Experiences with mini-HTA from Denmark
Kristian Kidholm,, HTA-consultant,, Ph.D.
Content

The Danish mini-HTA - definition and content
 Experiences
p
with p
production of mini-HTA?
 When is mini-HTA used?

Quality of mini-HTA
 Strengths and weaknesses

A European development
Mini-HTA in Denmark

Described by The National Board of Health in 2005
 Based on:




A need for evidence based decision making at hospitals
A need for rapid decision making at hospitals
A very large number of local decisions being made at the hospitals
Lack of capacity in The National Board of Health
Definition and content of mini-HTA
Mi i HTA
Mini-HTA

A check list (20-25 questions) describing consequences of introduction of
a specific
p
new technology
gy for a specific
p
patient g
p
group
p in a specific
p
clinical
department
 Based on a systematic literature review
 Used as a basis for decision making
The mini-HTA form:
•The
The proposer?
• The purpose and content of the proposal?
Technology
Patient aspects
Organization
Economy
Mi i HTA in
Mini-HTA
i practise
ti
Production of mini-HTA in hospitals
p
First meeting
Tasks:
Which parts of the staff ?
Which departments ?
The purpose of the technology?
Primary outcomes?
Relevant alternatives/?
Systematic literature search
Reading and assessment of the literature
Second meeting
Presentation of effectiveness data/evidence
Other alternatives
Third meeting
Discussion of organisational effects
Discussion of use of resources
Data collection? Prices?
Tasks:
Description of organisational effects
Calculation of cost per patient
Fourth meeting
Mini-HTA is
Discussion of results and uncertainty
SUBMIT THE MINI-HTA
Example:
p
Mini-HTA of Intracranial stents:
Neurologist, radiologist, nurse,
radiographer economist
radiographer,
Time used: 4 meetings, 25 hours
STOP?
STOP?
P
Practical
ti l experiences
i
with
ith production
d ti off mini-HTA
i i HTA

Questions on technology and clinical effects
• Are all relevant alternatives considered?
• Has systematic literature review been carried out?
• Are effects on patient health described in quantitative terms?
- RRR, ARR, etc.
- Response
R
rate
t
- Lengths of effects

Questions on patient aspects
• Often no evidence can be found
• The basis: Practical experiences in the clinical departments
P
Practical
ti l experiences
i
with
ith production
d ti off mini-HTA
i i HTA

Questions on organization
• Often no evidence exist
• The basis:Practical experiences in the clinical departments
• Remember:
R
b IInclude
l d other
th d
departments
t
t if th
they are affected
ff t d

Questions on economics
• Health economic studies are rarely useable
p
in the clinical departments
p
• The basis: Practical experiences
• Are potential reductions in use of staff included?
• Information about ICER is generally not requested
• Only information on hospital expenditure and revenue (DRG) is requested
When is a mini-HTA produced?
Decision
D
i i making
ki within
ithi the
th clinical
li i l department
d
t
t (within
( ithi their
th i budget)
b d t)
 When a doctor apply for introduction of a new technology
Decision making in the Board of Directors at the hospital
 Compulsory in applications for financial support for new treatments
Decision making in the National Board of Health
 Application for a new highly specialized treatment
 Application for a new DRG-rate
National Board
Regional level
Hospital level
Clin. department
When is a mini-HTA produced?
Decision
D
i i making
ki within
ithi the
th clinical
li i l department
d
t
t (within
( ithi their
th i budget)
b d t)
 When a doctor apply for introduction of a new technology
Decision making in the Board of Directors at the hospital
 Compulsory in applications for financial support for new treatments
Decision making in the National Board of Health
 Application for a new highly specialized treatment
 Application for a new DRG-rate
National Board
Regional level
Is the use of mini-HTA systematic
y
in DK?
• No!
• Varies between departments, hospitals, regions
Hospital level
Clin. department
What is the quality of the mini-HTAs produced?
Review of 52 mini-HTAs from 2008
Strengths
Yes
No
Description of the assessed health technology
98%
2%
Competing technology described
94%
6%
Systematic literature review performed
96%
4%
L
Level
l off evidence
id
d
described
ib d
94%
6%
References described
95%
5%
Types of costs elements described
88%
12%
Organisational consequences in the department described
81%
19%
Kristian Kidholm
Kidholm, Lars Ehlers,
Ehlers Lisa Korsbek
Korsbek, Rolf Kjærby and Mickael Beck (2009)
(2009). Assessment of the quality of mini
mini-HTA.
HTA
International Journal of Technology Assessment in Health Care, 25 , pp 42-48
What is the quality of the mini-HTAs produced?
Review of 52 mini-HTAs from 2008
Quality problems
Yes
No
Quantative description of effectiveness
25%
75%
Description on patient perception, satisfaction etc.
25%
75%
Description of organisational effects outside department
49%
51%
Examples: ”positive impact on mortality and morbidity”
”significant improvement in quality of life”
Conclusion:
- Less than 50 % are of good quality
- Quality assurance is still needed!
Strengths of mini
mini-HTA
HTA

Based on evidence, multidisciplinary assessment

No implementation problem: HTA is only produced when a decision must be made

HTA is p
produced by
y the clinical staff who know the p
patients,, treatment,, organisation…
g

Timeliness
Ref:
National Board of Health (2005): Introduction to mini-HTA
-a management and decision support tool for the hospital service
-http://www.sst.dk/~/media/Planlaegning%20og%20kvalitet/MTV%20metode/Introduction_mini_H
TA_hospital.ashx
Weakness of mini-HTA
mini HTA

Quality problems (25-50 % was OK!) – internal/external review is needed!
 It takes time (from patient treatment)
 Collaboration between departments and different professions is needed
Preconditions for succes:
 Scientific knowledge and ability to read the literature in the clinical departments
 A management who demands HTA as a basis for decision making
 Access to databases ((with full text):
) Medline, EMBASE, Cochrane, Cinahl…
Indberetning af nye behandlinger til mini-MTV databasen
2009
Materialet er tilgængeligt for alle ca. 1. juli
Mini-HTA: An international development!
Region of Lund:
Oslo: Kunnskapscentret:
p
Hospital internal HTA
Systems for decision making in hospitals
All danish hospitals, Regions
Ireland: Health Information and
Quality Authority
Regions in Austria
Goal: Establish a programme to
support HTAs carried out at local
level (hospitals etc.)
Rome: Policlinico “A
A. Gemelli
Gemelli”
Veneto Region:
GANT – Andalusia,
Andalusia Spain
Torino Region
Padova University Hospital
Hospital Clinic de Barcelona
+ Israeli Medical Centers: Greenberg et al. IJATHC,
21 (2) 2005
+ Rapid HTA, McGill University Hospital (Montreal)
Guide for the Acquisition of New Technologies (GANT).
Application form
Application form :
gy description
p
and basic information.
A. Technology
B. Clinical Characteristics
C. Evidence on eficacy, effectiveness and safety.
D. Organizational, patient and management
E. Economic evaluation
Summary
y
1.
Mini-HTA
Mi
i HTA ect.
t iis iincreasingly
i l b
being
i used
db
by h
hospitals
it l as th
the b
basis
i ffor
decisions on introduction of new treatments etc.
2.
Quality of Mini-HTA can vary and quality assurance is needed
- National assistance from Kunnskapssentret
- Local assistance from local HTA-units
HTA units
3.
Mini-HTA is now included in many educations
( di l consultant,
(medical
l
nursing,
i
MPH
MPH, MPM
MPM, radiographer,
di
h clinical
li i l engineering)
i
i )
4.
p
g
is an international development
p
The use of mini-HTA in hospitals/regions
.