Hospital-based Health Technology Assessment Research Articles

Overcoming Barriers in Hospital-Based Health Technology Assessment (HB-HTA): International Expert Panel Consensus.

The purpose of this article is to investigate the common facilitators and barriers associated with the implementation of hospital-based health technology assessment (HB-HTA) across diverse hospital settings in seven countries. Through a two-round Delphi study, insights were gathered from a panel of 15 HTA specialists from France, Hungary, Italy, Kazakhstan, Poland, Switzerland, and Ukraine. Experts initially conducted a comprehensive review of the HB-HTA implementation in their respective countries, identifying the barriers and facilitators through descriptive analysis. Subsequently, panel experts ranked these identified barriers and facilitators on a seven-point Likert scale. A median agreement score ≥ 6 and interquartile range (IQR) ≤ 1 was accepted as reaching a consensus. Out of the 12 statements categorized as external and internal barriers and facilitators, the expert panel reached consensus on six statements (two barriers and four facilitators). The external barrier, which achieved consensus, was the lack of the formal recognition of the role of HB-HTA in national or regional legislations. The internal barrier reaching consensus was the limited availability of human resources dedicated to HB-HTA. This qualitative study indicates that HB-HTA still has progress to make before being formally accepted and integrated across most countries, although by building on the facilitating factors we identified there may be an opportunity for the implementation of internationally developed strategies to strengthen HB-HTA practices.

Research on Hospital-Based Health Technology Assessment in Clinical Application Management of Medical Technology in Public Hospitals in China: Hainan Province Sample

Though investigating the knowledge of professional personnel on medical technology management, this study aimed to explore the establishment of an electronic HB-HTA approach in clinical application management of medical technology in public hospitals. The study designed a questionnaire to collect data and recruited a total of 1089 professional staff from 16 hospitals in Hainan. Medical staff had limited awareness of medical technology clinical application management and the HB-HTA approach. The working years, education level, and professional title level of medical staff were positively correlated with the awareness of medical technology management (P<0.05). In addition, the professional titles of medical staff were positively correlated with awareness(P<0.05). The higher the professional title level, the higher the awareness degree, followed by the correlation of working years. To increase the awareness and use of clinical applications of medical technology, the HB-HTA should be well organized. The electronic HB-HTA approach should be strongly formulated and undertaken by the medical staff in clinical application management of medical technology in public hospitals.

Introduction of hospital-based health technology assessment in China: experiences from seven pilot hospitals.

This study aimed to introduce a pilot program for hospital-based health technology assessment (HB-HTA) in China and present the participants' experiences based on seven case studies from seven tertiary hospitals. One-year pilot projects were initiated at the beginning of 2018. Seven pilot hospitals were closely followed from the beginning until the completion of their pilot HTA project. Regular interviews were conducted with the hospital managers leading the HB-HTA projects and key members of the special HTA teams. Observations were made based on field trips and written HTA reports. Three pilot projects evaluated the use of medical consumables, three evaluated the use of surgical or medical interventions, and one evaluated an innovative management model for ventilators. Real-world data were collected from all the pilot projects to assist with the assessments. Most HB-HTA pilot projects achieved remarkable results such as improvements in economic efficiency; however, there were also obvious deficiencies such as the lack of a necessary cost-effectiveness analysis. The results varied among the seven HB-HTA pilot projects. The HB-HTA pilot program was implemented to promote the use of HB-HTA in hospital decision making in China. At the same time, HB-HTA in China faces challenges. We have made some policy recommendations based on the findings of the pilot projects.

PP76 From Hospital-based Health Technology Assessment (HTA) To Treatment Decision: What Decisions Actually Result After HTA In A Resource Constrained Environment?

