Hospital-Based HTA Research Articles

Current approaches of health technologies introduction in Ukrainian hospitals

The study aimed to gather insights regarding current decision-making approaches and identify challenges and opportunities related to health technology implementation in Ukrainian hospitals. Materials and methods. A total of 28 respondents from three public hospitals across different regions of Ukraine participated in online semi-structured interviews conducted between September 2022 and March 2023. The respondents for this study encompassed a diverse range of stakeholders, including general managers, medical directors, economists, representatives from procurement departments, heads of clinical and diagnostic departments, clinicians, and pharmacists. To effectively guide the interview process, a comprehensive questionnaire was developed. The data collected from the respondents were analyzed and synthesized to results and conclusions. Results. The semi-structured interview study consistently revealed a common pattern in all the interviewed hospitals regarding the adoption of new health technologies. The process of introducing these technologies entails several stages, each demanding meticulous planning, coordination, and active engagement from various stakeholders. What stood out was that stakeholders from the same speciality were consistently involved in the same decision-making stage across all the hospitals we studied. The technical stages of implementing new health technologies, as outlined by the Law of Ukraine "On Public Procurement," are well-established in Ukrainian hospitals. However, there is room for improvement in selecting which type of health technology to procure. The current assessment process often relies on limited sources of information, lacking comprehensive literature reviews or robust comparisons with existing practices or placebos. This information gap hampers the ability to make well-informed decisions that account for all relevant factors. The study also identifies specific challenges for the future implementation of the Hospital Health Thechnology Assessment (HB-HTA) in Ukraine. These challenges necessitate investment in building HTA expertise at the hospital level, cultivating strong leadership support, providing professional staff training, and establishing robust data collection and management systems. Overcoming these obstacles is crucial for hospitals to bolster their capacity to effectively implement new health technologies and make informed decisions about their utilization. Conclusions. Our study has revealed that all the technical stages involved in implementing new health technologies in Ukraine are well established. It was observed that there is room for improvement in the process of selecting which new health technology to purchase. This stage, known as the decision-making process based on HTA, requires implementation at the hospital level. Our study highlights the evident interest and potential benefits associated with adopting HB-HTA in the hospitals under investigation. By integrating HB-HTA into existing practices and approaches, hospitals can significantly enhance their decision-making processes when introducing new health technologies. There is an urgent need to introduce the term "hospital-based HTA" into Ukrainian legislation, as well as to activate the training of HTA experts at the hospital level

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.

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.

Suture-Mediated Patent Foramen Ovale Closure Using the NobleStitch EL: Results from a Hospital-Based HTA.

(1) Background: Patent foramen ovale (PFO) is a congenital abnormality present in up to 25% of the general population, and it is a relevant cause of cryptogenic stroke. We applied the hospital-based HTA model (AdHopHTA) to conduct a multidimensional assessment of NobleStitch EL, an innovative suture-mediated PFO closure device. We compared it to Amplatzer PFO Occluder (APO) to provide evidence to inform technologies’ governance in hospital settings. (2) Methods: For each AdHopHTA dimension we: systematically retrieved available evidence from the literature applying the PRISMA guidelines and then analyzed original clinical and cost data of a NobleStitch EL device at San Raffaele research hospital in Milan (Italy). The economic dimension was analyzed through activity-based costing and a cost analysis. We conducted semi-structured interviews with selected healthcare professionals to explore the organizational, legal, social, and ethical impact. (3) Results: A single study was included for the NobleStitch EL, with 10 for APO. Both literature data and original data showed comparable safety. Efficacy data analysis found that the PFO closure was at 89% for NobleStitch EL vs. 89–97% for APO. APO has a better impact on the budget and minor process costs. Consulted experts reported that the organizational impact of NobleStitch EL in the short and the long run as null, albeit a better impact under the social and the ethical aspects. (4) Conclusion: We suggest that there is inadequate evidence to conclude the relative efficacy of NobleStitch EL as compared to APO. Nevertheless, this report shows a good safety profile and higher costs for NobleStitch EL, with no organizational or legal impact. Further studies in selected population are recommended.

