWOT Analysis to Assess Options for Implementing the HB-HTA Model

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.

HB-HTA as an implementation problem in Polish health policy

Hospital Based Health Technology Assessment (HB-HTA) is a new policy implemented in Poland to allow for a more practical and contextualized assessment related to the use of specific medical procedures, devices, or equipment. It requires changes in governance relating to the healthcare sector. One of the forms of governance improvement is to involve society in the process of creating public services. This can be implemented, e.g., by applying the pragmatic model of public responsiveness. The aim of this research was to identify and analyze forces which will shape a dynamic process in determining the implementation of HB-HTA. The results obtained in the Gioia analysis led to the identification of the main forces driving and restraining the implementation of HB-HTA. The grouping and interpretation allowed for the twelve most important dimensions to be distinguished, which were recognized as conceptual categories necessary to build theories that describe the studied phenomenon. This study contributes to the development of the idea of responsiveness in public management theory and in health care services, and ultimately helps to better enable the adjustment of health services to the dynamically changing needs of Polish society.