HTA - Health Technology Assessment

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Health Technology Assessment - what is that?

During the development of health innovations researchers/developers will want to address questions that fall outside the scientific and clinical validation of their inventions, but are crucial the implementation in clinical practice. For example:

- Does the innovation fit in in clinical practice, or does it require major changes to the current standard of care?
- How does my invention fit within the Dutch reimbursement system?
- Is the application cost-effective?
- What are the risks in the development of my invention?

These type of questions require knowledge of medical practice, regulatory affairs and the health care market. Moreover one needs to think about how to measure, model and value aspects like "economic impact". How do you determine what a health care application costs? This is the work of Health Technology Assessment specialists. HTA can be viewed as a bridge between science and policy makers.

Health Technology Assessment - when and why?

We can by and large discern two types of HTA; early HTA, and HTA to substantiate the acquirement of reimbursement.

Early HTA

An early HTA is of interest at the point when proof of principle is established and decisions have to be made about if and how to continue with (costly) larger scale technical and clinical validation. At that stage it is useful to assess the risks perceived by industry and the public sector associated with market access and reimbursement. This includes answering questions like: does the integration of the innovation in clinical practice require major changes in the clinical protocol? What would this entail in terms of financial costs, end-user involvement etc.? The results from an early HTA analyses can support decisions on the development, as well as regulatory and reimbursement strategies. Early HTA analyses are less extensive than HTA for reimbursement (faster and cheaper).

HTA for reimbursement

It can be worth wile to discuss the possibilities of performing HTA analyses with a specialist when you are setting up your clinical experiments or clinical trials. For a new technology/method to become part of the basic package of reimbursed care it is often necessary to demonstrate that is the application is cost-effective. This can be done by performing an HTA. It helps to answer the question: Are we (as a society) prepared to pay X (more than current standard of care) for health gain Y (over current standard of care)?

Determining the economic costs of an application is an intricate proces, that entails talking to care providers and patient, reviewing literature, and performing practical measurements, for example measuring the time in the operating room. Combined with data from clinical trials and experiments, a cost-effectiveness model is established.

As an HTA can be time consuming, it is wise to plan the assessments as early as possible and to efficiently combine HTA measurements with your clinical validation efforts.

 

Health Technology Assessment- how?

Performing an HTA requires specific knowledge and expertise, it is wise to contact an HTA expert if you are considering applying this in your research.

An overview of academic and (semi-) commercial providers of HTA expertise is found here.
 

Examples of HTA research groups in the Netherlands:

UMCU - Julius Centre - HTA

Erasmus - HTA

Radboud - HTA

Maastricht-UMC - KEMTA

UMCG - patient centered HTA

VU - HTA

NKI-HTA

Universiteit Twente - HTSR - HTA

Other parties that can help with cost-effectiveness and HTA

Thinc

HI-NL

iMTA

panaxea

Further reading

Nederlandse richtlijnen

International guidelines and good practice reports (e.g. trial based economic evaluations)