Health Technology Assessment: Introduction and Definition

Introduction to Health Technology Assessment

STUDIORUM
OM
UNIVERSITÀ
DEGLI STUDI
DI BERGAMO
Dipartimento
di Ingegneria Gestionale,
dell'Informazione e della Produzione
Health Technology Assessment
Engineering And Management For Health
Introduction to HTA
Silvia Baldassarre
e-learning key: Baldassarre2759

Definition of HTA

HTA
1
+
+
leo
«Health technology assessment (HTA) refers
to the systematic evaluation of properties,
effects, and/or impacts of health technology.
It is a multidisciplinary process to evaluate
the social, economic, organizational and ethical
issues of a health intervention or health
technology. »
World Health Organization (WHO)

Definition of Health Technology

"Health technology refers to the application of organized knowledge and skills in the form of
devices, medicines, vaccines, procedures and systems developed to solve a health problem and
improve quality of lives"
World Health Organization (WHO)

Healthcare Technology Classes and Examples

• Pharmaceuticals
  Traditional: antibiotics, antidiabetics, antihypertensives
  Biologics: vaccines, antibodies
• Medical Devices
  Medical devices: hearing aids, urinary catheters
  Large equipment: CT scan, MRI
• Medical and Surgical Procedures
  Psychotherapy, coronary angiography, appendectomy
• Support Systems
  Electronic health records, telemedicine systems
• Organizational and Functional
  Procedures
  Prospective payment through DRG, clinical care pathways
  Carta di Trento - Network Italiano di Health Technology Assessment (NIHTA)

Another Definition of HTA

CAN
HTA
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+
+
leo
HTA is a «A multidisciplinary process that uses
explicit methods to determine the value of a
health technology at different points in its
lifecycle. The purpose is to inform decision-
making in order to promote an equitable,
efficient, and high-quality health system »
International Network of Agencies for Health
Technology Assessment (INAHTA)

Technology Spectrum

The Five Stages of Technology Positioning and Evolution

State of the Science
State of the Art
Trailing Edge
Standard Edge
Leading Edge
Cutting Edge
Virtual Edge
TECHNOLOGY BLADE
Conceptual
Preferred alternatives
Diminishing use
Proven-Reimbursed
Widely available
(Standard of Care)
Experimental
Limited availability
CLINICAL PRACTICE
MEDICAL RESEARCH
Applied
Research
Basic
Research
Technology
Application
Technology
Development
Technology
Research
The five stages of technology positioning and evolution: from virtual to trailing
Mikhail, O., Swint, J. M., Brinker, M. R., Moye, L. A., & Sabino, M. (1999). Technology evolution: the technology spectrum and its application to
orthopedic technologies. International journal of technology assessment in health care, 15(1), 254-263.

Another Framework: Technology Adoption

Early safety concerns
detected by industry -
high probability of
occurrence
Health technology
assessment at
national level ideally
prior to widespread
use
Later safety concerns
detected by industry
or surveillance -
low probability of
occurrence
Training - at point of introduction of new staff
post marketing
surveillance
clinical engineering
Research &
Development
Experimental
Technology
Innovative
Technology
General
Use
Obsolescence &
Replacement
Mytton, O. T., Velazquez, A., Banken, R., Mathew, J. L., Ikonen, T. S., Taylor, K., ... & Ruelas, E. (2010). Introducing new technology safely. BMJ Quality
& Safety, 19(Suppl 2), i9-i14.

Another Definition of HTA and Its Importance

CAN
HTA
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+
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leo
"Health technology assessment (HTA) is a
tool to review technologies and provide
evidence of the value these technologies
can deliver to patients and their families,
health system stakeholders, and to society
more broadly."
International Network of Agencies for Health
Technology Assessment (INATHA)
WHY?

Why HTA is Necessary

Increasing Population

POPULATION OF THE EARTH
Number of people living worldwide since 1700 in billions
2048: 9 bln
2024:
8 bln-
1999:
6 bln
2012:
7 bln
1987: 5 bln
1960:
3 bln -
-1974:
4 bln
1804:
1 bln
1927:
2 bln
1700
1800
1900
2000
Source: United Nations World Population Prospects, Deutsche Stiftung Weltbevölkerung
For further information please visit: www.knowledge.allianz.com
1) Increasing population
Increasing potential
patients

Increasing Global Life Expectancy

GLOBAL AVERAGE LIFE
EXPECTANCY AT BIRTH (YEARS)
Years
100
80
72
60
66.5
40
20
2000
2016
In 2018
the population aged
65+ and above was
9% of the total
population and 16%
considering only
Europe, Central Asia
and North America
1) Increasing population
2) Increasing global life
expectancy
Increasing healthcare
resources absorbed

Epidemiological Context and Chronic Diseases

SHARES OF DEATH
DUE TO NON-COMMUNICABLE DISEASES
Ischaemic heart disease
Cerebrovascular disease
Trachea, bronchus, lung cancers
Alzheimer and other dementias
Lower respiratory infections
Chronic obstructive pulmonary disease
Colon and rectum cancers
Diabetes mellitus
Hypertensive heart disease
Breast cancer
Per cent of total deaths
O
2
4
6
8
10
12
14
16
18
1)
Increasing population
2) Increasing global life
expectancy
3) Epidemiological context
(e.g., chronic diseases,
especially among elder
people cause 71% of all
deaths globally)
Push scientific efforts
70-80% of healthcare resources worldwide are now spent on chronic disease management

