Health Technology Assessment Review Research Articles

Impact of primary care exercise referral schemes on the health of patients with obesity

Primary care exercise referral schemes (ERSs) are a potentially useful setting to promote physical activity (PA). It is not established, however, whether interventions to increase PA, such as ERSs, have differing health outcomes according to the participants’ body mass index (BMI). This paper summarizes evidence for the impact of primary care ERSs on the health of people with obesity and reports findings of a reanalysis of the EMPOWER study, providing the first data to report differential outcomes of ERSs by BMI category. Our literature review revealed a paucity of published data. A 2011 Health Technology Assessment review and 2015 update were identified, but normal-weight participants were neither excluded nor were results stratified by weight in the included studies. A study of the effect of exercise referral in overweight women reported a significantly greater increase in PA levels in the ERS group than the control group at 3 months. Reanalysis of the EMPOWER study data showed a significant improvement in PA at 3 months in both obese and overweight/normal BMI groups, with the effect size attenuated to 6 months. There was no significant difference from baseline to 6 months in blood pressure for either BMI category. At 6 months, there was a significant decrease in weight from baseline for the obese category. Comparison of crude mean differences between BMI groups revealed a significant mean difference in PA at 3 months favoring the overweight/normal BMI group, but not at 6 months. There were no further significant differences in unadjusted or adjusted mean differences for other outcomes at follow-up. We report some evidence of a differential impact of ERS on PA by BMI category. However, the effect of ERSs in primary care for patients with obesity remains unclear due to the small number of published studies that have reported outcomes by BMI category. Further research is needed.

Evidence synthesis to inform model-based cost-effectiveness evaluations of diagnostic tests: a methodological review of health technology assessments

BackgroundEvaluations of diagnostic tests are challenging because of the indirect nature of their impact on patient outcomes. Model-based health economic evaluations of tests allow different types of evidence from various sources to be incorporated and enable cost-effectiveness estimates to be made beyond the duration of available study data. To parameterize a health-economic model fully, all the ways a test impacts on patient health must be quantified, including but not limited to diagnostic test accuracy.MethodsWe assessed all UK NIHR HTA reports published May 2009-July 2015. Reports were included if they evaluated a diagnostic test, included a model-based health economic evaluation and included a systematic review and meta-analysis of test accuracy. From each eligible report we extracted information on the following topics: 1) what evidence aside from test accuracy was searched for and synthesised, 2) which methods were used to synthesise test accuracy evidence and how did the results inform the economic model, 3) how/whether threshold effects were explored, 4) how the potential dependency between multiple tests in a pathway was accounted for, and 5) for evaluations of tests targeted at the primary care setting, how evidence from differing healthcare settings was incorporated.ResultsThe bivariate or HSROC model was implemented in 20/22 reports that met all inclusion criteria. Test accuracy data for health economic modelling was obtained from meta-analyses completely in four reports, partially in fourteen reports and not at all in four reports. Only 2/7 reports that used a quantitative test gave clear threshold recommendations. All 22 reports explored the effect of uncertainty in accuracy parameters but most of those that used multiple tests did not allow for dependence between test results. 7/22 tests were potentially suitable for primary care but the majority found limited evidence on test accuracy in primary care settings.ConclusionsThe uptake of appropriate meta-analysis methods for synthesising evidence on diagnostic test accuracy in UK NIHR HTAs has improved in recent years. Future research should focus on other evidence requirements for cost-effectiveness assessment, threshold effects for quantitative tests and the impact of multiple diagnostic tests.

