Dimensi Health Technology

Assessment

Wahyu Sulistiadi
2019
 Septiara Putri, 2017
SP| Economic Evaluation | PG 2
 ISU-ISU DALAM HEALTH
TECHNOLOGY ASSESSMENT :

Lokus dalam Assessment “Membuat

atau Membeli”
 Evidence Based Medicine
Program efektitas layanan kes
 Pembuatan alat itu dilakukan di luar Indonesia
 Provider di Indonesia berlomba-lomba mengaplikasikan
perkembangan tersebut
 Alat –alat diagnosa teknologi baru seperti PET SCAN, USG
4 Dimensi, C-Arm
 Alat operasi baru seperti berbagai tehnik Minimal Invasif
Surgery ( operasi invasif minimal ) terus bermunculan ,
penggunaan alat canggih seperti Endoscopy, Ablation therapy
( radiofrequency ) , Laser for Eye surgery ( penggunaan
laser pada operasi mata ) , Cryosurgery ( bedah beku )
 Evidence Based Medicine
(1) Penerapan edukasi HTA paling dasar adalah
memberikan penjelasan pada masyarakat luas
tentang klasifikasi obat dan alat kesehatan yang
masuk diimport ke Indonesia, karena banyak merek,
dan Alat kesehatan & Obat yang masuk diimport ke
Indonesia .
(2) Penjelasan kelebihan-kekurangan dari tiap pilihan
yang diambil , selama ini pada masyarakat pilihan itu
sering berdasarkan asimetri hubungan provider -
pasien yang tidak berimbang.
 Kemajuan teknologi
 Makin banyaknya pilihan therapi yang bisa digunakan
tenaga kesehatan pada pasien yang membutuhkan
 Makin awal/dini diagnosa bisa ditegakkan dengan harapan
lebih mudah diobati daripada late stadium ( stadium lanjut )
 Provider Pemberi layanan yaitu RS perlu investasi lagi
alat yang baru bila ingin mengikuti perkembangan teknologi
 Loncatan Standart Penunjang Diagnosa Awal ( 1st line
assessment )
 Loncatan Standart Therapi Awal ( 1st line therapy ),
 Healthcare Technology Assessment
(HTA)

◦ is the systematic evaluation of the properties, effects,

and/or impacts of health technology.

Purpose- to address the direct, indirect, intended, and

unintended benefits and consequences of the adoption of
healthcare technology .
-Hailey, Babidge, Cameron, & Davignon 2010
The decision-making process with and without HTA

http://2.shamseya.org/2016/03/07/631/
Septiara Putri, 2017
SP| Economic Evaluation | PG 8
 Septiara Putri, 2017
SP| Economic Evaluation | PG 12
HTA process
High Medical,
High High
variability social, ethics
volume risk
High
cost
Affects Unecessary
many health cost

SP| EconomicSeptiara Putri,

Evaluation | PG 2017 13
Why did We research
HB-HTA & technology
decision making in
Healthcare?
HB-HTA

“To be useful to decision makers, HTA must

be tailored to the decision nodes of the health-
care system and the needs and interests of
decision makers at each of these nodes”

-Organization for Economic Co-operation and Development, 2005, p.

92
 HB-HTA emerged as a way for managers to respond to three
environmental “pressures”:

1. The need to improve the level of efficiency and

effectiveness, while operating under budgetary restraints.

2. The need to be cognizant of the “context” factor-

Opportunities and advantages vary based upon the
resources and competencies available within a healthcare
organization’s divisions.

3. The need to push forward scientific evidence to clinical

practice.
-HTAi, 2007
Why prioritize healthcare technology spending?

 New Healthcare technologies are introduced

daily
  Funding for healthcare is decreasing

In a time of finite resources and continually

increasing opportunities in healthcare
treatment, every healthcare organization faces
challenges concerning decisions about which
healthcare technologies to introduce into
clinical practice.
 Healthcare organizations must be fiscally
responsible, balancing funds & quality
healthcare

 To be fiscally responsible when using publicly

funded money, hospital decision makers have
the complex task of deciding how they will
best allocate resources within fixed budgets.
Our Responsibility?
Assessment & Prioritization of healthcare technologies.

◦ Without a systematic approach to assessment, it is possible

that medical technologies may be introduced into clinical
practice that cannot be utilized to their full functional
capability or they may not be compatible with other
existing technologies, work processes, resources or practice
approaches .

