Health Technology Assessment and evidence-informed decision making. Derek Cutler, MSc NICE International. Health systems everywhere are under pressure…. Burden of chronic disease and ageing populations. Users’ e xpectations and the promise of universal coverage.
Derek Cutler, MSc
Health systems makingeverywhere are under pressure…
Burden of chronic disease and ageing populations
expectations and the promise of universal coverage
Finite budgets and financial pressures
Policy and practice
Growth in technologies – expanding marketplace
“The NHS, just like every other healthcare system in the world—public or private—has to set priorities and make choices. The issue is not whether there are choices to be made, but how those choices are made. There is not a service in the world, defence, education or health, where this is not the case.”
UK Parliamentary Health Committee
“A multi-disciplinary field of policy analysis that examines the medical, economic, social and ethical implications of the incremental value, diffusion and use of a medical technology in health care.”
Medical technology: “Any intervention that may be used to promote health, to prevent, diagnose or treat disease or for rehabilitation or long-term care. This includes pharmaceuticals, devices, procedures and organizational systems used in health care.”
INAHTA (International Network of Agencies for Health Technology Assessment)
1. How well does the technology/intervention work compared to standard practice in OUR healthcare system? Health gain can be estimated using quality adjusted life years (QALYs)
2. How much does the technology/intervention cost compared to
standard practice in OUR healthcare system?
3. Incremental cost effectiveness can be calculated by comparing (1) and (2)
Difference in costs
Difference in effect
Extent of uncertainty
Legal and policy constraints
Non-utilitarian criteria: ethics, equity, rights
Practicalities of implementationCost-effectiveness and…
Open, consultative decision-making processes:
“Successful development depends to a large extent on a government‘s capacity to implement its policies and manage public resources through its own institutions and systems”
The Paris Declaration on Aid Effectiveness (2005) and the Accra Agenda for Action (2008)
in both areas
Need, relationship?demand, and supply are different in every country:
Demand for HTA
Who (departments, institutions) will be using the outputs of HTA?
Need for HTA:
What policy decisions will be informed by HTA?
Supply of HTA:
Who (departments, institutions) will be conducting HTA and running the HTA process?