VP216 Health Technology Assessment's Balance Between Additional Data, Adoption, And Patient Access

INTRODUCTION:Historically, many Health Technology Assessment (HTA) bodies were developed with a focus on addressing rapidly rising drug costs and the unique need to evaluate each drug as a de novo entity. The degree to which the unique needs for evaluating technologies vis a vis drugs are reflected in distinct HTA methods and activity is to date understudied.METHODS:We examined HTA's reviews of two technologies: WATCHMAN™, a device to reduce the risk of stroke in certain patients and Alair™, a procedure-based treatment for severe asthma. Both technologies have been extensively reviewed by HTA bodies and payers in many countries. These HTA reviews are compared to a convenience sample of these HTA's bodies reviews of drugs and qualitative differentiators between these two categories explored.RESULTS:The differences and similarities (for example, in rigor and necessity of evidence) between US Section 510(k) clearances, US premarket approval (PMA), and US new drug application (NDA) regulatory pathways have not been clearly understood by HTA or reflected in their methodologies employed. Additionally, emergent methodologies such as Bayesian statistical analyses may encounter challenges within technologies reviews. HTA bodies may not be cognizant of development timelines or the timelines of comparators. Finally, HTA bodies may overestimate device adoption rates.CONCLUSIONS:The differences in evidence requirements for regulatory approval between US 510(k), US PMA, and US NDA pathways have not been reflected in different methodological approaches within HTA bodies reviews. Opportunities and novel methods are needed for HTA bodies to derive imputed comparisons between technologies that may have inherently incongruent timelines. Finally, HTA bodies could benefit from methods to more accurately estimate projected adoption curves. Challenges exist using frameworks, paradigms, and methodologies initially established for, and commonly used for, pharmaceuticals on device evaluations; leaders of HTA methods can improve the situation by providing guidance and recommendations for more appropriate HTA methods to evaluate devices.

VP199 Limitations Of Studies On Oxygen Therapy In Acute Care Settings

INTRODUCTION:A high-level, rapid review (1) was conducted on oxygen therapy issues studied in the past 10 years in acute care settings. The main objective was to determine the appropriateness/inappropriateness of use, safety issues, and quality of care associated with oxygen prescription, administration, and monitoring. The results from this review were used to inform an upcoming provincial oxygen summit.METHODS:The Health Technology Assessment review (1) used a standardized rapid review approach: a comprehensive search of literature (published in English from 2005 to 2016), study selection using a priori developed criteria, and a qualitative synthesis of the results. Iterative interactions with the requester were necessary to clarify and refine the research questions, scope, and inclusion criteria.RESULTS:Twenty-four audit studies were reviewed, the majority published after 2011, in the United Kingdom, and also in single institutions. Twelve studies reported effects after implementing interventions for improvement of oxygen prescription. Many studies had caveats on design, data reporting, and outcomes, or they lacked an explanation of the methods of analysis. Studies conducted in rural settings, and on infants and children were unavailable. The reported issues with oxygen therapy included: a lack or an inconsistency of compliance with guidelines, local policies, and standards; inappropriate prescription and administration; variability in practice among healthcare providers; and suboptimal monitoring, including poor standards of medical chart documentation for patients receiving oxygen therapy, such as incomplete details on flow rate and oxygen concentration.CONCLUSIONS:Possibly due to the general tendency to publish research findings that have statistically significant results, relatively few publications were found in the literature search. The universal use of oxygen therapy and the enrolment of consecutive patients in some of the studies increase the applicability of the findings to other institutions. The rapid review provided a timely synthesis of the available, credible research for use by local stakeholders for further discussions and planning.

