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Samenvatting - Health Technology Assessment
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Summary Health technology assessment HEPL erasmus. Summary of all information needed for the exam
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Health technology assessment - Master HEPL 23/24HTA LECTURE 1 – INTRODUCTION
TO HTA
INTRODUCTION TO HTA
HTA is an important advisory tool to make transparent and unbiased decision. In many countries it is
compulsory for deciding on reimbursement, and it assures value for money.
Key elements on the definition of HTA;
- HTA covers the
o Direct, intended consequences: which are costs incurred in direct treatment of a patient
o indirect, unintended consequences: Which are consequences incurred in indirect treatment,
such as informal treatment, where the carer needs to take more time off from work etc.
- Economic evaluation is usually the core of HTA, which compares two alternatives regarding costs and
benefits
ECONOMIC EVALUATIONS IN HTA
Here we look at the benefits and outcomes of new health technologies. Economics evaluations provide insights
in costs and effects of: (new) interventions compared with existing interventions
6 steps of performing an economic evaluation
1. Study design
2. Cost measuring
3. Benefits measuring
4. Discounting
5. Sensitivity analysis
6. Policy making
,Health technology assessment - Master HEPL 23/24
STEP 1: STUDY DESIGN
1. What perspective are we going to use for the economic evaluation, starting with who is going to pay
o We distinguish two dominant perspectives; the perspective is important as it determines
which cost and effects to include in the assessment:
Health care perspective: cost and effects falling on health care budget
Societal perspective: all relevant costs and effects.
There are also patient and health insurance perspective
2. Choice of comparator
o In an economic evaluation we always evaluate one thing to another, it is a comparison
between two alternatives, however it is important to define what we compare.
o Most efficient alternative (not perse the most effective) to -> Standard treatment
o Consider “no treatment, such as in the case that the alternative is not efficient, but is
expensive.
o Placebo not preferred
3. Type of analyses
o Only cost
Cost minimization analysis (CMA
Effects are equal, focus on cost
Generally, not done in healthcare
o Cost and effects in monetary terms
Cost benefit analysis (CBA),
Quantification of effects, for example a year is worth a certain monetary unit
o Cost In monetary terms, effects in natural units
Cost-effectiveness analysis (CEA)
E.g., progression free life years of heart attacks avoided
-> check if the outcome is in QALY, otherwise it is a CUA)
o Cost in monetary terms, effects in QALYs
Cost-utility analysis (CUA)
4. Time horizon
o All consequences must be taken into account (lifetime horizon), If there is a difference in life
expectancy of a treatment, you always have to take into account a lifetime perspective, which
is complicated because there is a lack of information of a patient’s lifetime. Thus, we can
extrapolate this from different sources of data.
o Methods:
RCT,
Observational study
Model (cohort or individual patient model)
Combination.
,Health technology assessment - Master HEPL 23/24
STEP 2: MEASURING AND VALUING COST
- Identify all relevant cost items
- Measuring resources use
- Value resource use
The costs included depend on the perspective. Whether productivity losses are relevant depends on the
patient group that you are conducting your economic evaluation for.
1. People die younger and there thus will be more productivity losses
2. People live longer and can also be productive, we then include gains or less losses in productivity
STEP 3: MEASURING AN VALUING EFFECTS
- Identify, measure and value effects of interventions
- Disease specific measures
- Generic measures
STEP 4: DISCOUNTING
- People have time preference for both costs and health effects
o The want for positive health effects now
o The want to postpone cost to the future
- Cost later in time weight less
- Effects later in time have less value
STEP 5: UNCERTAINTY
- The values used in economic evaluations are estimates, based on sample of population
- Uncertainty remains and is associated with all estimates
- Sensitivity analysis is to find out how sensitive cost-effectiveness outcomes are to changes in
parameters
, Health technology assessment - Master HEPL 23/24
STEP 6: APPLYING A DECISION RULE / POLICY MAKING
- Calculation of ICER (incremental cost-effectiveness ratio)
Cost A−Cost B
o =€ … per effect
Effects A−Effects B
o E.g., 10.000 per QALY of life year gained
o Apply the decision rule
Is ratio below or above the willingness to pay for a QALY -> WTP (V threshold)
Is ratio below or above our current healthcare production -> marginal returns (K
threshold)
- Determination of cost-effectiveness intervention
- QALY thresholds
CONCLUSION AND SUMMARY
Economic evaluations are about rationalizing rationing decisions, it is not about saving costs, but about
efficiency in health care spending and value for money.
The scarcity of resources necessitates rationing, rationing in health care is an important and delicate matter, as
it affects vulnerable people and attracts the attention of media. Decisions are preferably transparent and
accountable.
The core of HTA is the economic evaluation (EE), EE’s always compare two or more health technologies, and
conducting an EE involves 6 steps.
The cost per QALY gained is valuable, but is not sufficient information for decision makers
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