Effects and repercussions of local/hospital-based health technology assessment (HTA): a systematic review.

Marie-Pierre Gagnon,Marie Desmartis,Thomas Poder,William Witteman

doi:10.1186/2046-4053-3-129

Abstract

BackgroundHealth technology assessment (HTA) is increasingly performed at the local or hospital level where the costs, impacts, and benefits of health technologies can be directly assessed. Although local/hospital-based HTA has been implemented for more than two decades in some jurisdictions, little is known about its effects and impact on hospital budget, clinical practices, and patient outcomes. We conducted a mixed-methods systematic review that aimed to synthesize current evidence regarding the effects and impact of local/hospital-based HTA.MethodsWe identified articles through PubMed and Embase and by citation tracking of included studies. We selected qualitative, quantitative, or mixed-methods studies with empirical data about the effects or impact of local/hospital-based HTA on decision-making, budget, or perceptions of stakeholders. We extracted the following information from included studies: country, methodological approach, and use of conceptual framework; local/hospital HTA approach and activities described; reported effects and impacts of local/hospital-based HTA; factors facilitating/hampering the use of hospital-based HTA recommendations; and perceptions of stakeholders concerning local/hospital HTA. Due to the great heterogeneity among studies, we conducted a narrative synthesis of their results.ResultsA total of 18 studies met the inclusion criteria. We reported the results according to the four approaches for performing HTA proposed by the Hospital Based HTA Interest Sub-Group: ambassador model, mini-HTA, internal committee, and HTA unit. Results showed that each of these approaches for performing HTA corresponds to specific needs and structures and has its strengths and limitations. Overall, studies showed positive impacts related to local/hospital-based HTA on hospital decisions and budgets, as well as positive perceptions from managers and clinicians.ConclusionsLocal/hospital-based HTA could influence decision-making on several aspects. It is difficult to evaluate the real impacts of local HTA at the different levels of health care given the relatively small number of evaluations with quantitative data and the lack of clear comparators. Further research is necessary to explore the conditions under which local/hospital-based HTA results and recommendations can impact hospital policies, clinical decisions, and quality of care and optimize the use of scarce resources.

Highlights

Health technology assessment (HTA) is increasingly performed at the local or hospital level where the costs, impacts, and benefits of health technologies can be directly assessed
The mini-HTA is usually done by a single professional who often participates in the assessment process, collecting data at the hospital level in order to inform decision makers
This paper presents a systematic review of the effects and impact of local/hospital-based HTA reported in the literature on decision-making or management

Summary

Introduction

Health technology assessment (HTA) is increasingly performed at the local or hospital level where the costs, impacts, and benefits of health technologies can be directly assessed. While health technology assessment (HTA) is often done at a national or international level, many local health services and hospitals consider that it makes sense to move the assessment closer to the point of care, where the costs, impacts, and benefits of technologies can be directly assessed. This is justified by the fact that many decisions regarding health technologies (prioritization, investment, adoption, and disinvestment) are made at the local/hospital level [1]. It is a formal organizational structure with specialized HTA personnel working on a full-time basis on the production of HTA material of high scientific quality

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Conclusion