VP200 Untangling What Information Specialists Should Document and Report

INTRODUCTION:Thorough documentation and clear reporting are essential when conducting a comprehensive literature search for a health technology assessment (HTA) or systematic review. The ultimate goal of this process is transparency and reproducibility with the added benefit of increasing the reader's confidence in the research. Thorough documentation of the search also allows for critical appraisal of the methodology used and facilitates future updating of a review (1,2).It has been found that large numbers of systematic review searches are inadequately documented and there is little consensus on best practices for reporting standards (3).As part of the SuRe Info Project, we conducted a review of all current reporting standards relevant to HTAs and systematic reviews in addition to looking at the published literature on this topic in order to synthesize the evidence in this area and create a standard set of agreed upon recommendations.METHODS:We conducted a comprehensive search of Medline, Embase, and LISA (Library & Info Studies Abstracts) databases. We also examined the Equator Network (http://www.equator-network.org/) website. Reference lists of included studies and reporting guidelines were also consulted. Eleven reporting guidelines and eight studies were included in the review by two independent reviewers. Anything published before 2006, that was not a research article (other than the guidelines), and/or that did not provide new recommendations (that is, a review of another set of recommendations) was excluded.RESULTS:After collecting data on the suggested reporting elements described in the literature, we pooled our results to create an overarching list of the most commonly recommended elements to describe and the most commonly recommended methods to use when documenting a comprehensive search. Not only did these elements pertain to documenting the search strategy for the final report, but they also pertained to the protocol and the abstract of a review.CONCLUSIONS:It is hoped that this overview of the literature and compilation of the evidence will clarify some of the confusion that seems to exist when documenting and reporting searches and perhaps it will even help to reduce the existence of poorly described strategies in the research literature.

VP71 Health Technology Assessment In Japan: Current Issues And Challenges

INTRODUCTION:Japan plans to introduce Health Technology Assessment (HTA) in 2018 after a two-year trial period. Japan currently requires HTA for certain innovative products which may have a large budget impact. Through this trial implementation, the government can examine the criteria of applicable products, the necessary infrastructure to conduct and evaluate HTA, the quality of data content, and localization to meet the current Japanese reimbursement and pricing scheme. However, the pharmaceutical industry in Japan is still puzzled by this introduction. The aim of this study is to visualize the issues and implementation challenges of HTA in Japan through a survey of the pharmaceutical industry.METHODS:A semi-structured nineteen-item questionnaire was designed and the survey was conducted through face-to face or phone interviews. Answers were summarized after the interview and confirmed with the respondents via e-mail. The survey focused on pharmaceutical companies which develop new innovative products.RESULTS:The differences between Japanese and non-Japanese pharmaceutical companies were observed in terms of HTA staff expertise and experience, the source of HTA data, and relationships with external vendors. Many respondents stated that a sufficient number of HTA professionals in Japan is critical to implement HTA, and raised a concern that the same public experts who are involved in HTA preparation may also review HTA submissions. Although companies are generally pessimistic about HTA for pharmaceutical pricing, they also have some positive views that HTA may be used as an indicator to enable stakeholders to understand product value. Many are unsure about the link between HTA and pharmaceutical prices.CONCLUSIONS:If HTA is implemented for an extended number of products, a shortage of experts may cause delays of HTA review and appraisal processes. Consequently, product launch and patient access will be delayed. Practical timing of HTA review and appraisal after product launch could affect the results of re-pricing.

PHP293 - Understanding Health Technology Assessment (HTA) Bodies in Major Latin-American (LATAM) Markets: Systematic Evaluation in 5 Latam Countries

The importance of HTA bodies in healthcare decision-making in Latin American markets has increased significantly in recent years. Rapidly growing markets, political changes, state of healthcare infrastructure add to the complexity of patient access to medicines. HTA bodies in LatAm countries vary significantly in characteristics, attributes, methodologies employed, and referencing practices as do the payer reimbursement architypes. The objective was to characterize the different HTA bodies used in LatAm markets. We conducted a systematic review of HTA bodies’ documentation of 5 LatAm markets (Brazil, Chile, Colombia, Cuba and Mexico) and of peer-reviewed publications through PubMed. Over 350 characteristics, attributes assessed and methodologies used by each HTA were assessed and mapped. Documentation for all 5 markets had limited information available on HTA websites or in peer-reviewed publications. Cuba, Mexico and Brazil are among the longest established HTA bodies in LatAm. The HTA body in Brazil is a department of the national health ministry, while in Chile and Colombia HTA bodies are in-regulatory agencies. All markets consider clinical evidence including clinical trials, systematic literature reviews, meta-analyses and economic analysis. Specifically, Chile, Colombia and Mexico require budget-impact analyses. No markets utilize an explicit ICER thresholds, 2 markets publish reports online, 1 market considers rare diseases, 2 markets consider unmet needs, and all 5 markets are a part of Red ETSA, a commission that promulgates the integration of policies, information diffusion and evidence generation. Brazil, Colombia and Mexico have a Memorandum of Understanding with National Institute for Health and Care Excellence (NICE, UK). HTA bodies in LatAm are influenced by payer architypes in respective countries. HTA bodies rely on HTA reviews from other countries and regional inter-communication regarding evidence-based decision-making than most other regions in the world. These markets are currently developing policies regarding cost-effectiveness evidence and rare diseases.

