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Linking HTA to priority setting – framework, concepts, and values. Professor Ole F. Norheim Department of Public Health and Primary Care University of Bergen, Norway. Drummond et al IJTAHC 2008. Framework: HTA in Norway. Health policy/ priority setting. HTA. Appraisal. Guidelines.

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Linking hta to priority setting framework concepts and values

Linking HTA to priority setting – framework, concepts, and values

Professor Ole F. Norheim

Department of Public Health and Primary Care

University of Bergen, Norway

U n i v e r s i t y o f B e r g e n


Drummond et al ijtahc 2008
Drummond et al IJTAHC 2008 values

U n i v e r s i t y o f B e r g e n


Framework hta in norway
Framework: HTA in Norway values

Health policy/

priority setting

HTA

Appraisal

Guidelines

Clinical research

Assessment of

evidence

Clinical practice

U n i v e r s i t y o f B e r g e n


Concepts
Concepts values

  • EBM: Evidence based medicine

  • CER: Comparative effectiveness research

  • HTA: Health technology assessment

  • AFR: Accountability for reasonableness

  • Partly overlapping aims and potential use:

     coverage decisions

U n i v e r s i t y o f B e r g e n


Accountability for reasonableness daniels sabin 2002 2008
Accountability for reasonableness values(Daniels & Sabin, 2002/2008)

  • Publicity

  • Relevant reasons

  • Revision and complaints

  • Institutionalization

U n i v e r s i t y o f B e r g e n


Common values in ebm cer hta afr
Common values in valuesEBM, CER, HTA, AFR

  • Transparency

  • Explicit about reasons

  • Unbiased, impartial

  • Open too critical review

  • Institutionalized processes

    • Except AfR

U n i v e r s i t y o f B e r g e n


Norwegian council for priority setting in health care
Norwegian Council for Priority Setting in Health Care values

  • As recommended in Lønning II

  • Standing committee

    • Served by Norwegian Knowledge Centre for the Health Services

    • Chaired by the head of Norwegian Directorate of Health

  • Committed to stakeholder involvement, publicity and accountability for reasonableness

U n i v e r s i t y o f B e r g e n


Linking hta to priority setting framework concepts and values

New guidelines and new principles for primary prevention of cardiovascular disease in Norway: differentiated risk thresholds according to age(HDir, 2009)

U n i v e r s i t y o f B e r g e n


Linking priority setting to hta
Linking priority setting to HTA cardiovascular disease in Norway: differentiated risk thresholds according to age

Health policy/

priority setting

HTA

Identify

consequences

Guidelines

Clinical research

Assess

evidence

Clinical practice

U n i v e r s i t y o f B e r g e n


Background
Background cardiovascular disease in Norway: differentiated risk thresholds according to age

  • Low risk thresholds

    • Risk of ”medicalization” of healthy people

    • Resource use, priority setting

U n i v e r s i t y o f B e r g e n


Risk table
Risk table cardiovascular disease in Norway: differentiated risk thresholds according to age


Priority relevant recommendations
Priority-relevant recommendations: cardiovascular disease in Norway: differentiated risk thresholds according to age

  • Medication for the following groups:

  • 40-49 years: if 10-year risk of cardiovascular death is ≥ 1%

  • 50-59 years: if 10-year risk of cardiovascular death is ≥ 5%

  • 60-69 years: if 10-year risk of cardiovascular death is ≥ 10%

U n i v e r s i t y o f B e r g e n


Priority table
Priority table cardiovascular disease in Norway: differentiated risk thresholds according to age


Impact on distribution
Impact on distribution cardiovascular disease in Norway: differentiated risk thresholds according to age

U n i v e r s i t y o f B e r g e n


Process
Process cardiovascular disease in Norway: differentiated risk thresholds according to age

  • Independent review of evidence on

    • Effectiveness

    • Cost-effectiveness

  • Independent guidelines development process

    • GRADE-system

    • Explicit on reasons

      • Medical

      • Ethical

      • Political

U n i v e r s i t y o f B e r g e n


Securing legitimacy for hard choices
Securing legitimacy cardiovascular disease in Norway: differentiated risk thresholds according to agefor hard choices

  • Advice from Norwegian Council for Priority Setting in Health Care on

    • Risk differentiation

    • Risk thresholds

  • Wide hearing process with key stakeholders

U n i v e r s i t y o f B e r g e n


Implementation
Implementation cardiovascular disease in Norway: differentiated risk thresholds according to age

  • Guidance linked to coverage decisions

    • (But less systematic and transparent process)

  • Too early to evaluate

  • U n i v e r s i t y o f B e r g e n


    Linking priority setting to hta1
    Linking priority setting to HTA cardiovascular disease in Norway: differentiated risk thresholds according to age

    Health policy/

    priority setting

    HTA

    Identify

    consequences

    Guidelines

    Clinical research

    Assess

    evidence

    Clinical practice

    U n i v e r s i t y o f B e r g e n


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