Importance of Health Technology Assessments in Public Health Interventions

Health technology assessment is the systematic evaluation of properties, effects and/or impacts of health technologies and interventions. It covers both the direct, intended consequences of technologies and interventions and their indirect, unintended consequences (WHO).

HTA is latest emerging field. It is crucial for policy makers and other stakeholders for decision making. 

Good read: //www.ncbi.nlm.nih.gov/pmc/articles/PMC3176700/

Health technologies include pharmaceuticals, medical devices, procedures, and the organizational and support systems within which health care is delivered. Health technology assessment (HTA) is defined as “a systematic evaluation of the properties and effects of a health technology, addressing the direct and intended effects of this technology, as well as its indirect and unintended consequences”.

Nevertheless, the aspects considered by decision makers regarding reimbursement of a health technology traditionally mainly include the direct and intended effects, such as the level of clinical benefit (compared with the current standard) and incremental cost-effectiveness. At last, Decision makers need assessments that are contextualized, involve a range of stakeholders, take interdependence and interactive aspects into account, and consider varying patient characteristics as well as implementation issues. Furthermore, there is a need to improve the quality of decision making. This asks for structured, explicit, and transparent (appraisal) approaches. It has been increasingly acknowledged that it is the decision-making process, and not the robustness of relevant evidence or the formal procedure followed that warrants the legitimacy of reimbursement decisions.

There's a very interesting article in which the study presents a framework for assessing the level of comprehensiveness of the HTA process in a country. On the basis of applying the framework, we formulate recommendations on how the HTA community can move toward a more integrated decision-making process using HTA.

Read more at: //www.sciencedirect.com/science/article/pii/S1098301517301742  

@bhavya

Agree, HTA aids in the assessment of PHIs in a comprehensive and transparent manner which facilitates the policy decision making processes involving several stakeholders.

To evaluate the PHIs and make well-informed decisions, it is crucial for policymakers to have up-to-date reliable and valid information about the effectiveness, safety and cost-effectiveness of PHIs. Besides this, HTA also focuses on aspects like benefits, costs, adverse effects and ethics.

Intervention in public health is essential for healthcare services sustainability. Health technology Assessment (HTA) mainly focus on clinical settings, pharmaceuticals and medical devices. There are few numbers of public health technologies assessed by HTA bodies due to the complex nature of public health interventions which involve various methodologies which are difficult to apply in non-clinical settings. The study conducted in this article involved cross- sectional survey among 85 HTA-related European and international societies, health bodies, and networks from September 2018 to January 2019 and reported limited proportion of HTA agencies involved in Public health interventions assessment particularly in evaluating behavioral and lifestyle interventions. There is  a need to strengthen the existing Public health HTA methods  and policies for effective implementation of interventions.

read here :

//www.frontiersin.org/articles/10.3389/fpubh.2020.00106/full#:~:text=Health%20technology%20assessment%20(HTA)%2C,and%20indirect%20consequences%20(7).

Health Technology Assessment has become an international gold standard and in addition, it has become a useful policy tool in LMICs as there is a significant need for evidence to guide Universal Health Coverage policies.

In India, it is increasingly getting acknowledged as it seeks to bring improvement in the efficiency and equity of the healthcare system by focussing on clinical effectiveness, in the assessment of evidence for cost by using health economic principles, in prioritization of health resources, and in its functionality of providing evidence as to whether an intervention is a cost-effective investment.

It is the best time to consider the role of HTA in India as it is dealing with the major dual public health burden of non-communicable diseases as well as communicable diseases. So for making important decisions and interventions for combating both the challenges, it is critical that the healthcare spending is done with an equitable and efficient approach with a transparent framework, which is offered by Health Technology Assessment.

Read more about “Health Technology Assessment for Policy Making in India: Current Scenario and Way Forward” available at  //link.springer.com/article/10.1007/s41669-017-0037-0

@kamalpreet

Very interesting read evaluating the involvement of HTA in the Public health technologies. Since it is a young discipline that originated from the need to support decision making on value in healthcare. Indeed the implementation of collaborative HTA approaches in the setting of Public health practice and policy needs to be prioritized and further strengthened. Moreover, ensuring reliable data structures and consolidation of HTA methods for the evaluation of Public health technologies will be crucial for tackling the enormous burden of diseases in the societies.