Decision-making regulatory framework of the introduction of health technologies at the hospitals in Ukraine

The limited resources of the health care system and the COVID-19 pandemic encourage more rational and cost-effective administrative and clinical decisions. To achieve the best health care within available resources, the introduction of the most efficient technologies should be supported, considering organizational, social and ethical issues. Assessment of health technologies at different levels, namely national/regional and hospital, is becoming increasingly important. Adherence to cost-effective approaches to administrative and clinical decision-making will ensure the rational use of the state budget and improve clinical outcomes, improve the quality and life expectancy of patients.
 The purpose of the study was to analyze the current regulatory framework for the introduction of health technologies (medicines and medical devices) at the hospital level. During the research the methods of content analysis, historical, system-analytical, generalization was used.
 According to the analysis of the decision-making regulatory framework for the health technology’s introduction, it was drawn the next conclusions. The active HTA development in Ukraine is noted. In a short time, a legal framework for state HTA for medicines was created and approved, amendments were made to the Law of Ukraine ‘On Public Procurement’ and other Ukraine’s laws on medicine procurement under managed entry agreements, the further steps for development of the HTA ecosystem in Ukraine were identified.
 The legal framework for the circulation of medical devices needs to be updated in Ukraine, starting with technical regulations in accordance with EU regulations №745 and №746 and further approval of the Law on Medical Devices.
 Procedures for evaluation and selection of medicines and medical devices at the level of medical institutions are absent in Ukraine and require separate elaboration. The introduction of HB-HTA will help hospital managers to make independent, transparent, reasonable, and impartial management decisions on the selection of drugs and medical devices.
 The obtained results prove the need for further research of everyday decision-making practices on the introduction of health technologies at the hospitals, development of methodology for hospital-based HTA and update regulation of HB-HTA in the current legal framework of Ukraine.

OP74 Stoma Cover Use By Fully Laryngectomized Patients

IntroductionThe use of stoma covers has been a common clinical practice for laryngectomized patients for several years. In the province of Québec, Canada, laryngectomized patients can obtain stoma covers through a dedicated program providing them with medical supplies and voice re-education services. For many years, the program's supply has included cloth and/or foam covers, but the supply of Heat and Moisture Exchangers (HME) has been limited. Two hospital-based HTA units joined their expertise to assess the opportunity of providing HMEs to more patients, depending on their clinical characteristics.MethodsTheir joined assessment rested on a systematic review (SR) and a field assessment. The systematic review aimed at assessing the efficacy, clinical effectiveness and safety of various types of stoma covers. The field inquiries intended to assess the perceptions of clinicians and managers towards stoma covers in clinical practice.ResultsWe included 27 studies in the SR. Most of them appraised the clinical effectiveness or safety of HME filters. Their methodological quality was very low with potential conflicts of interest whereas many studies were financed by the industry. The heterogeneity of study designs, expected outcomes and paucity of comparative studies prevented the pooling of results. Industry sponsorship appeared to be an important issue, since 17 of the included studies were sponsored. The SR did not provide conclusive evidence concerning the efficacy, clinical effectiveness and safety of the various types of stoma covers. The field inquiries intended to assess the perceptions of clinicians and managers towards stoma covers in clinical practice. It showed that industry representatives are quite active in clinical settings, promoting their products. Clinicians’ opinions and preferences were coherent with the systematic review main observations: in a context where the quality of the evidence is low, clinicians’ recommendations of stoma protectors for laryngectomies are mainly based on their professional experience and academic training.ConclusionsFuture research of high methodological quality would strengthen the evidence concerning the relative efficacy and safety of different stoma protectors. These studies would help define evidence-based allocation criteria and set parameters so that the choice of a stoma protector is best adapted to a laryngectomized patients’ condition.