IntroductionThe Northern Region Clinical Practice Committee (NRCPC) conducts hospital-based health technology assessments (HTA) to provide advice to hospital managers regarding both the implementation of new technologies and the configuration of existing services. To assist in the comparison of dissimilar health technologies applied across different disciplines and different hospitals, the NRCPC developed a prioritization tool. This abstract reports the use of the tool over the 17-year period that the committee has been in operation.MethodsThe score given to each HTA depends on cost-utility, predicted health improvements and the quality of evidence. In addition to the scoring tool, editorial notes are provided to contextualize the agreed score and to explain the NRCPCs interpretation of the evidence.ResultsMost of the time hospital managers have made decisions concordant with the recommendations of the NRCPC; submissions are recommended to be implemented, declined, or receive interim approval with data collection. The latter often occurs when there are uncertainties about efficacy, but no (or very few) safety concerns, or where there are uncertainties about whether the proposed costs are reproducible in the hospital setting. In these cases, management responses often require submitters to undertake a limited number of cases and collect data for audit over a one-to two-year period. Low-scoring submissions are often declined, whereas high-scoring submissions have not been declined to date. The interim approval (with data collection) strategy has had variable outcomes based on the willingness of the implementing clinicians to collect accurate data about both costs and outcomes. From 2005 to 2022, the NRCPC received 146 submissions. This poster reports graphical representations of the decisions made over the NRCPCs period of operation.ConclusionsThe NRCPC scoring tool has been successful to date in providing a framework for decision makers to allow consistent, unbiased and objective assessments of dissimilar technologies. Prioritization tools in hospital-based HTA are beneficial to decision makers in hospital settings.

OP148 Influence Of The Hospital-Based Health Technology Assessment Unit On New Technologies Transfer At The National Level In Kazakhstan

IntroductionThe hospital-based Health Technology Assessment (HB-HTA) Unit in the Hospital of the President’s Affairs Administration has been operating since 2015 and is the first example of the implementation of the HB-HTA system in Kazakhstani hospitals. In addition to assessing the feasibility of implementing new health technologies (HTs) into the hospital’s practice, the Unit also interacts with the National Regulatory Authority (NRA) to transfer new technologies into the National Reimbursement System (NRS). We report on the transformation of the HB-HTA Unit from a stand-alone entity to an integrated, specialized agency.MethodsData were drawn from reports of the HB-HTA Unit and internal NRA documents. Inclusion of new HTs into the NRS consists of the following sequential stages: (i) implementing the technology in at least one hospital; (ii) filing an application with the Ministry of Health Care (MoH) in the field of HTA to resolve the issue of reimbursement at the national level; (iii) in case of a positive decision, approval at the national level of the clinical protocol for using the medical intervention; (iv) agreement on the reimbursement price of the technology.ResultsBased on positive recommendations from the HB-HTA report in 2015, the hospital implemented 19 new nuclear medicine technologies. In 2016, the hospital initiated an application to the MoH to include these technologies in the NRS (previously, these technologies were carried out only for a fee or with private insurance). From 2016 to 2020, a positive decision from the MoH was received, protocols for medical interventions were published at the national level, and cost estimates were formulated. In 2021, 19 new medical services in nuclear imaging and scintigraphy were included in the NRS.ConclusionsDespite the long and bureaucratic process of including new HTs in the NRS, the HB-HTA Unit managed to speed up this process. One of the main priorities of the integrated HB-HTA Unit is to promote the transfer of HTs into the health system at the national level.

HTA258 A Hospital-Based Health Technology Assessment of Near-Infrared Fluorescence Using Indocyanine Green for Sentinel Lymph Node Mapping for Breast Cancer and Gynecologic Cancer

HTA258 A Hospital-Based Health Technology Assessment of Near-Infrared Fluorescence Using Indocyanine Green for Sentinel Lymph Node Mapping for Breast Cancer and Gynecologic Cancer

HB-HTA focus in a tertiary hospitals' network in Northern Italy: A three-years experience analysis.