Vitamin D supplementation should be routine in pregnancy: AGAINST: Proven benefits of vitamin D supplementation remain elusive.

Obstetricians have an unfortunate track record of implementing interventions before they are properly evaluated—examples include thalidomide for pregnancy nausea, tocolytics to suppress preterm labour, and vitamins C and E for the prevention of pre-eclampsia. In 2012 the Chief Medical Officers of the UK (Vitamin D—advice on supplements for at risk groups) recommended that, ‘All pregnant and breastfeeding women should take a daily supplement containing 10 μg of vitamin D’. However, as recently as 2003 the National Collaborating Centre for Women's and Children's Health antenatal care guideline (p.42) had recommended that ‘There is insufficient evidence to evaluate the effectiveness of vitamin D in pregnancy. In the absence of evidence of benefit, vitamin D supplementation should not be offered routinely to pregnant women’. This was updated in 2008 (p.12) to ‘women may choose to take 10 μg of vitamin D per day’ and supplementation was only ‘advised’ in women in high-risk groups (essentially, those with pigmented skin, or who usually remain covered when outdoors, or who have a poor diet, or are obese). There have been claims for the benefits of vitamin D in almost every pathological condition, and yet proven benefits remain elusive (Harvey BMJ 2012;345:e4695). The US Institute of Medicine in 2010 (Dietary Reference Intakes for Calcium and Vitamin D) concluded that, ‘More targeted research should continue. Higher levels have not been shown to confer greater benefits, and in fact, they have been linked to other health problems, challenging the concept that “more is better”. There is emerging evidence that too much of these nutrients may be harmful’. The Committee on Obstetric Practice of the American College of Obstetricians and Gynecologists (Vitamin D: Screening and Supplementation During Pregnancy) stated in July 2011 that, ‘At this time there is insufficient evidence to support a recommendation for screening all pregnant women for vitamin D deficiency’ and suggested that ‘vitamin D supplementation during pregnancy beyond that contained in a prenatal vitamin should await the completion of ongoing randomized clinical trials’. A 2013 comment in the Lancet suggested that the safest approach was to recommend supplementation only in high risk women as defined by the National Institute of Health and Clinical Excellence (NICE) (Steer Lancet 2013;381:2143–5). The latest Health Technology Assessment review of vitamin D supplementation in pregnancy (Health Technol Assess 2014;18:1–190) has concluded that ‘It is not possible to make rigorously evidence-based recommendations regarding maternal vitamin D supplementation during pregnancy’ and added ‘Although modest doses of vitamin D in pregnancy might well be relatively safe, at least in the short term, there are no long-term data to inform their potential long-term effects on offspring health. As with most interventions, it is probably optimistic to expect that there will be no risk of adverse events’. Surely it is time that we learned to do the proper studies before making potentially harmful recommendations. Philip Steer is Emeritus Editor, BJOG. For a full disclosure of interests, please go to www.BJOG.org.

Health technology assessment on cervical cancer screening, 2000-2014.

The aim of this study was to conduct a review of health technology assessments (HTAs) in cervical cancer screening to highlight the most common metrics HTA agencies use to evaluate and recommend cervical cancer screening technologies. The Center for Reviews and Dissemination (CRD), MedLine, and national HTA agency databases were searched using keywords ("cervical cancer screening" OR "cervical cancer" OR "cervical screening") and "HTA" from January 2000 to October 2014. Non-English language reports without English summaries, non-HTA reports, HTAs unrelated to a screening intervention and HTAs without sufficient summaries available online were excluded. We used various National Institute for Health and Care Excellence (NICE) methods to extract key assessment criteria and to determine whether a change in screening practice was recommended. One hundred and ten unique HTA reports were identified; forty-four HTAs from seventeen countries met inclusion criteria. All reports evaluated technologies for use among women. Ten cervical screening technologies were identified either as an intervention or a comparator. The most common outcome metric evaluated was diagnostic accuracy, followed by economic effectiveness. Additional outcome metrics such as the use of adjunct testing, screening intervals, and age-specific testing were commonly evaluated. Nearly one-third (fifteen of forty-four) of HTAs recommended a change in practice. This review highlights popular metrics used in HTAs for cervical cancer screening. Clinical and economic effectiveness metrics have been consistently assessed in HTAs, while the use of adjunct testing, screening intervals, and age-specific screening became increasingly prevalent from after 2007. Moreover, we observed an increase in optimized recommendations after 2007.

Health Economic Impact of Bariatric Surgery Revisted: Structured Review of Literature and Health Technology Assessments.

Health Economic Impact of Bariatric Surgery Revisted: Structured Review of Literature and Health Technology Assessments.

PSY104 - Health Technology Assessment, Price and Reimbursement Review for Orphan Drugs In France

PSY104 - Health Technology Assessment, Price and Reimbursement Review for Orphan Drugs In France

PSY103 - Health Technology Assessment, Price and Reimbursement Review for Orphan Drugs In Italy

PSY103 - Health Technology Assessment, Price and Reimbursement Review for Orphan Drugs In Italy

PRM17 - Strategies To Overcome Hurdles In Hta Appraisals Amid Limitations Resulting From Single-Arm Trial Data

The purpose of this study was to evaluate the barriers that arise in constructing strong pharmacoeconomic (PE) submission based on evidence from single-arm clinical trials, and to evaluate strategies to overcome them. A set of therapeutics were selected based on the following criteria: oncology indication with a PE submission for health technology assessment (HTA) review, utilising single-arm trial data. HTA appraisals in five major markets were considered – GBR, CAN, SCT, GER, and FRA. Modelling approaches used in each appraisal were enumerated, and HTA body comments on each employed strategy were collected. Each identified modelling strategy was evaluated for its likelihood in overcoming a negative appraisal across the selected major markets. The PE model barriers associated with single-arm trial data included: lack of direct comparison with comparator, reliance on surrogate endpoints, and lack of long-term follow-up. The techniques employed to address these drawbacks included: comparison with historical control, comparison with self-control, comparison with non-responder control, comparison with placebo-arm of a published trial, correlation of surrogate endpoints to hard outcomes, survival extrapolation methodology (including parametric extrapolation and cumulative survival approach). These methods were most successful in FRA and CAN, where positive HTA appraisals were awarded 7/8 and 2/2 times, respectively; and were least successful in GBR and SCT, where positive HTA appraisals were awarded 1/4 and 2/8 times, respectively. Manufacturers may face difficulties when modelling a product’s economic benefit based on data from a single-arm trial. While securing a positive HTA appraisal for such PE submissions remains difficult, there exist strategies that can help to overcome identified barriers, which have led to success in major HTA markets – most notably FRA and CAN.

