ADVANCE_HTA

Advancing and strengthening the methodological tools and practices relating to the application and implementation of Health Technology Assessment (HTA)

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 Obiettivo del progetto (Objective)

'The use of HTA has increased recently in Europe and more widely (e.g. Americas) to enable evidence-based coverage decisions and improve efficiency in resource allocation. HTA has often resulted in different coverage decisions across settings despite the same evidence being used for this purpose. This may reflect in part societal preferences about value, priorities or risk perceptions, suggesting a significant need for methodological improvements and extensions. The fundamental objective of ADVANCE_HTA is to contribute to advancements in the methods for HTA in European and other settings by involving the wider stakeholder community in areas actively and heavily debated given their implications for decision-making and resource allocation, as follows: • First, the issue around value for money and the different approaches surrounding current thresholds for resource allocation; • Second, the concept of value assessment, and the factors that need to be considered beyond cost effectiveness, such as disease severity; • Third, to improve the quality of the evidence required for and the methods associated with the assessment of rare diseases; • Fourth, to advance the debate in the elicitation of preferences by deriving these in more realistic settings within the patient community in the wider EU; • Fifth, to advance the debate on the suitability of current HTA tools across different categories of medical devices (e.g. diagnostics); and • Sixth, to improve the implementation and capacity building of HTA including outside Europe, where HTA is considered explicitly in decision-making. ADVANCE_HTA aims to broaden the spectrum, complement and address areas of intense methodological debate in the application, use and implementation of HTA. It also aims to improve HTA methods, which can be taken further by competent authorities nationally whilst supplementing the work of supra-national bodies (e.g. EUnetHTA) towards a common understanding of choices in health care decision-making.'

Introduzione (Teaser)

Scientific and technological advancements in the health care sector make decision making a complex endeavour. As a result, use of health technology assessment (HTA) tools to optimise resource allocation in health care settings is steadily increasing.

Descrizione progetto (Article)

The EU-funded http://www.advance-hta.eu (ADVANCE_HTA) project is working on improving HTA methodologies, broadening its scope and relevance for better implementation in various types of health care systems. Efforts will be made to obtain inputs from all stakeholders, starting from decision makers and ending with patients.

Areas of research include factors such as cost-benefit, cost effectiveness, burden of disease and disease severity. Data and methodologies will be analysed using decision analytic frameworks such as discrete choice experiments (DCEs) and multiple-criteria decision analysis (MCDA).

HTA systems of 15 EU countries were comprehensively analysed and a taxonomy of important variables was developed. This taxonomy has been applied to four countries so far for cancer disease and work is ongoing to construct an econometric model for analysis.

Systematic country-specific literature reviews were carried out to assess HTA decisions across different types of drugs, therapy areas and countries. Besides determining differences in how health technology is valued, this should help in developing an MCDA-based methodological framework that is adaptable to any health care system.

Emphasis was placed on understanding and optimising HTA decision making with regard to rare diseases. For this purpose, ADVANCE_HTA forged strong links with other European initiatives associated with rare diseases, such as BURQOL-RD, EPIRARE and http://www.eunethta.eu/ (EUNetHTA). Data on 10 orphan drugs from 4 countries was analysed to quantify the socioeconomic costs and health-related quality of life of such patients. As a result, a DCE survey was modelled and is currently being pilot tested.

ADVANCE_HTA developed a taxonomic model for HTA on medical devices incorporating factors such as risk and functionality. Data collection on capacity and HTA decision-making processes is currently ongoing to better support HTA implementation. Surveys were sent to 41 countries in Central and Eastern Europe and in Latin America and are currently being piloted in 5 Caribbean countries.

ADVANCE_HTA activities should help identify evidence gaps and facilitate development of robust and adaptable HTA methodologies to guide policies, future research agenda and best practices. This should optimise resource allocation and ensure health system sustainability irrespective of system- or therapy-specific HTA-based decisions.