Nowadays Health Technology Assessment (HTA) is becoming more important in the hospital management, until the conception of Hospital Based HTA (HB-HTA), considered as a tool of HTA that is a multidisciplinary process to determine the value of a health technology in health sector. The aims of this study are the investigation of the current state of the art and of the diffusion of the HTA culture in hospitals (HB-HTA) also the analysis of the thinking of healthcare professionals regarding the usefulness of HTA. The study was performed through the administration of two questionnaires respectively to hospitals' HealthCare Workers (HCW) to assess the HTA's knowledge and to hospitals' HCW that have submitted a new technologies or devices' request to Direction between 2017 and 2019. Considering 988 questionnaires send to HCW only 416 (42.1%) answer were collected, with a higher attention towards HTA made by physicians (148; 35,6%). It's fundamental to observe that despite a mean response rate all the population shows interest for the HB-HTA concept as an instrument to help the hospital management. About the 23 questionnaires to HCW that have made request show a higher attention and knowledge to HTA. In conclusion, in the current welfare landscape and for the future developments that will ensue from it, especially in the Italian context due to the increase of healthcare funds provided by the NRRP (National Recovery and Resilience Plan), the adoption of the HB-HTA method will represent a strategic lever to support clinical and organizational decision-making processes governance.

The first experience in developing a training methodology for the hospital-based health technology assessment in Ukraine

Health technology assessment in the world is increasingly conducted at the hospital level, where the costs, impacts and benefits of health technology can be directly assessed in a specific hospital. One of the urgent issues is the preparation of qualified hospital staff for the implementation of hospital-based HTA. Aim. Develop and conduct the first training on hospital-based health technology assessment for hospital stakeholders of Ukraine. Materials and methods. DACEHTA (англ. Danish Centre for Evaluation and Health Technology assessment) and AdHopHTA (англ. Adopting hospital-based Health Technology Assessment) guidelines were included into the analysis. The methods of content analysis, systematization and data generalization were used. Results. The first training on hospital-based HTA was conducted in the Regional Clinical Hospital named after O. O. Gerbachevsky of the Zhytomyr Regional Council. 9 hospital stakeholders were identified by preliminary semi-structured interview: the medical director of therapy, the medical director of surgery, the deputy director of economic, the head of the monitoring department, the representative of the information and statistics department, representatives of two clinical departments, of laboratory department and department of functional diagnostics. The curriculum was build taking into account he basic HB-HTA skills needed for hospital specialist should possess and included 8 blocks, each lasting 1.5 hours. Each block consisted of both theoretical and practical components and finished with homework, which was discussed at the beginning of the next block. This approach enabled the participants to better assimilate the presented information and carefully complete the homework of each block. Conclusions. The participants of the training noted that the use of hospital-based HTA is the most relevant issue today. Making management decisions based on HB-HTA will allow a more optimized hospital budget usage. At the same time, the participants emphasized the importance of the work of a cross-functional team in conducting HB-HTA with the mandatory involvement of hospital economists. Based on training participants and HTA international experts feedback, a two-week post-graduated course "Hospital-based HTA is a practical tool for making scientifically based decisions at the hospital level" was developed and approved in the NMU named after O.O. Bogomolets.

The initiation, exploration, and development of hospital-based health technology assessment in China: 2005 ‒ 2022.

A hospital-based health technology assessment (HB-HTA) can provide the evidence needed to inform clinical decisions at the administrative level. With the implementation of a new round of medical and health care system reforms in China, such as the abolition of medical mark-ups, adoption of modern hospital management systems, reform of diagnosis related groups (DRGs) payment, and performance evaluations for public hospitals, medical institutions increasingly need HB-HTA. The development of HB-HTA in China can be divided into three phases: An initiation phase (2005-2014), a preliminary exploratory phase (2015-2017), and a rapid development phase (2018-present). HB-HTA has been used to manage medical consumables, medical devices, and medicines, but there are still problems and challenges in terms of concept recognition, the mode of development, and limited professionals and data. To promote and use HB-HTA in developing countries, we have identifies the development paths and recommendations for implementation based on a case study in China, which can be summarized as follows: enhancing the top-level design of HB-HTA, formulating HB-HTA guidelines, further promoting the main ideas of HB-HTA, concentrating on the training of evaluation personnel, establishing an HB-HTA network and paying attention to the flexibility of HB-HTA in the application process, and multi- stakeholder participation.