What is the Clinical and Cost Effectiveness of Erythropoietin-Stimulating Agents for the Treatment of Patients with Cancer-Treatment Induced Anaemia? Insights from Cumulative Meta-Analyses (Cma) and Lessons for Cost-Effectiveness Analyses

ABSTRACT Aim: A health technology assessment (HTA) informing the recent NICE guidance use of erythropoiesis-stimulating agents (ESA) in cancer-treatment induced anaemia (CIA) identified uncertainty around precision and the direction of overall survival hazard ratio (OSHR). It also found that cost-effectiveness results were extremely sensitive to changes in OSHR. We investigate how the understanding of OS in CIA patients treated with ESAs has shaped over time and the effects of accumulating OS evidence on cost-effectiveness. Methods: CMA was applied to the HTA review OS data to identify patterns in results; study results were accumulated by the year of publication. As with the HTA review a random effects model was assumed. The annual OSHR results from the CMA were applied to an economic model developed in the HTA to calculate long term quality-adjusted life year (QALY) gains and the corresponding incremental cost-effectiveness ratios. Results: Although the precision of the OSHR estimate appeared to be improving with additional evidence, the true location of the estimate remained uncertain and the best estimate varied over time; no conclusive patterns were identified. Using the CMA, results from 2001 and 2002 suggested survival benefits to using ESAs (0.77, 95% CI 0.60–0.98 and 0.78, 95% CI 0.65–0.93 respectively), with ESAs being cost-effective at a willingness to pay threshold of £30,000 per QALY, even at the upper limit of the OSHR 95% confidence interval. Apart from the 2001 and 2002 results, the CMA for other years, including the most recent estimates and including the overall estimate, did not suggest any significant effects of ESAs on OS. Conclusions: CMA results confirm the lack of stability of OSHR. The possibility that there is no difference in OS for patients receiving ESAs compared to those who do not cannot be rejected, nor is there sufficient evidence to support this conclusion. This analysis also highlights the additional uncertainty of the current evidence base on cost-effectiveness analyses, which cannot be captured in standard sensitivity analyses. Disclosure: All authors have declared no conflicts of interest.

When pneumonia does not respond to antibiotics: a challenging neonatal diagnosis

Baby girl C was born at 41+2 weeks, weighing 2.8 kg, by vaginal delivery after induction of labour. This was the 24-year-old mother's first pregnancy, which was uncomplicated, with normal...

RETRACTED: Systematic Review of Economic Evaluation Literature in Ghana: Is Health Technology Assessment the Future?

In many countries, such as Ghana, there is an increasing impetus to use economic evaluation to allow more explicit and transparent health care priority setting. An important question for policymakers in low-income countries, however, is whether it is possible to introduce economic evaluation data into health care priority-setting decisions. This article systematically reviewed the literature on economic evaluation on medical devices and pharmaceuticals in Ghana published between 1997 and 2012. Its aim was to analyze the quantity, quality, and targeting of economic evaluation studies that relate to medical devices and pharmaceuticals and provide a framework for those conducting similar health technology assessment reviews in similar contexts. The review revealed that the number of publications reporting economic evaluations was minimal with regard to medical devices and pharmaceuticals. With the introduction of the National Health Insurance Scheme since 2004 policymakers are confronted with the challenge of allocating scarce resources rationally. Priority setting therefore has to be guided by a sound knowledge of the costs of providing health services. The need for economic evaluation is thus important. More costing studies were found; there were very few cost-effectiveness analysis studies. If economic evaluation is useful for policymakers only when performed correctly and reported accurately, these findings depict barriers to using economic evaluation to assist decision-making processes in Ghana; hence, there is a need for an independent health technology assessment unit.

Screening for type 2 diabetes: a short report for the National Screening Committee

