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Methods, procedures, and contextual characteristics of health technology assessment and health policy decision making: Comparison of health technology assessment agencies in Germany, United Kingdom, France, and Sweden

Published online by Cambridge University Press:  21 July 2009

Ruth Schwarzer  and
Uwe Siebert
Ruth Schwarzer
Affiliation:
UMIT–University of Health Sciences, Medical Informatics and Technology
Uwe Siebert
Affiliation:
UMIT–University of Health Sciences, Medical Informatics and Technology; Harvard School of Public Health; and Harvard Medical School
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Abstract

Objectives: The objectives of this study were (i) to develop a systematic framework for describing and comparing different features of health technology assessment (HTA) agencies, (ii) to identify and describe similarities and differences between the agencies, and (iii) to draw conclusions both for producers and users of HTA in research, policy, and practice.

Methods: We performed a systematic literature search, added information from HTA agencies, and developed a conceptual framework comprising eight main domains: organization, scope, processes, methods, dissemination, decision, implementation, and impact. We grouped relevant items of these domains in an evidence table and chose five HTA agencies to test our framework: DAHTA@DIMDI, HAS, IQWiG, NICE, and SBU. Item and domain similarity was assessed using the percentage of identical characteristics in pairwise comparisons across agencies. Results were interpreted across agencies by demonstrating similarities and differences.

Results: Based on 306 included documents, we identified 90 characteristics of eight main domains appropriate for our framework. After applying the framework to the five agencies, we were able to show 40 percent similarities in “dissemination,” 38 percent in “scope,” 35 percent in “organization,” 29 percent in “methods,” 26 percent in “processes,” 23 percent in “impact,” 19 percent in “decision,” and 17 percent in “implementation.”

Conclusion: We found considerably more differences than similarities of HTA features across agencies and countries. Our framework and comparison provides insights and clarification into the need for harmonization. Our findings could serve as descriptive database facilitating communication between producers and users.

Keywords

Health technology assessmentDecision makingHealth policyMethods
Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 25 , Issue 3 , July 2009 , pp. 305 - 314
Copyright
Copyright © Cambridge University Press 2009