International experience of using report forms for hospital-based health technology asssessment

Hospital-based health technology assessment (HB-HTA) is one of the components of public management and support hospital managers to science-based decision-making regarding the implementation of new and innovative health technologies (HT). HB-HTA includes the processes and methods used to make HTA reports in and for hospitals. Ukraine has already started implementing hospital-based HTA, but a number of steps are still needed to fully implement HTA at the hospitals. One of them is the choice of HB-HTA report form, which will be appropriate to use in the practical activities of hospitals in Ukraine.
 The purpose of the study is to analyse the international experience of using different HB-HTA report form with the aim of selecting the optimal HB-HTA report form for hospitals in Ukraine. There were analysed different forms of HTA reports in Ukraine regulatory framework, international scientific literature, the AdHopHTA handbook, which included the following countries: Norway, Finland, Turkey, Spain, Austria, Italy, Estonia, Denmark, Switzerland, in international HTA database INAHTA, Canadian and Kazakhstan report databases. The methods of content analysis, systematization and generalization were used.
 Making managerial decisions about investment or disinvestment in health technology requires information that meets the hospital stakeholders needs. Such scientifically based information is provided by HB-HTA report form.
 There are a wide range of HB-HTA reports forms in terms of content, subject matter, structure and resources (time and staff). Each is based on the EUnetHTA HTA core model. For introducing a hospital-based HTA, the countries of the world most often choose the mini-HTA form. Mini-HTA supports hospital managers to make science-based strategic decisions of the introduction of new treatment methods, new indications for the use of existing technology, medical equipment, medical devices, or stopping the usage of health technology. The choice between performing a mini-HTA or a more comprehensive hospital-based HTA often requires a balance between the quality and thoroughness and the necessary speed of assessment in a specific situation.
 From the authors' point of view, the most applicable to Ukrainian context is the mini-HTA form. Adapting mini-HTA and approving it as a recommended report form at the state level will provide an opportunity to more widely HTA usage by hospitals in Ukraine.

Hospital-based health technology assessment of innovative medical devices: insights from a nationwide survey in France.

To better understand the process of hospital acquisition of innovative medical devices (MDs) and the hospital-based health technology assessment (HB-HTA) pathways in France, an in-depth study based on a quantitative approach is needed. The aim of the present study was to assess through a national survey how HB-HTA is currently implemented in French hospitals and to identify its level of formalization. A quantitative online survey was conducted among hospitals performing HB-HTA in France, with a focus on the acquisition of innovative MDs for individual use. The survey, conducted between March and June 2022, was developed by a scientific board composed of members of the French-speaking Society for HB-HTA. Sixty-seven out of 131 surveyed hospitals with HB-HTA activities responded, including 29 university hospitals, 24 nonprofit private hospitals, and 14 local hospitals. Sixty-one respondents (91 percent) reported the existence of a process dedicated to evaluating innovative MDs; of these, 16 declared that their hospitals had a formalized unit with HB-HTA activity. These units were more frequently found in larger hospitals with more than 500 inpatient beds (n=16, p=0.0160) and in university hospitals (n=12, p=0.0158). No hospital reported any collaboration with HAS, the French national HTA agency. A diverse range of HB-HTA organizations with different structural levels exist in France for MD procurement linked to the category of hospitals. The study highlights the need for recognition of HB-HTA activity at the regulatory level in France and for direct collaboration between HTA activities performed at local and national levels.

Advancing hospital-based health technology assessment: evaluating genomic panel contracting strategies for blood tumors through a multimethodology.