Healthcare as an Economic Good

Healthcare is an economic good as it is limited compared to the needs
Potentially uncountable number of needs
Scarcity of resources
+
Physical resources
medical equipment, facilities,
and supplies
Human resources
physicians, nurses, technicians,
and support staff
+
Financial resources
funding for healthcare
organizations, reimbursement
models, and budgeting processes
Information resources
electronic health records (EHRs),
data analytics, and
telemedicine platforms

The Structural Disequation and Rationing

The structural disequation
Needs and demand
for healthcare
!!
1
Available
resources
Rationing
Implicit
Rationing without pre-defined criteria.
Explicit
Rationing based on ex-ante defined decision rules
maximizing health benefits using scare resources

Functions of a Healthcare System

Production/Delivery of
goods/services
Patients
Suppliers
Procurement of resources
Allocation of resource
Buyer

The Economic Problem in Healthcare

The emerging problem is to ensure the "best" allocation of resources given the needs
to enhance ability to deliver quality care, improve patient outcomes, and effectively
manage resource allocation challenges.
The decision maker (e.g., hospitals) aims to optimize the activity of the healthcare
system, which are quantified as the sum of healthcare services (output) delivered to
patients, in order to:
· maximize the outcome (the impact on health of patients)
· and improve operational efficiency

Example: COVID-19 Relief Fund Allocation

Decision Maker: Public Authorities
Context:
During the COVID-19 pandemic, governments needed to allocate emergency healthcare funding to
support hospitals, vaccine development, and public health measures.
Challenges Faced by Decision-Makers:
Addressing disparities in healthcare access for underserved communities.
Preventing fraud and misuse of funds.
Balancing immediate pandemic response vs. long-term healthcare resilience.
Funding Allocation Decisions:
. To hospitals and healthcare providers to cover COVID-19 response costs.
· Devices (e.g., ventilators).
· For expanding COVID-19 testing.
· Vaccine development.
Outcome:
· Accelerated vaccine development and distribution.
· Provided financial support to struggling hospitals.
· Helped expand testing and treatment capacity across the country.

Example: Therapies

Decision Maker: Hospital
Context:
A hospital is deciding among two different therapies (biological drugs) for dealing with aged-related
molecular degeneration. The effectiveness of the therapy decreases if the number of administrations is
below the optimal.
Alternative A
· Lower price
· Higher number of administrations
Alternative B
· Higher price
. Lower number of administrations
L
Applied where the system has no
problem in following the protocol
Applied where a high number of
administrations can't be granted (due to
e.g., overload of system)

Opportunity Cost in Healthcare

Opportunity cost
Choosing whether investing in a health good or a services generates the opportunity cost of inventing in
another good, representing the benefits lost that would be obtained by producing the other good.
A decision maker should compare explicit costs (not only monetary) and the opportunity cost with the
benefit of the investment to take an informed decision.
What to produce? What combination of medical and non-
medical goods produce in the economic system?
How to produce? What combination of resources (inputs)
should be used to produce a performance healthcare?
For whom to produce? (Who should receive these services?
How to distribute the benefits among the population
healthcare?)

Key Challenges in Resource Allocation

• Limited founding - Opportunity cost
  Choices about how to allocate their
  limited financial resources among
  various competing needs.
• Balancing Demand and Capacity
  Managing resources to ensure that they
  can meet the needs of their patients
  without compromising the quality of
  care.
• Ethical Considerations
  Decisions about allocating
  scarce resources to patients
  with different levels of need
• Geographic Disparities
  in healthcare access and
  availability

Balancing Fairness and Efficiency

Balancing fairness and efficiency
It is crucial to ensure that decision makers make ethical decisions while optimizing the allocation of
resources.
O
Fairness is a fundamental principle in healthcare resource allocation. It entails ensuring
that resources are distributed equitably, without discrimination or bias, considering various
factors such as need, urgency, and the potential impact of the allocated resource.
D
L
Efficiency refers to the optimal utilization of resources to achieve the best possible
outcomes. It can be achieved by considering factors such as cost-effectiveness, evidence-
based practices, and the potential benefits of the allocated resource.
Striking a balance between fairness and efficiency involves establishing transparent
and consistent guidelines that prioritize patients based on objective criteria.

Technological Innovation in the Healthcare Sector

Technological innovation in the healthcare sector
New technologies improve population health by enabling the treatment of previously incurable
diseases, increasing life expectancy, and enhancing patients' quality of life.
Increasing volume of innovations introduced into the market, with medical technology playing an
increasingly prominent role.
29.000
28.000
27.000
Number patents
in healthcare
26.000
25.000
24.000
23.000
22.000
21.000
20.000
2011
2012
2013
2014
2015
2016
2017
2018
2019
Years
Percentage of patents
19
18
in healthcare
17
16
15
14
13
12
2011
2012
2013
2014
2015
2016
2017
2018
2019
Years
Source: European Patent Office