Overcoming Barriers in Hospital-Based Health Technology Assessment (HB-HTA): International Expert Panel Consensus
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Participants
3.2. Round 1: Descriptive Analysis of HB-HTA Development along with Identified Barriers and Facilitators
3.2.1. An Example of Expert Group Report including Descriptive Analyses of HB-HTA Development along with Identified Barriers and Facilitators for Hungary
Background
Legal Aspects of HB-HTA
Methodology of HB-HTA
Practical Aspects of HB-HTA
3.2.2. Summary of Descriptive Analyses of HB-HTA Development
3.3. Round 2: Expert Panels’ Consensus on Barriers and Facilitators in Developing HB-HTA
4. Discussion
4.1. The Appreciation and Recognition of HB-HTA’s Role in Healthcare System
4.2. HB-HTA and the Practice of HTA in Healthcare Decision Making
4.3. Promoting High-Quality Assessment Standards and Best Practice in HB-HTA
4.4. Link between National HTA and HB-HTA
4.5. Educational and Awareness-Raising Initiatives and Target Audiences
4.6. Study Limitations
4.7. Future Developments
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | Number of Experts, n (%) |
---|---|
Participation | |
Round 1 | 15 (100) |
Round 2 | 15 (100) |
Age, years | |
30–39 | 4 (27) |
40–49 | 5 (33) |
50–59 | 6 (40) |
Gender | |
Female | 7 (47) |
Male | 8 (53) |
Expertise in HTA, years | |
<5 | 2 (13) |
5–9 | 3 (20) |
10–14 | 4 (27) |
≥15 | 6 (40) |
Clinical role—Medical Doctor | 2 (13) |
Expertise (more than one answer can be selected) | |
Health economics | 14 (93) |
Public health | 10 (67) |
Medical doctor | 4 (27) |
Pharmacy | 5 (33) |
Medical or natural sciences | 2 (13) |
Social sciences | 2 (13) |
Other | 3 (20) |
Current work environment (more than one answer can be selected) | |
Public healthcare payer | 1 (7) |
HTA organization | 2 (13) |
Academia/research institution | 12 (80) |
Health care provider, including hospitals | 4 (27) |
Non-governmental organization | 2 (13) |
Consulting | 3 (20) |
Hungary | Barriers | Facilitators |
---|---|---|
Background | HTA is mainly focused on centralized assessments. HTA dossiers are mainly submitted by the manufacturers and carried out either by the manufacturers or consultancy firms. Most of the investments (e.g., the purchase of the high-cost medical equipment) are financed by the government, not by the hospitals, so there is limited need for HTA-based decision support at the hospital level. | The availability of HTA experts is sufficient. The awareness of HTA methods across various stakeholder groups is increasing. |
Legal aspects of HB-HTA | Most of the procedures performed in hospitals are not subject to HTA and are reimbursed on a DRG or fee-for-service basis. The introduction of new innovative health technologies in the hospitals may require the creation of a new DRG code to cover the additional costs. | The centralized HTA process has been well embedded in the legal framework of the country for pharmaceuticals and medical devices. |
Methodology of HB-HTA | No specific guidance on HB-HTA. | The existence of a regularly updated and detailed national pharmacoeconomic guideline that can be applied to HB-HTA as well. |
Practical aspects of HB-HTA | HB-HTA is relatively new in Hungary. The two HTA centers at universities do not aim to facilitate decision making at the hospital level, but rather work with the clinical centers to perform a full HTA for technologies where no submission from the manufacturers is expected. | Experience with HTA in the country is available, in connection with the centralized process since 2004. Two HTA centers have been established at universities with large clinical centers in 2018 and 2019. Large-scale hospital infrastructure projects funded by the EU have in the past required cost–benefit analyses (CBAs). Therefore, expertise is available to hospitals on how to carry out a CBA. |
Country | Early Initiatives | HB-HTA Processes | Legal Recognition; Collaboration with National HTA Agency | Networking and Advocating | ||
---|---|---|---|---|---|---|
Methodological Foundation | Assessment Criteria | Participating Hospitals; Evaluation Focus | ||||
France | 1982: hospitals’ initiative in Paris region | Initially structured by the hospitals themselves; developed by experts at the request of the Ministry of Health, drawing on the AdHopHTA methodology in 2018 | Clinical, economic, organizational, and ethical, including patient perspectives | University and other major hospitals; primarily focusing on pharmaceuticals and medical devices, although other medical technologies included as well | Not formally recognized; national HTA agency not involved in HB-HTA | 2022: Society of professionals for HB-HTA networking to promote HB-HTA and foster collaboration with the national HTA agency (still pending) |
Hungary | 2018: the initiative of two medical universities | The national pharmacoeconomic guideline | Clinical, economic, and organizational, including hospital strategy | A select group of university hospitals and highly specialized hospitals; focusing on medical devices and highly innovative diagnostic and therapeutic technologies, including digital solutions | Not formally recognized; the national HTA agency serving both as a training center and regulator for the approval and reimbursement of the DRGs | Synergy between hospitals performing HB-HTA and research centers |