OP16 Assessing The Viability Of Medical Equipment Procurement In Hospital

IntroductionABC-VEN analysis is an easy method of clinical and economic analysis on the costs of drug coverage and an important tool for monitoring and ensuring the rational use of medicines. However, this methodology is difficult to apply in assessing the viability of medical equipment procurement (MEP) in hospital. Using a combined model of ABC analysis and Multiple criteria decision analysis (MCDA) may be more appropriate to apply to MEP.MethodsWe created five standardized criteria, which present the main results of assessment of the viability of MEP for implementing new health technologies (HTs). These criteria address the following: 1) Novelty/innovation; 2) Comparative clinical effectiveness and safety; 3) Relevance (demand); 4) Economic effectiveness; and 5) Payback period. Based on these criteria we determine the threshold values of priority for MEP: 1) High priority; 2) Medium priority; 3) Low priority.ResultsUsing the ABC model and five standardized criteria, we analyzed all proposals from the Hospital units for implementing new HTs connected with MEP for 2018. In total, proposals contained 11 items of ME, among them three items were in group A (27%), two items were in group B (18%), and six items were in group C (55%). All items were high priority for procurement with the exception of one item from group B with medium priority. Items with low priority were not revealed which can be considered as a direct indicator of the operational effectiveness of Hospital-based HTA Unit. Excluding ME with a medium priority from the procurement plan would reduce Hospital costs by 13.5 percent.ConclusionsCombined ABC and MCDA analysis in the process of assessment the viability of MEP can give the opportunity to make comparative assessment of different types of ME based on standardized criteria; determine the priority for procurement of new ME; and avoid the influence of subjective factors of the managerial decision-making process in hospital.

VP57 Using Capital Bids For Hospital-Based Health Technology Assessment

IntroductionThe Evelina London Children's Hospital (ELCH) is undergoing a period of growth, including a new building planned to be completed within the next five years. Due to limited space and ambitions to be a state-of-the-art hospital, Horizon Scanning (HS) was considered important to ‘future-proof’ new facilities. As the aim of HS is to identify signals of coming change, ‘scanning’ the previous five years’ trends may be beneficial to an iterative HS methodology. Thus, it was thought that capital bids could provide a range of useful information required to make procurement decisions.MethodsKing's Technology Evaluation Centre (KiTEC) provided hospital-based HTA and HS support for the expansion of a London-based paediatric hospital. KiTEC focused on imaging technology due to its large spatial requirements and high-costs and assessed all capital bids made over the previous five years. A capital bidding system is used within GSTT to allocate funding for medical equipment that costs more than GBP5000 (USD 6540.70). Information was collated for all imaging equipment bid for over the previous five years and assessed for trends in imaging modalities and purchase costs.ResultsA total of 135 bids were made in the period 2013-2018, eight of which were by ECLH. Bids for ultrasound equipment were most common and rose over the period. Bids for CT scanners also rose, while bids for MRI scanners and x-ray technology were consistent and bids for fluoroscopy fell. The total cost of imaging bids over the interval rose steadily from GBP5.4 million to GBP6.9 million.ConclusionsDue to the lifespan of imaging technology, some trends may not emerge within a five year window. While some interesting findings were made, a ten to fifteen year period may require to be scanned for a robust analysis. This methodology is best applied in an iterative fashion along with standard HS techniques.

OP43 Robotic Or Conventional Gait Training Rehabilitation? A Health Technology Assessment Study

Introduction:The purpose of this study is to gather evidence on safety and overall effectiveness of three alternative technologies for gait rehabilitation in diplegic children with Cerebral Palsy: robotic, conventional and joint conventional and robotic gait training.Methods:A new methodology, decision-oriented health technology assessment (DoHTA), was applied to assess the technology on clinical, technical, organizational, economic, social and ethical, legal and safety domains. This method, conceived as a hospital-based HTA tool for supporting the introduction of innovative technologies, has been implemented merging the EUnetHTA Core Model® with the Multi-Criteria Decision Analysis. In particular, the general items of the EUnetHTA Core Model® are re-formulated as performance indicators and re-placed along a decision tree structure that, from the one hand, respects the original top-down design of the EUnetHTA model (growing level of detail from domains to issues) and, from the other hand, allows obtaining a quantitative evaluation of each identified performance indicator.Results:The multiple indicators, which have been identified for the seven domains, play important and different roles in the alternative technologies evaluation. DoHTA results showed that robotic system offers the possibility to control more accurately the exerted forces and movement trajectories than the traditional therapy. It gives the possibility to measure the task performances parameters and to receive the patient feedback simultaneously. To carry out robotic gait rehabilitation fewer therapists are required compared with the conventional therapy, resulting in lower therapists’ physical workload.Conclusions:Despite the great perspectives that robotics offer to motor rehabilitation, it seems that robotic gait training could not provide greater benefits in terms of motor and functional recovery compared to the conventional therapy. Preliminary results, supported by most recent literature evidence, lead to the hypothesis that joint use of robotic and conventional therapy can produce better clinical outcomes than the separate use of the two rehabilitation techniques.