The prevalence of type 2 diabetes mellitus (T2DM) has been increasing, owing to increases in overweight and obesity, decreasing physical activity and the changing demographic structure of the population. People can develop T2DM without symptoms and up to 20% may be undiagnosed. They may have diabetic complications, such as retinopathy, by the time they are diagnosed, or may suffer a heart attack, without warning. Undiagnosed diabetes can be detected by raised blood glucose levels. The aim of this review was to provide an update for the UK National Screening Committee (NSC) on screening for T2DM. As this review was undertaken to update a previous Health Technology Assessment review published in 2007, and a more recent Scottish Public Health Network review, searches for evidence were restricted from 2009 to end of January 2012, with selected later studies added. The databases searched were MEDLINE, EMBASE, MEDLINE-in-Process & Other Non-Indexed Citations, Science Citation Index and Conference Proceedings Citation Index. The case for screening was considered against the criteria used by the NSC to assess proposed population screening programmes. Population screening for T2DM does not meet all of the NSC criteria. Criterion 12, on optimisation of existing management, has not been met. A report by the National Audit Office (NAO) gives details of shortcomings. Criterion 13 requires evidence from high-quality randomised controlled trials that screening is beneficial. This has not been met. The Ely trial of screening showed no benefit. The ADDITION trial was not a trial of screening, but showed no benefit in cardiovascular outcomes from intensive management in people with screen-detected T2DM. Criterion 18 on staffing and facilities does not appear to have been met, according to the NAO report. Criterion 19 requires that all other options, including prevention, should have been considered. A large proportion of cases of T2DM could be prevented if people avoided becoming overweight or obese. The first stage of selection would use risk factors, using data held on general practitioner computer systems, using the QDiabetes Risk Score, or by sending out questionnaires, using the Finnish Diabetes Risk Score (FINDRISC). Those at high risk would have a measure of blood glucose. There is no perfect screening test. Glycated haemoglobin (HbA1c) testing has advantages in not requiring a fasting sample, and because it is a predictor of vascular disease across a wider range than just the diabetic one. However, it lacks sensitivity and would miss some people with diabetes. Absolute values of HbA1c may be more useful as part of overall risk assessment than a dichotomous 'diabetes or not diabetes' diagnosis. The oral glucose tolerance test is more sensitive, but inconvenient, more costly, has imperfect reproducibility and is less popular, meaning that uptake would be lower. When considered against the NSC criteria, the case for screening is less strong than it was in the 2007 review. The main reason is the absence of cardiovascular benefit in the two trials published since the previous review. There is a case for selective screening as part of overall vascular risk assessment. Population screening for T2DM does not meet all of the NSC criteria. The National Institute for Health Research Health Technology Assessment programme.

CASE STUDIES THAT ILLUSTRATE DISINVESTMENT AND RESOURCE ALLOCATION DECISION-MAKING PROCESSES IN HEALTH CARE: A SYSTEMATIC REVIEW

Technological change accounts for approximately 25 percent of health expenditure growth. To date, limited research has been published on case studies of disinvestment and resource allocation decision making in clinical practice. Our research objective is to systematically review and catalogue the application of frameworks and tools for disinvestment and resource allocation decision making in health care. An electronic literature search was executed for studies on disinvestment, obsolete and ineffective technologies, and priority healthcare setting, published from January 1990 until January 2012. Databases searched were MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, Embase, The Cochrane Library, PubMed, and HEED. Fourteen case studies on the application of frameworks and tools for disinvestment and resource allocation decisions were included. Most studies described the application of program budgeting and marginal analysis (PBMA), and two reports used health technology assessment (HTA) methods for coverage decisions in a national fee-for-service structure. Numerous healthcare technologies and services were covered across the studies. We describe the multiple criteria considered for decision making, and the strengths and limitations of these frameworks and tools are highlighted. Disinvestment and resource allocation decisions require evidence to ensure their transparency and objectivity. PBMA was used to assess resource allocation of health services and technologies in a fixed budget jurisdiction, while HTA reviews focused on specific technologies, principally in fee-for-service structures. Future research can review the data requirements and explore opportunities to increase the quantity of available evidence for disinvestment and resource allocation decisions.

PMD53 A Review of Health Technology Assessments (HTAS) for Cervical Cancer Screening Technologies

PMD53 A Review of Health Technology Assessments (HTAS) for Cervical Cancer Screening Technologies

PHP26 Health Outcomes and Economics Research for Regenerative Medicine and Cellular Therapies: Lessons From A Multi-Market Health Technology Assessment and Reimbursement review

PHP26 Health Outcomes and Economics Research for Regenerative Medicine and Cellular Therapies: Lessons From A Multi-Market Health Technology Assessment and Reimbursement review