The adoption of genomic technologies in the context of hospital-based health technology assessment presents multiple practical and organizational challenges. This study aimed to assist the Instituto Português de Oncologia de Lisboa Francisco Gentil (IPO Lisboa) decision makers in analyzing which acute myeloid leukemia (AML) genomic panel contracting strategies had the highest value-for-money. A tailored, three-step approach was developed, which included: mapping clinical pathways of AML patients, building a multicriteria value model using the MACBETH approach to evaluate each genomic testing contracting strategy, and estimating the cost of each strategy through Monte Carlo simulation modeling. The value-for-money of three contracting strategies - "Standard of care (S1)," "FoundationOne Heme test (S2)," and "New diagnostic test infrastructure (S3)" - was then analyzed through strategy landscape and value-for-money graphs. Implementing a larger gene panel (S2) and investing in a new diagnostic test infrastructure (S3) were shown to generate extra value, but also to entail extra costs in comparison with the standard of care, with the extra value being explained by making available additional genetic information that enables more personalized treatment and patient monitoring (S2 and S3), access to a broader range of clinical trials (S2), and more complete databases to potentiate research (S3). The proposed multimethodology provided IPO Lisboa decision makers with comprehensive and insightful information regarding each strategy's value-for-money, enabling an informed discussion on whether to move from the current Strategy S1 to other competing strategies.

PD03 Uptake Of Health Technology Assessment In Hospitals: A Scoping Review

IntroductionThe use of Health Technology Assessment (HTA) in hospitals contributes to decision-making, professional training, greater interaction with technical to scientific knowledge, resource-saving, and partnerships. Hospitals are strategic for the field of clinical management and quality of care and are open to partnerships with national and international agencies and groups. Despite the hospital-based (HB)-HTA movement, the incipient application of HTA to the hospital decision-making process is related to incipient planning, and there is still much room for progress worldwide. The aim of this study was to analyze the uptake level of HB-HTA in diverse contexts.MethodsA scoping review was conducted according to the methodology of the Joanna Briggs Institute, whose data analysis model consisted of the combination of Donabedian’s structure, process, and outcome categories and the dimensions of the project Adopting Hospital Based Health Technology Assessment in European Union (AdHopHTA).ResultsWe identified 270 studies, and after removing duplicates and reading full texts, 36 references met the eligibility criteria. Thirty-six hospitals were identified, of which there were 24 largescale hospitals with extra bed capacity. Twenty-three hospitals were affiliated with universities. Canada stood out with five university hospitals, four of which with public funding. Half of the identified hospitals had HB-HTA units (18/36). Hospitals with full uptake level of HTA corresponded to 75 percent of the sample (27/36), and the remainder had partially uptake level of HTA, or 25 percent of the hospitals in the review (9/36). There were no hospitals with incipient uptake level of HTA.ConclusionsMeasuring the uptake level of HTA in hospitals contributed to understanding how their participation has occurred in the field of HB-HTA. This study revealed the importance of identifying factors such as sustainability, growth, and evolution of HB-HTA in countries with and without a tradition in this field.

HTA86 Health Technology Assessment in Hospitals: A Systematic Review on Methods and Practices

Hospitals are at the forefront of health technology innovation. Being hospitals characterized by constrained budgets, competencies, and time, they need a reference framework to select value-for-money technologies. Contrary to what happens for Health Technology Assessment (HTA) at national/regional level, there are not generally accepted guidelines for running Hospital-Based Health Technology Assessment (HBHTA).

Possibilities of Implementing Hospital-Based Health Technology Assessment (HB-HTA) at the Level of Voivodeship Offices in Poland.

The Health Technology Assessment is based on the evaluation of the characteristics and effects of health technologies to properly spend resources in healthcare. For the needs of hospitals, a special HTA department, Hospital-Based Health Technology Assessment (HB-HTA), has been established. The objective of the article is to assess the possibility of implementing a functional model with the coordinating role of Health Departments of the Voivodeship Offices with the support of the National Health Fund and the HTA Agency in Poland. Ten semi-structured interviews were conducted with representatives from eight Voivodeship Offices. The interviews consisted of nine questions related to the possibility of introducing a functional model with the participation of the Voivodeship Office. The material was divided into seven codes relating to the questions included in the topic guide. From the perspective of Voivodeship Offices, HB-HTA could contribute to the improvement of the methodology used in the Evaluation Instrument of Investment Motions in Health. The lack of personnel in the Voivodeship Offices was identified as one of the greatest barriers to the implementation of HB-HTA. These public administration units should not be involved in the hospital health technology assessment process.

