Hospital-based health technology assessment: insights from New Zealand.

Abstract

The paper by Assistant Prof. Gagnon, published in this issue of PharmacoEconomics [1], succinctly summarizes the current status of hospital-based, health technology assessment activities around the world. Such a summary is timely given the multiplicity of new health technologies clambering for a place in our public hospitals, which are often inundated in red ink. How is it possible to maintain the dual goals of optimal patient care and fiscal prudence? Apart from the ever-elusive ‘Wisdom of Solomon’, one practical tool is the appropriate use of health technology assessment ‘at the coalface’, as it were. Here in New Zealand, as elsewhere, that coalface is often the tertiary hospital where caring and eager clinicians are enthusiastic protagonists of novel cutting-edge technology. Where those innovations can potentially improve outcomes whilst reducing costs, they are greeted with open arms. Sadly, a much more common scenario is one where the innovation is an improvement over current therapies but whilst the improvements might be measurable and real (with reduced morbidity and/or mortality rates), the costs are often eye watering when compared with the quantum of improvement. The metric for this, in health technology terms, is the incremental cost-effectiveness ratio (ICER) and it is not uncommon for new technologies to be presented with tentative ICERs of tens of thousands of dollars for every added quality-adjusted life-year. When healthcare dollars are in short supply, as they have been since the global financial crisis of 2008, it makes novel health technologies seem like desirable but unaffordable luxury cars. Ernest Rutherford, that great Nobel prizewinner from New Zealand, was a master of bluntness when he accurately stated the New Zealand stance on technological matters: