hospital-based hta: does it impact on medical technologies’ expenditure and consumption?

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Hospital-based HTA: does it impact on medical technologies’ expenditure and consumption?

Paola Roberta Boscolo

Paola Roberta Boscolo, MSc *, Oriana Ciani, PhD student **, Aleksandra Torbica, Assitant Professor, PhD**Centre for Research on Health and Social Care Management, Bocconi University, Italy** Peninsula College of Medicine & Dentistry , University of Exeter

HTAi Conference - Bilbao - June 2012

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Agenda

Background Research questions and objectives Methods Results Conclusions


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Background

HTA in Italy: History:▪ ‘80s: HTA started at the National Institute of Health, by clinical engineers who

aimed at assuring a rational utilization of big ticket technologies while taking into account safety issues (Favaretti et al., 2009);

▪ ‘90s: HTA’s expansion in an “untargeted, uncoordinated” way (France, 2000), often without a clear priority setting stage;

▪ Early development of HTA is largely based on experimental approaches to the hospital-based technology assessment (HB HTA), which are argued to be the most important peculiarity of the country and (still) the real driver of the HTA movement (Catananti et al., 2005).

Institutional model(s) At country level

▪ National “Clearing House”: Age.Na.s At regional level

▪ 2o different models At local level

▪ Bottom up initiatives, not a reference model

Age.Na.S

H

H

H

H

H


4

Procurement Commission

HTA Commission

Clinicians

Formularies, tenders’ documentations, contracts

Forms/reports/hospital guidelines

HTA and the hospital framework

Hospital provision


Requests based on knowledge, use, patients’ outcomes, preferences, ...

Patients

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Research questions and objectives

How diffused HB HTA is in Italy? To survey the diffusion and use of HTA practice

in Italian hospitals

Does HB HTA impact hospital decisions? To propose a model to evaluate HTA at

hospital level


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Methods

1. Literature review

2. Hospital survey

3. Complementary data collection

4. Database construction

5. Statistical Analysis


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Reasons for HB HTA’s impact: • Selection of topics relevant to the Hospital’s administration• Timeliness• Formulation of policy reflecting community values by a local representative committee

Facilitating factors at the healthcare organization level:• existing collaboration between the hospital and the HTA agency• formalism in the organization

Facilitating factors at the professional level:• high degree of autonomy of specialists• importance of peers• collegial controls• definition of professional roles/responsibilities may influence physicians’ willingness to integrate HTA into practice

KEYWORDS: HTA organization administration;

HTA organizational characteristics

HTA Hospital based ;

HTA’s impact; Hospital based HTA’s impact; evaluation of HTA

PubMed, EBSCO, JSTORE

170 TITLES

Literature reviewExplore available knowledge, understand and elaborate appropriate HB HTA outcome measures

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Titles and abstracts selection

MAIN MESSAGES:

Causes of HB HTA’s

diffusion and use

Reasons for HB HTA’s impact

Factors facilitating effectivene

ss of HB HTA

What in HTA could demand for the development of Hospital based HTA?• Organizational structure• Processes study• Patients’ experiences/actions/perspectives• Decentralization • Need to check for the adaptability of national/international studies at the local level


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Objectives: To assess HTA activities at the hospital level, on a

sample of Italian hospitals, in terms of:

▪ Structure

▪ Role

▪ Outputs

▪ Linking with decision-making

To investigate potential and effective impacts of HTA principles’ implementation in the healthcare trusts.

Hospital survey (1/2)


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Hospital survey (2/2)

Semi – structured questionnaire on: Data on volumes and unitary expenditure of selected

medical devices (i.e. hip prostheses, coronary stents) 2008 and 2009 data

HTA activities (e.g. institution of committees, role, expertise, outputs, relevance for local management).

HTA organizational variables surveyed: Presence of HTA Commissions

Type of activities conducted

Commissions’ members and competencies

HTA’s aims (perceived/declared)

HTA and other decision making processes links


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46 health care organizations located in 15 regions and one Autonomous Province provided data on:

Selected devices’ volumes and expenditures (i.e.: coronary stents)

HTA’s organizational characteristics

Sample

2

1

1

1

6

1

2

4

1

1

1

10

33

5

5


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Hospitals:

Sample’s characteristics

North Center South Total

N. of Health care organizations 21 12 13 46

ASL AO IRCSSESTAV*

Type of health care organization 23 19 3 1Average size (n. of beds) 791 839 419 /

min (n. of beds) 137 179 132 /max (n. of beds) 2004 1533 827 /

*inter-hospital organization


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Almost half of the hospitals have the commission:

Processes Indicators for hospitals with HTA Commission:

Hospital HTA Commissions


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HTA commissions’ activities and aspects considered

Outputs

How many hospitals out of 22 give high importance (4 or 5) to different dimensions?

Outputs N. of hospitals %Repertory update 13 59Hospital guidelines 8 36Evaluation form 14 64Others 8 36

Aspects N. of hospitals %Clinical 21 95Economic 16 72Organizational 9 40Social 5 22

14HTAi Conference - Bilbao - June 2012

HB HTA “use”

How much are HTA principles used?

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13

16

6

2

0

5

10

15

20

1 2 3 4 5

N. o

f hos

pita

ls

Perceived importance (scale 1-5)

Perceived importance of HTA's principles

Perceived importance - Mean (sd)

Overall 2.5 (1.1)

HTA Commission 3 (0.99)

No HTA Commission

2.1 (1)

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Focus: Coronary Stents (DES & BMS)

Measured dimensions:

1. Intensity of HTA activities (processes indicators)

2. Importance of HTA (overall and by aspect)

3. Total expenditure (BMS and DES)

4. Total volume of purchased units (BMS and DES)

5. Average unit expenditure (BMS and DES)


Potential impact’s analysis

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Focus: DES

1. Statistically significant, positive correlation between “intensity” of HTA activities and level of importance of HTA overall (and in each of the 5 dimensions)

2. Correlations between variables reflecting expenditures/volumes of DES with data on HTA activities:

• Statistically significant, negative correlation (although not very strong) between level of importance of “economic” issues in HTA and total expenditure of DES (log)

1112

1314

15Ln

Sp

esa

DE

S 2

009

1 2 3 4 5int_commazdm_aspettieconomicodm

ln_des_s09 Fitted values

Focus: DES – presence of HTA Commissions

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Conclusions

1. HB in Italy, although based on experimental approaches, is quite diffused

2. There are no clear impact’s evidences, but there may be certain relations between HTA procedural and organizational characteristics and its real use and efficacy

3. Nowadays, high demand for cost containment policies may lead policy makers to consider HTA among “rationalization” instruments, somehow forgetting HTA foundations related to best resources allocation choices

4. Future steps of research will concern the evaluation of other dimensions, that, even if more difficult to be evaluated than variation in expenditures and volumes, could probably tell more about HB HTA effects, providing reasons for its aware diffusion


hospital-based hta: does it impact on medical technologies’ expenditure and consumption?

Health & Medicine

hta activities

htai conference

coronary stents

processes

experimental

perceived

hospital

level