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References

REFERENCES

1. Anonymous. [Evaluation of the technology employed in health care]. Rev Panam Salud Publica. 1997;2:363–372.Google Scholar
2. Banta, D. A review of health technology assessment methods in the field of pharmaceuticals. Poland: TNO Prevention and Health. Ministry of Health, Office for Foreign Aid Programs in Health Care, Poland. This report is part of a project that was financed through World Bank Loan 3466-POL; 2002.Google Scholar
3. Banta, HD, Gelband, H, Jonsson, E, Battista, RN. Special issue: Health care technology and its assessment in eight countries: Australia, Canada, France, Germany, Netherlands, Sweden, United Kingdom, United States. Health Policy. 1994; 30:1–421.CrossRefGoogle Scholar
4. Barbieri, M, Drummond, M, Willke, R, et al. Variability of cost-effectiveness estimates for pharmaceuticals in Western Europe: Lessons for inferring generalizability. Value Health. 2005;8:10–23.CrossRefGoogle ScholarPubMed
5. Battista, RN. Expanding the scientific basis of health technology assessment: A research agenda for the next decade. Int J Technol Assess Health Care. 2006;22:275–280; discussion 280–272.CrossRefGoogle ScholarPubMed
6. Brehaut, JD, Juzwishin, D. Bridging the gap: The use of research evidence in policy development. Alberta, Canada: Alberta Heritage Foundation of Medical Research (AHFMR); 2005:1–29.Google Scholar
7. Bronner, D, Federal Joint Committee (G-BA). Assessment of benefit Implementation of medical innovations in Germany. (Oral presentation). College voor zorgverzekeringen (CVZ) and Gemeinsamer Bundesausschuss (G-BA), January 26. Amsterdam 2007.Google Scholar
8. Bundesgesetzblatt. Art. §35b Benefit and cost assessment of drugs. [Social Code Book V. Statutory Health Insurance. Based on Art. 1 Social Security Code V on Social Health of 20th December 1988, BGBl. I S. 2477. Last revision based on Art. 5 G of 2007 April 20]. Bundesgesetzblatt.Google Scholar
9. Bundesgesetzblatt. Art. §139a The Institute for Quality and Efficiency in Health Care. [Social Code Book V. Statutory Health Insurance. Based on Art. 1 Social Security Code V on Social Health of 20th December 1988, BGBl. I S. 2477. Last revision based on Art. 5 G of 2007 April 20]. Bundesgesetzblatt.Google Scholar
10. Bundesgesetzblatt. Art. §139b Conduct of tasks. [Social Code Book V. Statutory Health Insurance. Based on Art. 1 Social Security Code V on Social Health of 20th December 1988, BGBl. I S. 2477. Last revision based on Art. 5 G of 2007 April 20]. Bundesgesetzblatt.Google Scholar
11. Bundesgesetzblatt. Art. §139c Funding. [Social Code Book V. Statutory Health Insurance. Based on Art. 1 Social Security Code V on Social Health of 20th December 1988, BGBl. I S. 2477. Last revision based on Art. 5 G of 2007 April 20]. Bundesgesetzblatt.Google Scholar
12. Bundesgesetzblatt. Statutory Health Insurance [SHI] - Act to Promote Competition (GKV-Wettbewerbsstaerkungsgesetz – GKV-WSG) of March 26 2007. Bundesgesetzblatt Part I No. 11 administered at Bonn March 30, 2007. pp. 378–473.Google Scholar
13. Chinitz, D. Health technology assessment in four countries: Response from political science. Int J Technol Assess Health Care. 2004;20:55–60.CrossRefGoogle ScholarPubMed
14. Cox, P. Financing sustainable health care in Europe: New approaches for new outcomes. Conclusions from a collaborative investigation into contentious areas of healthcare. Helsinki: www.sustainhealthcare.org 2007. pp 1–192.Google Scholar
15. Cranovsky, R, Matillon, Y, Banta, D. EUR-ASSESS project subgroup report on coverage. Int J Technol Assess Health Care. 1997;13:287–332.CrossRefGoogle ScholarPubMed
16. Degos, L. Benefit of health technologies: Where do we come from, where are we now, where do we go? (Oral presentation). IQWiG Herbstsymposium: Wissen als Entscheidungsgrundlage für Patienten und Ärzte (Nov 23). Der finanzielle Wert von Krankheit und Gesundheit (Nov 24). Cologne, Germany: November 24, 2007.Google Scholar
17. Dickson, M, Hurst, J, Jacobzone, S. Survey of pharmacoeconomic assessment activity in eleven countries. Paris: Directorate for Employment, Labour and Social Affairs, Employment, Labour and Social Affairs Committee; 2003:1–44.Google Scholar
18. Dowie, J. Research implications of science-informed, value-based decision making. Int J Occup Med Environ Health. 2004;17:83–90.Google ScholarPubMed
19. Draborg, E, Andersen, CK. Recommendations in health technology assessments worldwide. Int J Technol Assess Health Care. 2006;22:155–160.CrossRefGoogle ScholarPubMed
