Article type
Abstract
"Background: Following the widespread of national health technology assessment (HTA) agencies, the next step towards standardized, transparent, and objective decision making regarding the adoption of technologies is starting to thrive. As hospitals are where most health technologies are purchased and become available for patient’s care, hospital-based health technology assessments (HB-HTA) impact directly in access as a guide towards investing in more cost-effective technologies.
Objectives: To identify, analyse, and synthesize the available literature addressing the methodologies used to implement HB-HTA.
Methods: A search of reviews and guidelines was in biomedical databases and national HTA agencies, finding 1547 documents. Titles and abstracts were screened by duplicate; afterwards, selected documents were read in full text by one of three reviewers for final inclusion and extraction. The matrix with extraction topics included: conceptual frameworks, domains relevant for evaluation, strengths and weaknesses identified in different HB-HTA experiences, methodologies for evaluating clinical effectiveness and safety together with methods for economic evaluations.
Results: 36 systematic reviews and 46 documents from HTA agencies were included. Findings showed that all HTA bodies included clinical safety and efficacy as relevant domains for evaluation, but only one third of the bodies considered ethical, organizational, or legal aspects as relevant domains for the assessment. Regarding stakeholders involved in the process, all bodies included clinical experts, but only 40% society, administrative, or financial planning; biomedical engineering and infrastructure was only considered a relevant stakeholder in one agency. Differences between hospital HTA and national assessments lied mainly in the timeliness stressed in hospital settings and their approach economic evaluations, being HB-HTA more focused on cost comparisons and budget impact analyses than cost-effectiveness. The AdhopHTA handbook stood out as an important effort to collect and organize different experiences surrounding HB-HTA.
Conclusions: This review reveals an optimistic outlook for HB-HTA, as existing literature with documented guidelines and methodologies facilitate their implementation. Multidisciplinary HB-HTA can guide decision making in healthcare institutions with a positive impact in health outcomes while optimizing healthcare expenditure.
The dissemination of HB-HTA will aid to provide patients with the best mix of technologies available.
No public or consumers were involved in the study. "
Objectives: To identify, analyse, and synthesize the available literature addressing the methodologies used to implement HB-HTA.
Methods: A search of reviews and guidelines was in biomedical databases and national HTA agencies, finding 1547 documents. Titles and abstracts were screened by duplicate; afterwards, selected documents were read in full text by one of three reviewers for final inclusion and extraction. The matrix with extraction topics included: conceptual frameworks, domains relevant for evaluation, strengths and weaknesses identified in different HB-HTA experiences, methodologies for evaluating clinical effectiveness and safety together with methods for economic evaluations.
Results: 36 systematic reviews and 46 documents from HTA agencies were included. Findings showed that all HTA bodies included clinical safety and efficacy as relevant domains for evaluation, but only one third of the bodies considered ethical, organizational, or legal aspects as relevant domains for the assessment. Regarding stakeholders involved in the process, all bodies included clinical experts, but only 40% society, administrative, or financial planning; biomedical engineering and infrastructure was only considered a relevant stakeholder in one agency. Differences between hospital HTA and national assessments lied mainly in the timeliness stressed in hospital settings and their approach economic evaluations, being HB-HTA more focused on cost comparisons and budget impact analyses than cost-effectiveness. The AdhopHTA handbook stood out as an important effort to collect and organize different experiences surrounding HB-HTA.
Conclusions: This review reveals an optimistic outlook for HB-HTA, as existing literature with documented guidelines and methodologies facilitate their implementation. Multidisciplinary HB-HTA can guide decision making in healthcare institutions with a positive impact in health outcomes while optimizing healthcare expenditure.
The dissemination of HB-HTA will aid to provide patients with the best mix of technologies available.
No public or consumers were involved in the study. "