@bhavya

I agree, with digitization and intervention based technological reforms in healthcare delivery system, it is crucial to assess the effectiveness, feasibility and impact of these reforms. Most of the current literature available on HTA is from high income countries thus questioning its applications in middle and low income countries. HTAIn is certainly a step forward, their mandate is that HTAIn aims to maximize health in the population, reduce out of pocket expenditure (OOP) and reduce inequity; to support the process of decision-making in health care at the Central and State policy level by providing reliable information based on scientific evidence and develop systems and mechanisms to assess new and existing health technologies by a transparent and inclusive processes. HTAIn will appraise health interventions and technologies based on available data on resource use, cost, clinical effectiveness, and safety; collect and analyze evidence in a systematic and reproducible way and ensure its accessibility and usefulness to inform health policy. Dissemination of research findings and resulting policy decisions to educate and empower the public to make better informed decisions for health will be done.

3 basic objectives of HTAIn are:

• Maximizing Health – Expanding coverage without compromising the quality of healthcare services.
• Reducing out of pocket expenditure - reduction in proportion of catastrophic households’ expenditures and consequent impoverishment.
• Reducing Inequality - Minimizing disparity on account of gender, poverty, caste, disability, other forms of social exclusion and geographical barriers

HTAIn is entrusted with the responsibility to collate and where needed generate evidence related to the clinical effectiveness, cost-effectiveness, and safety of medicines, devices and health programs using the Health Technology Assessment (HTA) approach.

It is a powerful tool to make informed policy decisions. Cost effectiveness Assessment is an important aspect of devising policies and interventions that are sustainable and impact oriented. Various barriers that policy makers comes across while using the CEA information are Methodological inconsistencies, Data Unavailability, Lack of generalizability, Limited technical or implementation capacity.

Out of these points Methodological Inconsistencies especially grabbed  my attention as various health policies functional do not take into consideration the assessment of informal care, travel and productivity losses. All these are possible reasons for decreased cost effectiveness and inability to reproduce similar policy models from the available HTA information.

Technology Assessment is a concept, which embraces different forms of policy analysis on the relation between science and technology on the one hand, and policy, society and the individual on the other. Capacity building, Policy brief from HTA study and creating data repositories are the foundational stones of HTA in India. Data collected from HTA and studies will be instrumental in devising a sound and robust healthcare policy ecosystem.

@ashruti-bhatt

While assessing the comprehensiveness of an HTA process using frameworks, it is important to look at different elements of the HTA system. To judge the level of comprehensiveness, it is of utmost importance to look at to what extent the phases of an HTA process are linked, particularly the assessment and appraisal phases. We may consider that Canada is the best practice for assessment whereas Scotland is the best practice for appraisal. Moreover, the best practices that may work in Canada might not necessarily work well in Scotland. A particular country may not be the best practice for all aspects of the HTA process.

Further, it may not be necessary to consider all the elements of an HTA process, some elements may be more crucial than others depending upon the country/context. Hence, a framework may be fabricated based on the elements in the context of the local health system of a country as it reflects the development of the health system as well as the political process of that country.

@kamalpreet

Interesting read. Health technology assessment (HTA) could offer a comprehensive methodological basis for the interventions involving e-health and m-health as well. Digital technologies are increasingly used to address the issues of public health and uplift the healthcare system. Hence, there is a need for standardized, evidence-based approaches to encourage the implementation of effective digital technologies.HTA can act as a bridge between evidence and policy-making. It also describes the technical, economic, clinical, legal, ethical, social, and organizational aspects associated with health technology. Furthermore, the assessment of eHealth/m-Health interventions should take into account the patient’s and general public's perspective and roles to detect areas of improvement.

Read More: //www.researchgate.net/publication/323266656_HEALTH_TECHNOLOGY_ASSESSMENT_EVIDENCE_on_E-HEALTHM-HEALTH_TECHNOLOGIES_EVALUATING_the_TRANSPARENCY_and_THOROUGHNESS/link/5dadabcd92851c577eb9561e/download

@ritikakaur

it is indeed not necessary to consider all the elements of an HTA process, it is absolutely segregated at multiple levels depending upon varying  direct and indirect factors considering the cluster of population in hand. HTA play a crucial role in optimizing healthcare resources, but the factors influencing decision making vary by country. Notwithstanding their diversity, all systems, however, share a common reason for their existence, namely the improvement of health for their entire populations. To attain this objective a health system undertakes a series of functions, most notably, the financing and delivering of health services. And altogether work towards a common goal of informed decision making. 