20. Draborg, E, Andersen, CK. What influences the choice of assessment methods in health technology assessments? Statistical analysis of international health technology assessments from 1989 to 2002. Int J Technol Assess Health Care. 2006;22:19–25.CrossRefGoogle Scholar
21. Draborg, E, Gyrd-Hansen, D. Time-trends in health technology assessments: An analysis of developments in composition of international health technology assessments from 1989 to 2002. Int J Technol Assess Health Care. 2005;21:492–498.CrossRefGoogle ScholarPubMed
22. Draborg, E, Gyrd-Hansen, D, Poulsen, PB, Horder, M. International comparison of the definition and the practical application of health technology assessment. Int J Technol Assess Health Care. 2005;21:89–95.CrossRefGoogle ScholarPubMed
23. Drummond, M, Manca, A, Sculpher, M. Increasing the generalizability of economic evaluations: Recommendations for the design, analysis, and reporting of studies. Int J Technol Assess Health Care. 2005;21:165–171.CrossRefGoogle ScholarPubMed
24. Drummond, M, Schwartz, JS, Jonsson, B, et al. The international working group for HTA advancement. Key principles for the improved conduct of health technology assessments for resource allocation decisions. Int J Technol Assess Health Care. 2008;24:244–258.CrossRefGoogle Scholar
25. Drummond, M, Schwartz, JS, Jonsson, B, et al. The International Working Group for HTA Advancement. Key principles for the improved conduct of health technology assessments for resource allocation decisions: Authors reply. Int J Technol Assess Health Care. 2008;24:367–368.CrossRefGoogle Scholar
26. Easton, D. The political system: An inquiry into the stale of political science. New York: Knopf; 1953.Google Scholar
27. EUnetHTA. European network for Health Technology Assessment (Oral presentation). Fourth Annual Meeting of Health Technology Assessment International (HTAi) June 17-20. Barcelona, Spain 2007.Google Scholar
28. European Commission. The Swedish Council on Technology Assessment in Health Care (SBU). The ECHTA/ECAHI Project. 1999:1–552.Google Scholar
29. European Union (EU) [homepage on the Internet]. Health-EU. The public health portal of the European Union. Medicines and treatment. http://ec.europa.eu/health-eu/care_for_me/medicines_and_treatment/index_en.htm (accessed May 2008).Google Scholar
30. Ferguson, JH, Dubinsky, M, Kirsch, PJ. Court-ordered reimbursement for unproven medical technology. Circumventing technology assessment. [see comment]. JAMA. 1993;269:2116–2121.CrossRefGoogle ScholarPubMed
31. Francke, R, Hart, D. [HTA in the decision-making processes of health care institutions. Current state and relevant questions of regulatory health law]. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz. 2006;49:241–250.CrossRefGoogle ScholarPubMed
32. Freeman, JM. Beware: The misuse of technology and the law of unintended consequences. Neurotherapeutics. 2007;4:549–554.CrossRefGoogle ScholarPubMed
33. Gagnon, MP, Sanchez, E, Pons, JM. Integration of health technology assessment recommendations into organizational and clinical practice: A case study in Catalonia. Int J Technol Assess Health Care. 2006;22:169–176.CrossRefGoogle ScholarPubMed
34. Garcia-Altes, A, Ondategui-Parra, S, Neumann, PJ. Cross-national comparison of technology assessment processes. Int J Technol Assess Health Care. 2004;20:300–310.CrossRefGoogle ScholarPubMed
35. Gerhardus, A, Dintsios, CM. [Der Einfluss von HTA-Berichten auf die gesundheitspolitische Entscheidungsfindung - Eine systematische Übersichtsarbeit] The impact of HTA reports on decision-making processes in the health sector in Germany. Series of the German Institute for Medical Documentation and Information commissioned by the Federal Ministry of Health. Köln: ; 2005:1–111.Google Scholar
36. Gibis, B, Rheinberger, P. [Experiences with and impact of health technology assessment on the German Standing Committee of physicians and patients]. Z Arztl Fortbild Qualitatssich. 2002;96:82–90.Google ScholarPubMed
37. Goodman, CS. HTA 101: Introduction to health technology assessment [Update of 1998, webpublished on NLM]. Virginia: The Lewin Group; 2004:1-155.Google Scholar
38. Granados, A, Jonsson, E, Banta, HD, et al. EUR-ASSESS project subgroup report on dissemination and impact. Int J Technol Assess Health Care. 1997;13:220–286.CrossRefGoogle ScholarPubMed
39. Hailey, D. Elements of effectiveness for health technology assessment programs. Alberta, Canada: Alberta Heritage Foundation of Medical Research; 2003:1–41.Google Scholar
40. Hansson, SO. Decision theory. Brief introduction. Stockholm, Sweden: Department of Philosophy and the History of Technology, Royal Institute of Technology (KTH); 1994:1–94.Google Scholar