Italy | 2006–2012: active engagement in international HTA and HB-HTA projects (EUnetHTA and AdHopHTA) | Drawing on international methodologies, the AdHopHTA handbook, and Core Model | Clinical, economic, and organizational, including hospital strategy | A select group of highly experienced hospitals, recognized as clinical excellence centers; primarily focusing on integrating new technologies into existing medical pathways | Not formally recognized; the national HTA agency as a coordinator of the national and regional HTAs and while also serving as a conduit for disseminating outcomes | Collaboration among hospitals performing HB-HTA and research centers |
Kazakhstan | 2015: activity undertaken in two prominent hospitals | Developed and published by the leading hospital | Clinical and economic | Two hospitals having dedicated HB-HTA units | Not formally recognized | Early stage of development due to the shortage of trained personnel and financial constrains |
Poland | 2020: pilot studies conducted as a national grant project »Implementation of HB-HTA in Poland« | 2022: »Methodology of HB-HTA« prepared by experts as a draft version, drawing on the AdHopHTA guidelines and insights from pilot implementations in hospitals | Clinical, economic, and organizational | A dozen hospitals primarily from higher reference levels designated as pilot sites; evaluating the different types of medical technologies (diagnostic, therapeutic, and organizational) | Not formally recognized; the national HTA agency serving as the official coordination center for HB-HTA | At an early stage of development, such as training sessions and consultations on the coordination model with the Ministry of Health, National Health Fund, and regional health administrations |
Switzerland | 2009: national medical board initiative to perform HTA reports in one of the cantons | Drawing on AdHopHTA and aligning with national HTA requirements | Clinical, economic, and organizational | Hospitals participating in international, national, and/or regional HTA projects, with at least two hospitals establishing HTA units | Not formally recognized | National/regional HTA assessments |
Ukraine | 2021: analyses on legal framework for introducing HB-HTA 2022–2023: study on current decision-making approaches regarding HB-HTA implementation in Ukrainian hospitals | The HB-HTA methodology has been crafted by Ukrainian experts, drawing on the AdHopHTA guidelines and Core model. | Clinical, economic, and organizational | Three hospitals designated as pilot sites for the implementation phase | Not formally recognized. Formal/legal groundwork at an early preparation phase | At an early preparation phase, focusing on training HB-HTA personnel and generating awareness among key stakeholders |
Statement | MS | IQR |
---|---|---|
Barriers—external | ||
No formal recognition of the role of HB-HTA in national/regional legislations | 6.0 | 1.0 |
The potential overlapping of HB-HTA with HTA performed at national/regional level | 5.0 | 3.0 |
The lack of coordination among the different levels of HTA (macro/meso/micro) | 6.0 | 2.5 |
The isolation of hospitals performing HB-HTA (Lack of connections among hospitals performing HB-HTA) | 6.0 | 2.0 |
Barriers—internal | ||
The lack of support from top hospital management | 6.0 | 2.0 |
The lack of the involvement of HB-HTA in the definition of hospital strategy | 6.0 | 2.0 |
Limited human resources | 7.0 | 1.0 |
Facilitators—external | ||
The creation of a network among hospitals performing HB-HTA | 7.0 | 1.0 |
The dissemination of HB-HTA methods and activities (i.e., publicly available methodology and free access to HB-HTA reports) | 6.0 | 1.0 |
Facilitators—Internal | ||
Top hospital management supports evidence-based decision making | 6.0 | 1.0 |
Consensus building in the definition of HB-HTA guidelines and activities | 5.0 | 1.5 |
Training initiatives dedicated to HB-HTA | 6.0 | 0.5 |
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Share and Cite
Lipska, I.; Di Bidino, R.; Niewada, M.; Nemeth, B.; Bochenek, T.; Kukla, M.; Więckowska, B.; Sobczak, A.; Iłowiecka, K.; Zemplenyi, A.; et al. Overcoming Barriers in Hospital-Based Health Technology Assessment (HB-HTA): International Expert Panel Consensus. Healthcare 2024, 12, 889. https://doi.org/10.3390/healthcare12090889
Lipska I, Di Bidino R, Niewada M, Nemeth B, Bochenek T, Kukla M, Więckowska B, Sobczak A, Iłowiecka K, Zemplenyi A, et al. Overcoming Barriers in Hospital-Based Health Technology Assessment (HB-HTA): International Expert Panel Consensus. Healthcare. 2024; 12(9):889. https://doi.org/10.3390/healthcare12090889
Chicago/Turabian StyleLipska, Iga, Rossella Di Bidino, Maciej Niewada, Bertalan Nemeth, Tomasz Bochenek, Monika Kukla, Barbara Więckowska, Alicja Sobczak, Katarzyna Iłowiecka, Antal Zemplenyi, and et al. 2024. "Overcoming Barriers in Hospital-Based Health Technology Assessment (HB-HTA): International Expert Panel Consensus" Healthcare 12, no. 9: 889. https://doi.org/10.3390/healthcare12090889