The Need to Implement Health Technology Assessment in Polish Hospitals-A Survey of 50 Hospital Managers.

Hospital-based health technology assessment (HB-HTA) is a scientific approach to inform decisions on investments in health technologies across multiple medical specialties at a hospital level. HB-HTA is not currently practiced in Poland. This study aimed to assess the need for HTA in Polish hospitals, including perceived benefits and challenges of adoption of HB-HTA in Poland, expected demand for training in HB-HTA, and perception of incentives to foster HB-HTA adoption. Study data were gathered using the computer-assisted telephone interview (CATI) technique. Between June and August 2021, 50 interviews were conducted: 52% of respondents had over 10 years of experience, and 40% comprised the highest degree reference hospitals. A high or moderate need for HB-HTA was reported by 86% of managers. The ability to indicate valuable and affordable medical technologies was the main reported benefit of HB-HTA (90%). The main obstacle to the adoption of HB-HTA was the shortage of competent staff (84%). The most important incentives to adopt HB-HTA were free training and premium financing from the National Health Fund. There is a clear need for HB-HTA in Polish hospitals despite some important obstacles.

Scoping review of domestic and overseas hospital-based health technology assessment

This paper systematically sorted out the related research on hospital-based health technology assessment(HB-HTA) and clarified the research status of this field to provide a basis for the future research direction and focus of HTA in traditional Chinese medicine(TCM) hospitals. Based on the scoping review, relevant research papers were retrieved from Chinese databases(including CNKI, Wanfang, VIP, and SinoMed) and PubMed and analyzed. Among the included 99 papers, the earliest one was published in 2005 in China, and the number of papers has been increasing since 2016. In terms of journals, the included papers were published in 39 journals, including 24 core ones and 2 SCI ones. In terms of the number of publications, the Chinese Journal of Evidence-Based Medicine accounted for the majority(n=6). Among the 175 authors involved, three of them published 15 papers, respectively, accounting for 20.83% and ranking the top, and they came from Renmin University of China and the National Health Commission of China. There were 38 first units dominated by hospitals. Hebei General Hospital published the most papers(n=10), followed by Renmin University of China(n=9) and the National Health Commission of China(n=7). In terms of research type, the research papers were dominated by evaluation and practice ones(n=29), followed by reviews(n=20). In terms of research topic, the research was mainly carried out from devices(n=26) and macro-perspective scope(n=24). Half of the research in China was funded. For 27 research papers published abroad, the number of publications in the past five years was small, with 16 countries involved. Developed countries paid more attention to this field than developing countries. Especially in Europe and the US, the publishing institutions were mainly universities, and the types of research were mainly interviews and evaluation or practice. In recent years, the attention of HB-HTA in China has been increasing year by year, and the development of related projects has provided a scientific decision-making basis for the admission and management of new technologies in hospitals in China. However, there are few researchers and institutions in this field, and the research scope is small. In the future, more investment is needed to encourage more hospitals, especially TCM hospitals, to carry out HB-HTA, explore the HB-HTA system suitable for Chinese conditions, and improve the scientific decision-making of hospitals.