41. Haute Autorité de Santé. Code de la sécurité sociale. Version à venir au 1 juin 2008. Chapitre 1 bis. Paris: Haute Autorité de Santé Article L161-37; 2008.Google Scholar
42. Hemminki, E, Hailey, D, Koivusalo, M. Health care policy - The courts - A challenge to health technology assessment. Science. 1999;285:203–204.CrossRefGoogle Scholar
43. Henshall, C, Koch, P, von Below, GC, et al. Health technology assessment in policy and practice - Working group 6 report. Int J Technol Assess Health Care. 2002;18:447–455.CrossRefGoogle Scholar
44. Henshall, C, Oortwijn, W, Stevens, A, Granados, A, Banta, D. Priority setting for health technology assessment. Theoretical considerations and practical approaches. Priority setting Subgroup of the EUR-ASSESS Project. Int J Technol Assess Health Care. 1997;13:144–185.CrossRefGoogle ScholarPubMed
45. Hivon, M, Lehoux, P, Denis, JL, Tailliez, S. Use of health technology assessment in decision making: Coresponsibility of users and producers? Int J Technol Assess Health Care. 2005;21:268–275.CrossRefGoogle ScholarPubMed
46. Hjelmgren, J, Berggren, F, Andersson, F. Health economic guidelines–similarities, differences and some implications. [see comment]. Value Health. 2001;4:225–250.CrossRefGoogle ScholarPubMed
47. Hutton, J, McGrath, C, Frybourg, JM, et al. Framework for describing and classifying decision-making systems using technology assessment to determine the reimbursement of health technologies (fourth hurdle systems). Int J Technol Assess Health Care, 2006;22:10–18.CrossRefGoogle ScholarPubMed
48. Introduction to the EUR-ASSESS Report. Int J Technol Assess Health Care. 1997;13:133–143.CrossRefGoogle Scholar
49. Jann, W, Wegrich, K. Phasenmodelle und Politikprozesse: Der Policy Cycle. In: Schubert, K, Bandelow, N, eds. Lehrbuch der Politikfeldanalyse. München/Wien; 2003.Google Scholar
50. Jonsson, E, Banta, D, Henshall, C, Sampietro-Colom, L. The ECHTA/ECAHI project. European Commission; 1999:1–552.Google Scholar
51. Kristensen, FB. First plenary session. Health technology assessment (HTA) in Europe - is harmonization possible? (Oral presentation). 11th Annual Congress of the International Society of Pharmacoeconomics and Outcomes Research (ISPOR). Athens, Greece, November 8–11, 2008.Google Scholar
52. Kuhn, T. The structure of scientific revolutions. Chicago: University of Chicago Press; 1962.Google Scholar
53. Lafortune, L, Farand, L, Mondou, I, Sicotte, C, Battista, R. Assessing the performance of health technology assessment organizations: A framework. Int J Technol Assess Health Care. 2008;24:76–86.CrossRefGoogle ScholarPubMed
54. Lehoux, P, Tailliez, S, Denis, JL, Hivon, M. Redefining health technology assessment in Canada: Diversification of products and contextualization of findings. Int J Technol Assess Health Care. 2004;20:325–336.CrossRefGoogle ScholarPubMed
55. Lehoux, P, Williams-Jones, B. Mapping the integration of social and ethical issues in health technology assessment. Int J Technol Assess Health Care. 2007;23:9–16.CrossRefGoogle ScholarPubMed
56. Liberati, A, Sheldon, TA, Banta, HD. EUR-ASSESS project subgroup report on methodology. Methodological guidance for the conduct of health technology assessment. Int J Technol Assess Health Care. 1997;13:186–219.CrossRefGoogle ScholarPubMed
57. Martelli, F, Torre, GL, Ghionno, ED, et al. Health technology assessment agencies: An international overview of organizational aspects. Int J Technol Assess Health Care. 2007;23:414–424.CrossRefGoogle ScholarPubMed
58. McGivney, WT. Coverage, technology assessment, and the courts. Physician Exec. 1991;17:36–38.Google ScholarPubMed
59. Miles, MB, Huberman, AM. Qualitative data analysis. CA: Thousand Oaks: Sage; 1994.Google Scholar
60. Mintzberg, H. Die Mintzberg-Struktur. Organisationen effektiver gestalten. Landsberg/Lech: Verlag Moderne Industrie; 1992.Google Scholar
61. National Institute for Health and Clinical Excellence (NICE). Homepage on the Internet. http://www.nice.org.uk/ (accessed May 2008).Google Scholar
62. National Institute for Health and Clinical Excellence (NICE). Homepage on the Internet. Guide to the methods of technology appraisal [issued June 2008]. London, UK: http://www.nice.org.uk (accessed October 19, 2008).Google Scholar
63. Newcomer, LN. Technology assessment, benefit coverage, and the courts. In: Gelijns, AC, Dawkins, HV, eds. Adopting new medical technology, vol. 4. Washington, DC: National Academy Press; 1994:117–124.Google Scholar
64. Oliver, A, Mossialos, E, Robinson, R. Health technology assessment and its influence on health-care priority setting. Int J Technol Assess Health Care. 2004;20:1–10.CrossRefGoogle ScholarPubMed