TECHNOLOGY ASSESSMENT IN HOSPITALS: LESSONS LEARNED FROM AN EMPIRICAL EXPERIMENT.

Hospital Based Health Technology Assessment (HBHTA) practices, to inform decision making at the hospital level, emerged as urgent priority for policy makers, hospital managers, and professionals. The present study crystallized the results achieved by the testing of an original framework for HBHTA, developed within Lombardy Region: the IMPlementation of A Quick hospital-based HTA (IMPAQHTA). The study tested: (i) the HBHTA framework efficiency, (ii) feasibility, (iii) the tool utility and completeness, considering dimensions and sub-dimensions. The IMPAQHTA framework deployed the Regional HTA program, activated in 2008 in Lombardy, at the hospital level. The relevance and feasibility of the framework were tested over a 3-year period through a large-scale empirical experiment, involving seventy-four healthcare professionals organized in different HBHTA teams for assessing thirty-two different technologies within twenty-two different hospitals. Semi-structured interviews and self-reported questionnaires were used to collect data regarding the relevance and feasibility of the IMPAQHTA framework. The proposed HBHTA framework proved to be suitable for application at the hospital level, in the Italian context, permitting a quick assessment (11 working days) and providing hospital decision makers with relevant and quantitative information. Performances in terms of feasibility, utility, completeness, and easiness proved to be satisfactory. The IMPAQHTA was considered to be a complete and feasible HBHTA framework, as well as being replicable to different technologies within any hospital settings, thus demonstrating the capability of a hospital to develop a complete HTA, if supported by adequate and well defined tools and quantitative metrics.

Quality assessment of Hospital-Based HTA

Quality assessment of Hospital-Based HTA

Organizational Impact of the Introduction of a New Portable Syringe Pump for Iloprost Therapy in Italian Hospital Settings

Purpose: The study aims at assessing the organizational and economic impact related to the use of a new portable syringe pump (Pompa Infonde®, Italfarmaco S.p.A., Cinisello Balsamo, Italy) at a hospital level. Methodology: Based on the HTA approach, the analysis assessed the organizational and economic impact of the new device at hospital level, using the traditional methods of Iloprost infusion as comparator. After a pilot evaluation, the organizational impact was assessed within 24 Italian hospitals. Structured interviews were conducted with clinicians and nurses. According to the Hospital-Based HTA approach, a questionnaire assessed the impact on human resources, training activities, internal meetings, spaces needed, facilities, clinical practice implications. Using Activity Based Costing approach, the economic evaluation was performed within the pilot center “Ospedale Civile” of Legnano, Italy. Findings: The new device leads to a positive managerial impact, with a substantial reduction of time to monitor patients by nurses. This resulted in a better management of human resources and in a reduction in nursing cost. Although a mild negative impact on training time for personnel, the structured interviews allowed the identification of three main areas of positive impact: (i) efficiency of internal processes, (ii) clinical pathways, (iii) synergies between wards. Originality: The organizational impact of Pompa Infonde®, showed that it is an efficient alternative to traditional methods, with benefits in the management of patients administered with Iloprost.

083PS Incorporating Guidelines into Local Clinical Practice and Policy Through the Use of Practice-Based Health Technology Assessment

BackgroundPractice-based health technology assessment (PB-HTA) has the potential to improve the quality, safety and value of patient care by synthesising evidence to provide timely guidance for clinical practice, policy, formulary...

PA2 Hospital-Based HTA in Italy: Diffusion and Potential Impact

PA2 Hospital-Based HTA in Italy: Diffusion and Potential Impact