◦ If we are going to prioritize,

we’re going to need
some priorities
 Methodology

 Combined an:
◦ exhaustive literature review,
◦ a brief but real case study of a failed technology
assessment,
◦ a survey of key decision makers,
◦ focus groups with managers and staff at Eastern Health,
◦ and a series of interviews.
Decision-making Criteria in
Healthcare
 Main aspects for decision criteria
identified in the literature
Poulin et al., 2013 Draborg et al, Johnson-Masotti & Goetghebeur
2005 Eda, 2005 et al., 2008
• Health Gain • Clinical • Patient centered • Quality of
• Service Delivery • Economic • Organizational evidence
• Strategic Fit • Patient-related • External • Disease
• Innovation • Organizational impact
• Financial • Intervention
• Economics
 Decision Making
The rational decision-
1. Define
making model the
problem
• includes six steps and
describes how individuals 6. Select
2. Identify
should work through the best
the criteria
alternative
decisions to maximize the
outcome.

A mathematical model that

support multi-criteria
decision making: 5. Evaluate 3. Allocate
the weights to
alternatives the criteria
• Decision Matrix Model.
4. Develop
alternatives

-Langton, Robbins, and Judge (2011)

 Decision Matrix
 A decision matrix is a process to assist in choosing the best
alternative.

◦ It applies numerical weights to the criteria being used to choose

a product or technology.

◦ When the criteria are scored for each alternative, preference is

given to the alternative with the best score.

 In the matrix, the rows represent the criteria and the columns represent
the alternatives. An additional column represents the scored weights

The decision matrix method is simple, efficient, and can be quite

effective.
-Fraser et al, 2009
Strategic Priorities
 Quality and Safety

 Access

 Sustainability

 Population Health

-Eastern Health, 2014

Decision Criteria
Research findings:
 Approach to local level HTA and decision
making processes are not consistently
applied throughout the organization.

 Pathways for technology assessment and

decision making are not clearly defined.

 There is no policy to guide HB-HTA nor

technology acquisition decision making
leaving processes open to interpretation.
 Stakeholders: middle managers, frontline staff,
patients are not involved to the level they
could or should be.

 Data collection in relation to specific

decision criteria is not standardized & the
tools to collect this information is not
priority focused or user friendly.

 Assessment is not comprehensive due to

inconsistently applied decision criteria.
 Criteria for decision making are not
identified or communicated to requestors,
leaving some important criteria unassessed
unknowingly.

 The decision making process at all levels is

vague and non-transparent.

 Timelines regarding approval and stage in the

approval process is not clearly
communicated to the requestors.
 How can this
information help
Hospital & other
Health Authorities?
Framework development
 Based on:
◦ the literature review
◦ the research conducted at Hospital in relation
to HTA practices, and decision making criteria
and prioritization methods used by Health
decision makers

 Identifies areas to work on to improve

HB-HTA.
A Framework for improving HB-
HTA
 Model/ Process/ Transparency
 An organization the size of
Hospital requires dedicated
resources to oversee HB-HTA.
◦ Most HealthCare Agencies use the HTA
Unit as it provides higher quality results.

 Local HTA Advisory Committee

◦ These committees would make
recommendations to executive
 Knowledge
 Pathways for HB-HTA
◦ Establish clear pathways for technology assessment.

 Policy Development
◦ Clarify: expectations, scope, roles and responsibilities,
means of information collection, standardized tools,
and pathways for evaluation.

 Increase Stakeholder involvement

◦ Build into Policy- Patients,
Frontline, Managers, Directors,
Support Programs
 Analytical Decision Making

 Seek all available data

◦ Improve Information collection tools
(Forms/Strata)

 Increase assessment comprehensiveness

◦ Continue/validate criteria, establish weights for
criteria
 Decision Support Tools

 Increase decision-support tools for managers

and directors using a Priority Setting System:
◦ Build expectations into Policy
◦ Screening/Request Forms
◦ Multi-criteria decision matrix
Screening for pathway
 Managers presenting requests for
technology need guidance on which
pathway would be best based on specific
criteria.

 Example : Alberta Health Surgical Services

 Standardized information gathering
and case presentation

 Giving managers an all inclusive form to

complete regarding the technology request
will guide information to enable decision
making committees to use the same criteria.

 Example: Alberta Health Services- SSCN

-Alberta Health Services (AHS) Surgery Strategic Clinical Network (SSCN)

Decision Tools
Consistent application of decision tools
standardizes decision making practices.

 A Decision Matrix tool integrates the

organization’s strategic priorities as well as
the decision criteria that managers as a
collective at Hospital are already using.
-Any organization can contextualize such a tool

 The tool uses a weighted decision matrix for

a mathematical multi-criteria analysis of
technologies for prioritization.
 The steps required to use the Matrix Decision Support Tool are:

Step 1- Assign a weight to each criteria based on importance to

the decision. Together all assigned weights will total 100.

Step 2- Assess each technology using the points system of 0-5,

based on data collection tool (i.e. Strata or via Technology
Request Form.) provided by the requestor of the
technology.