65. Oortwijn, W, Banta, HD, Cranovsky, R. Introduction: Mass screening, health technology assessment, and health policy in some European countries. Int J Technol Assess Health Care. 2001;17:269–274.CrossRefGoogle ScholarPubMed
66. Organisation for Economic Co-operation and Development. The OECD Health Project. Health technology and decision making. Paris: OECD; 2005.Google Scholar
67. Perleth, M, Busse, R, Gerhardus, A, Gibis, BR, Luhmann, D, (Hrsg.). Health technology assessment. Konzepte, Methoden, Praxis für Wissenschaft und Entscheidungsfindung. Berliner Schriftenreihe Gesundheitswissenschaften. Berlin: Medizinisch Wissenschaftliche Verlagsgesellschaft; 2008:1–260Google Scholar
68. Perleth, M, Jakubowski, E, Busse, R. [“Best practice” in health care–or why we need evidence-based medicine, guidelines and health technology assessment]. Z Arztl Fortbild Qualitatssich. 2000;94:741–744.Google ScholarPubMed
69. Perleth, M, Jakubowski, E, Busse, R. What is ‘best practice’ in health care? State of the art and perspectives in improving the effectiveness and efficiency of the European health care systems. Health Policy. 2001;56:235–250.CrossRefGoogle ScholarPubMed
70. Perry, S, Gardner, E, Thamer, M. The status of health technology assessment worldwide. Results of an international survey. Int J Technol Assess Health Care. 1997;13:81–98.CrossRefGoogle ScholarPubMed
71. Perry, S, Thamer, M. Health technology assessment: Decentralized and fragmented in the US compared to other countries (corrected). Health Policy. 1997;42:269–290.Google Scholar
72. Perry, S, Thamer, M. Evaluation of health care technologies in the united states compared to Canada and European countries. J Public Health Policy. 1999;20:168–191.CrossRefGoogle Scholar
73. Petherick, ES, Villanueva, EV, Dumville, J, Bryan, EJ, Dharmage, S. An evaluation of methods used in health technology assessments produced for the Medical Services Advisory Committee. Med J Aust. 2007;187:289–292.CrossRefGoogle ScholarPubMed
74. Philips, Z, Bojke, L, Sculpher, M, Claxton, K, Golder, S. Good practice guidelines for decision-analytic modelling in health technology assessment: A review and consolidation of quality assessment. Pharmacoeconomics. 2006;24:355–371.CrossRefGoogle ScholarPubMed
75. Reinermann, H. Neues Politik- und Verwaltungsmanagement: Leitbild und theoretische Grundlagen. http://www.dhv-speyer.de/rei/publica/online/spah130.pdf (accessed February 28, 2008).Google Scholar
76. Sassi, F. The European way to health technology assessment. Lessons from an evaluation of EUR-ASSESS. Int J Technol Assess Health Care. 2000;16:282–290.CrossRefGoogle ScholarPubMed
77. Velasco-Garrido, M, Perleth, M, Drummond, M, et al. Best practice in undertaking and reporting health technology assessments. Working group 4 report. Int J Technol Assess Health Care. 2002;18:361–422.Google Scholar
78. von Rosenstiel, L, Molt, W, Rüttinger, B. Organisationspsychologie. Stuttgart: W. Kohlhammer; 2005.CrossRefGoogle Scholar
79. Wanke, M, Juzwishin, D, Thornley, R, Chan, L. An exploratory review of evaluations of health technologies assessment agencies. Alberta, Canada: Alberta Heritage Foundation of Medical Research (AHFMR); 2006:1–61.Google Scholar
80. Weed, M. Meta interpretation: A method for the interpretive synthesis of qualitative research [53 paragraphs]. Forum Qualitative Sozialforschung/Forum: Qualitative Social Research. 2005; 6:Art. 37. http://nbn-resolving.de/urn:nbn:de:0114-fqs0501375 or http://www.qualitative-research.net/index.php/fqs/article/viewArticle/508/1096.Google Scholar
81. Weiss, CH. The many meanings of research utilization. Public Adm Rev. 1976;39:426–431.CrossRefGoogle Scholar
82. Werko, L, Banta, D. Report from the EUR-ASSESS Project. Int J Technol Assess Health Care. 1995;11:797–799.Google ScholarPubMed
83. Wild, C, Gibis, B. Evaluations of health interventions in social insurance-based countries: Germany, the Netherlands, and Austria. Health Policy. 2003;63:187–196.CrossRefGoogle ScholarPubMed
84. Working Group on Relative Effectiveness. 5th Meeting of the Working Group on Relative Effectiveness October 2007. Brussels, Belgium. http://ec.europa.eu/health/ph_overview/other_policies/pharmaceutical/ev_20071002_mi_en.pdf (accessed March 23, 2008.Google Scholar
85. Zentner, A, Velasco-Garrido, M, Busse, R. Methoden zur vergleichenden Bewertung pharmazeutischer Produkte. Eine internationale Bestandsaufnahme zur Arzneimittelevaluation. Köln: Deutsches Institut für Medizinische Dokumentation und Information (DIMDI); 2005:1–158.Google Scholar