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EC8001 Assignment 2 Group 3 Marie Sinnott Deirdre Mahony. Health technology assessment of a population-based colorectal cancel screening programme in Ireland (2009). HiQA – Health Technology Assessment (HTA). HiQA has statutory responsibility for Health Technology Assessment;

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Ec8001 assignment 2 group 3 marie sinnott deirdre mahony

EC8001 Assignment 2

Group 3 Marie Sinnott

Deirdre Mahony

Health technology assessment of a population-based colorectal cancel screening programme in Ireland(2009)

Hiqa health technology assessment hta
HiQA – Health Technology Assessment (HTA)

  • HiQA has statutory responsibility for Health Technology Assessment;

    • Ensuring the best outcome for the service user by evaluating the clinical and economic effectiveness of drugs, equipment, diagnostic techniques and health promotion activities;

  • Required to make recommendation to the Minister on the preferred option

  • HTA directorate manages the research project but “buys in” expertise based on the requirements identified by the Expert Advisory Group

The problem
The Problem

  • Colorectal cancer is the second most frequently diagnosed cancer in both men and women;

  • Slow progression – 10-15 years to occur – patient prognosis is much better with early diagnosis;

  • On average 2,040 cases identified each year with 925 deaths each year;

  • Older people are most at risk;

  • Presents major challenges for an ageing population;

  • OECD critical of Irish performance in cancer care services.

The possible solution

Conduct population-based screening to save lives:

Preventing disease;

Earlier detection and treatment for better outcomes;

Invite a defined population who are at average risk to attend screening;

Many different interventions available with different age targets;

Population screening programmes widely used internationally

Found to be cost-effective and occasionally cost-saving

WHO guidance – must be effective, safe and acceptable to the population. Must be cost-effective and feasible for the health care system

The Possible Solution?

Purpose of hta
Purpose of HTA

  • Does the intervention (technology) work?

  • For whom does it work?

  • What is the benefit to the individual?

  • At what cost?

  • How does it compare to the alternative options available?

Specific evaluation questions
Specific Evaluation Questions

  • Evaluate the cost-effectiveness of three selected screening options, relative to each other and against no-screening;

  • To estimate the resource requirements and health outcomes over 10 years;

  • To examine the ethical considerations arising from these findings;

  • The HTA did not estimate the budgetary impact of establishing such a screening programme – this had previously been done by the NCSS and formed part of the rationale for the HTA.

Hta process
HTA Process

  • Project Management Methodology & Approach

    • Expert Group

  • Multi-disciplinary team with experience of economic modelling, HTA, and Health Services Research;

  • Literature Review – published and unpublished

  • Economic Evaluation to determine the most cost-effective interventions;

  • Report on Ethical considerations;

  • Longitudinal resource implications.

  • Review planned for 2012

Economic analysis in hta
Economic Analysis in HTA

  • Particularly useful for assessing cost-effectiveness of screening programmes

  • Three possible analytic approaches

    • Cost-effectiveness analysis (CEA) – uses LYG

    • Cost-Utility analysis (CUA) – uses - QALYs

    • Cost-Benefit – monetises benefits

  • Similar approaches to measuring costs – direct rather than indirect

  • Differences in measuring benefits

    • Cost-Utility analysis most widely used

  • Current evaluation uses both CEA and CUA

  • Incremental Cost Effectiveness Ratios

Economic model

Economic model useful:

Dealing with uncertainty

To predict the Future

ScHARR Model – modified to the Irish setting;

Assumptions documented

Whole of population approach;

Cost estimates were compiled from hospital/pharmacies data and other studies;

Extensive sensitivity analysis was conducted

Economic Model


  • Population data

  • Rates of diagnosis

  • Rates of mortality

  • Costs of screening/diagnostics/treatment

  • Lifetimes costs of colorectal cancer

  • Assumptions/sensitivity analyses

Hta conclusions recommendations
HTA Conclusions & Recommendations

  • HTA found that any of the proposed screening options was more cost-effective than the “do nothing” option;

  • The optimal strategy among the “do something” options was found to be a biennial immunochemical faecal testing for individuals aged 55-74 years;

  • This was based on considerations of health gain and cost-effectiveness, including 10-year resources

Critical appraisal
Critical Appraisal

  • Benefit of a HTA directorate within HiQA with particular evaluative (oversight) expertise. Lack of robust Irish data;

  • Possible disconnect between budgetary process and HTA;

  • Cost estimates were not derived from any particular estimation exercise but rather an amalgam of available information;

  • Extensive sensitivity analysis including one way and multi-way analyses;

  • Criticality of Assumptions e.g. immediate roll out assumed, discount rate used


  • Good example of a thorough Evaluation Process

  • In line with stated Health Policy objectives

    • “evidence and strategic objectives underpin all planning/decision making”

  • Approach has the benefit of international comparison

  • Will the Programme survive the budget cuts?

    • Cancer services ringfenced