@shyamlithakur

Yes absolutely, Health technology assessment is one mechanism through which evidence-based decision making can be achieved in India. The Department of Health Research (DHR) under the Ministry of Health and Family Welfare (MoHFW), Government of India established HTAIn similar to the Health Intervention and Technology Assessment Program in Thailand and the Health Technology Assessment Committee in Indonesia. HTAIn will appraise a wide range of health technologies and healthcare interventions to inform health policy. However, there is a need for readily accessible cost data in India as it would aid in allocating limited funds to health interventions and technologies to address out-of-pocket expenditure. HTA has significant data and technical requirements however, the rapid development of a robust data infrastructure is in nascent stages in India. 

Ways in which HTA can support strengthing the healthcare system of India are: 

1. Facilitating strategic purchasing of services from the private sector
2. Incorporating value-based pricing for drugs and devices
3. Improving the quality of care
4. Regulation of healthcare provision
5. Achieving policy convergence and cooperation
6. Incorporating concerns of equity and social justice in health policy decisions

Read More : //reader.elsevier.com/reader/sd/pii/S2212109920300091?token=882D231292734AED293E8A0220B34342A2DCC6A2D2B6C1E506638928729A795280E7CBCB888C0582C11412285882CE5A

//www.jogh.org/documents/issue201802/jogh-08-020311.pdf

@shyamlithakur

It is very interesting paper. Healthcare policy decision making process in India is very slow and complex while it is used in other countries. In India, there is a gradual growth in healthcare sector but need for innovate and implement affordable medical devices and services, so for better access to cost-effective healthcare services HTA needs to be properly linked with policy making.

HTA is a multidisciplinary policy approach. It can be applied for drug, medical device or rehabilitation and also used for individual health or population health, that mean we can say HTA is helpful for simple and complex intervention both. We can apply this in many ways such as to minimize cost, health intervention, reduce overall medical treatment expenditure and so on.

Read more:

• //press.ispor.org/asia/index.php/2020/04/13/health-technology-assessment-program-in-india-updates-2020/

Health technology Assessment India (HTAIn), previously known as the Medical Technology Assessment Board (MTAB), was established in January 2017 under the Department of Health Research (DHR), part of the Ministry of Health and Family Welfare (MoHFW), by the government of India.however, there are  very few studies on the assessment topics have been completed. Reasons may include lack of trained manpower, lack of experience and awareness among stakeholders for conducting HTA studies.

The article “How the Adoption of Health Technology Assessment Is Changing the Healthcare Landscape of India “addresses some of the challenges for successfully implementation of health technology assessment in India (HTAin) which include:

1) Healthcare decision makers lacks basic understanding of key principles of HTA and evidence-based resource allocation.

2) Biased decision making, the current regulatory framework, and scarcity of data

3) Political and religious influence on healthcare decision making process

4) Unstructured infrastructure of regulatory framework as well as different requirements of India’s constituent states also pose a challenge to adopt HTAin

5) Dearth of e -healthcare data and lack of systems which can provide better understanding of health results or outcomes, quality and HTA assessments costs

Article also talks about solution in terms of adoption of HTAin   the details of which can be found in the article here:

//www.xcenda.com/insights/htaq-spring-2020-emerging-market-india-hta

I think We are living in the best time in this world. If we look inside our history then we will be able to see how our ancestors lived and if we could not take proper care of our resources, environment and our health facilities and develop it properly then I fear that maybe We may get to see very bad days ahead. Health technology assessment has become an important tool to support health care services and health policy. HTA has a very important contribution to maintaining and enhancing the quality of health service. Health technology assessment considered many topics Safety, clinical effectiveness, economic considerations, budget impact analysis, organizational impact, equity issues, ethical issues, feasibility considerations, acceptability to health care providers, and acceptability to patients.