Hospital-Based Health Technology Assessment of Machine Perfusion Systems for Human Liver Transplantation

Based on published data, we have carried out a hospital-based health technology assessment of machine perfusion in adult liver transplantation using cold storage as a comparator, and within the perspective of a national health system-based hospital practice and disease-related group reimbursement policy. A systematic literature review on machine perfusion for adult liver transplantation was conducted exploring the Pubmed, CINAHL, Scopus, Embase, and Cochrane databases. The literature was analyzed with the intent to provide information on 6 dimensions and 19 items of the hospital-based health technology assessment framework derived from previous studies. Out of 705 references, 47 (6.7%) were retained for current analysis. Use of machine perfusion was associated with advantages over cold storage, i.e., a 10%–50% reduced risk for early allograft dysfunction, 7%–15% less ischemia reperfusion injury; 7%–50% fewer ischemic biliary complications, comparable or improved 1-year graft and patient survival, and up to a 50% lower graft discard rate. Hospital stay was not longer, and technical failures were anecdotal. Information on costs of machine perfusion is limited, but this technology is projected to increase hospital costs while cost-effectiveness analysis requires data over the transplant patient lifetime. No hospital-based health technology assessment study on machine perfusion in liver transplantation was previously conducted. From the hospital perspective, there is evidence of the clinical advantages of this novel technology, but strategies to counterbalance the increased costs of liver transplantation are urgently needed. Further studies should focus on the ethical, social, and organizational issues related to machine perfusion.

Health Technology Assessment in technological innovation processes; implementation of a management model for hospital technological governance at the Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo in Alessandria

Objectives. Definition of a hospital-based technology governance model (hospital-based Health Technology Assessment (HTA)), involving health professionals at different organizational levels; applying HTA as a rational support tool at corporate organizational level for decisions concerning acquisitions, disposal, monitoring of technologies; implementation of the HTA methodology to create an organizational context favorable to the transfer of scientific evidence in clinical practice and managerial decision-making processes.
 Methods. At the end of 2014, the AO Hospital of Alessandria established a Technology Assessment Unit to analyze the requests for the supply of medical and non-medical equipment, involved in healthcare pathway processes. A training course has started, aimed at creating specific skills, to support the clinician requesting the adoption of a new technology.
 Results. Over the last 5 years, testing the form deployment has concerned: 56 requests examined by NVT; 226 cases concerning gathering information using the forms; 24 IT instances managed by ICT; 62 requests examined through facilitator support.
 Conclusions: To implement at micro level, the HTA methodology within the clinical-organizational structure governance, including decisions concerning clinical practice protocols, auditing and quality monitoring of healthcare performance.

Multiple Criteria Decision Analysis (MCDA) for evaluating cancer treatments in hospital-based health technology assessment: The Paraconsistent Value Framework.

BackgroundIn recent years, the potential of multi-criteria decision analysis (MCDA) in the health field has been discussed widely. However, most MCDA methodologies have given little attention to the aggregation of different stakeholder individual perspectives.ObjectiveTo illustrate how a paraconsistent theory-based MCDA reusable framework, designed to aid hospital-based Health Technology Assessment (HTA), could be used to aggregate individual expert perspectives when valuing cancer treatments.MethodsAn MCDA methodological process was adopted based on paraconsistent theory and following ISPOR recommended steps in conducting an MCDA study. A proof-of-concept exercise focusing on identifying and assessing the global value of first-line treatments for metastatic colorectal cancer (mCRC) was conducted to foster the development of the MCDA framework.ResultsOn consultation with hospital-based HTA committee members, 11 perspectives were considered in an expert panel: medical oncology, oncologic surgery, radiotherapy, palliative care, pharmacist, health economist, epidemiologist, public health expert, health media expert, pharmaceutical industry, and patient advocate. The highest weights were assigned to the criteria “overall survival” (mean 0.22), “burden of disease” (mean 0.21) and “adverse events” (mean 0.20), and the lowest weights were given to “progression-free survival” and “cost of treatment” (mean 0.18 for both). FOLFIRI and mFlox scored the highest global value score of 0.75, followed by mFOLFOX6 with a global value score of 0.71. mIFL was ranked last with a global value score of 0.62. The paraconsistent analysis (para-analysis) of 6 first-line treatments for mCRC indicated that FOLFIRI and mFlox were the appropriate options for reimbursement in the context of this study.ConclusionThe Paraconsistent Value Framework is proposed as a step beyond the current MCDA practices, in order to improve means of dealing with individual expert perspectives in hospital-based HTA of cancer treatments.