Step 3- Multiply each criterion’s rating points with its weight and
write it in the far right column (Score).

Step 4- Total all criterion scores in the far right column.

Step 5- Prioritize based on the overall score of individual

technologies at the bottom.
 Weights
Priority
Criteria 0 Points 1 Point 3 points 5 Points Rating Points
Total = 100
Score

No improvement in patient health gain compared Minimal improvement in patient health gain Moderate improvement in patient health Vast improvement in patient health gain
Efficacy with current practices compared with current practices gain compared with current practices compared with current practices
Short/long term Health Gain
Population

Benefits cases with few alternatives

The technology address a condition with very low The technology address a condition with low The technology address a condition with The technology address a condition with
Health

Population Health prevalence (rate/100,000 < 1) prevalence (rate/100,000 btw 1-10) moderate prevalence (rate/100,000 btw 10 - high prevalence (rate/100,000 btw 1,000-
Prevalence/Incidence 1000) 10,000)
5-year projected prevalence

The technology does not represent the Standard of The technology represents standard of care The technology represents standard of care The technology represents new standard
Standard of care Care in other health regions in NL in some health regions in NL in most health regions in NL of care in our health region or NL
In other Health Regions
New Standard of Care

Not innovative Small gains in innovation Moderate gains in innovation Large gains in innovation
Knowledge & Research
Controversial documentation of safety Minimal documentation of safety Moderate documentation of safety High degree of documentation of safety
Safety
Has significant levels of controversy and ethical Has moderate ethical impact Has minimal ethical impact Has no ethical impact
Ethical Impact impact

The client does not accept this technology for use. The client has a moderate level of concern The client has minimal concerns with this The client is satisfied fully with the
Client Experience
Quality & Safety

with this technology technology performance of this technology

Patient comfort, ease of use, acceptability

Has significant negative social impact on clients Has moderate negative social impact on Has moderate positive social impact on Has significant positive social impact on
Social Impact & population clients and population clients and population clients and population

Significant training required in terms of cost, time, Moderate training required in terms of cost, Minimal training required in terms of cost, No training required
Training and number of individuals time and number of individuals time and number of individuals

Adds significant amount of additional workload Adds moderate amount of additional Adds small amount of additional workload Decreases workload and creates
End user impact
Efficiency, workload, routines, skill 5. Compare workload workload efficiency
Efficiency

Service Coordination alternatives by

No reduction in load on other services Minimal reduction in load on other services Moderate reduction in load on other services Vast reduction in load on other services

Reduces load on other services

overall score
Does not support department strategic goals Minimal fit with department strategic goals Moderate fit with department strategic goals Strong fit with department strategic goals
Strategic Fit
High level of additional human resources required Moderate additional human resources Minimal additional human resources No additional human resources required
Sustainability Has no impact on the Healthy Workplace Program required required. Has Moderate impact on the Increases employee engagement,
Availability of human resources required (physicians, Has minimal impact on the Healthy Healthy workplace Program knowledge transfer and decreases sick
nurses, and support staff) Workplace Program leave.

Not sustainable or adverse impact on health Technology requires significant resource Technology requires start-up funds, but will Technology is viable and sustainable
Cost (Resources & Infrastructure) system funding over time (next 5 years). investment in order to be viable and be viable and sustainable following initial within available resources and/or
Sustainability

sustainable. investment. technology creates new resource capacity

in the local system.
No evidence of cost-effectiveness and/or cost- Minimal evidence of cost-effectiveness Moderate evidence of cost-effectiveness Clear evidence of cost-effectiveness
Economic Analysis (Cost benefit and/or cost-benefit and/or cost-benefit and/or cost-benefit
effectiveness & Cost benefit)
Risks associated with the technology cannot be Risks associated with the technology require Risks associated with the technology require Risks associated with the technology
Risk mitigated. a high level of mitigation. moderate mitigation. require minimal mitigation

No improvement in access Minimal improvement in access Moderate improvement in access High degree of improvement in access
Access Creates additional access to services Creates additional access &/or decreases Creates additional access, decreases wait
Access

wait times times, & moves services closer to the

client
The right service, the right time in the right place

OVERALL SCORE
/100
 Prioritization

Using the contextualized

multi-criteria decision matrix
tool, needs for healthcare
technologies can be assessed
and then prioritized.
 Outcomes
 Improve Timeliness
◦ Increase efficiency, Share expected process
timelines

 Review outcomes:
◦ Reassess before automatically replacing
technology for changing needs
◦ Assess whether implementations were
successful
◦ Listen to the frontline when assessing
◦ Track issues & learn from mistakes
 When the HB-HTA process is:
transparent and trusted,
and those applying it are
knowledgeable and engaged within a
culture of HTA…

the application of the assessment

process will be consistent.
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