Introduction to Health

Technology Assessment
Origins of Technology Assessment
• Technology assessment (TA) arose in the mid-1960s
from an appreciation of the critical role of
technology in modern society and its potential for
unintended, and sometimes harmful,
consequences.
• The term “technology assessment” was introduced
in 1965 during deliberations of the Committee on
Science and Astronautics of the US House of
Representatives with the primary purpose of
serving policymaking
Origins of Technology Assessment
• The role of HTA in the Philippines has grown and
evolved over the years with its first 10 stages of
development seen in PhilHealth in the early 2000’s
informing coverage decisions for 11 medicines and
medical procedures.
Fundamental Concepts of HTA
• Health Technology
• Physical Nature:
• drugs, biologics, devices/equipment/supplies, medical and
surgical procedures, public health programs, support system,
organizational and managerial systems
 Fundamental Concepts of HTA
• Health Technology
• Purpose of application
• Prevention, screening, diagnosis, treatment,
rehabilitation, palliation,
• Stage of Diffusion
• Future
• Experimental
• Investigational
• Established
• Obsolete/outmoded/
abandoned
Fundamental Concepts of HTA
• Factors that Reinforce the Market for Health
Technology
• Advances in science and engineering
• Intellectual property, especially patent protection
• Aging populations
• Increasing prevalence of chronic diseases
• Emerging pathogens and other disease threats
• Third-party payment, especially fee-for-service
payment
• Financial incentives of technology companies,
clinicians, hospitals, and others
Fundamental Concepts of HTA
• Factors that Reinforce the Market for Health
Technology
• Public demand driven by direct-to-consumer
advertising, mass media reports, social media, and
consumer awareness and advocacy
• Off-label use of drugs, biologics, and devices
• “Cascade” effects of unnecessary tests,
unexpected results, or patient or physician anxiety
• Clinician specialty training at academic medical
centers
• Provider competition to offer state-of-the-art
technology
• Malpractice avoidance
• Strong or growing economies
Health Technology
Assessment
DEFINITION
Health Technology Assessment
• Medicines
• Medical device
• Vaccines
• Procedures and systems
Health Technology Assessment
• Purpose:
• Regulatory agencies about whether to permit the commercial
use (e.g., marketing) of a drug, device or other regulated
technology
• Payers (health care authorities, health plans, drug
formularies, employers, etc.) about technology coverage
(whether or not to pay), coding (assigning proper codes to
enable reimbursement), and reimbursement (how much to
pay)
• Clinicians and patients about the appropriate use of health
care interventions for a particular patient’s clinical needs and
circumstances
• Health professional associations about the role of a
technology in clinical protocols or practice guidelines
• Hospitals, health care networks, group purchasing
organizations, and other health care organizations about
decisions regarding technology acquisition and management
Health Technology Assessment
• Purpose:
• Standards-setting organizations for health technology and
health care delivery regarding the manufacture, performance,
appropriate use, and other aspects of health care
technologies
• Government health department officials about undertaking
public health programs (e.g., immunization, screening, and
environmental protection programs)
• Lawmakers and other political leaders about policies
concerning technological innovation, research and
development, regulation, payment and delivery of health care
• Health care technology companies about product
development and marketing decisions
• Investors and companies concerning venture capital funding,
acquisitions and divestitures, and other transactions
concerning health care product and service companies
• Research agencies about evidence gaps and unmet health
needs
Health Technology Assessment
• 3 Basic orientation of HTA:
• Technology-oriented assessments
• Problem-oriented assessments
• Project-oriented assessments
Health Technology Assessment
• Properties and Impacts Assessed
• Technical properties
• Safety
• Efficacy and/or effectiveness
• Economic attributes or impacts: microeconomic
or macroeconomic
• Social, legal, ethical and/or political impacts
Health
Technology
Assessment
• Methods
used for
Ethical
Analysis in
HTA
Health Technology Assessment
• Measuring Health Outcomes
• Mortality
• Morbidity
• Adverse health events
• Quality of life
• Functional status
• Patient satisfaction
Health Technology Assessment
• Measuring Health Outcomes
• 1. Biomarkers, intermediate endpoints and
surrogate endpoints
• 2. Quality of Life Measures
• CAHPS (formerly Consumer Assessment of Healthcare Providers and
Systems)
• EuroQol (EQ-5D)
• Health Utilities Index
• Nottingham Health Profile
• Quality of Well-Being Scale
• Short Form (12) Health Survey (SF-12)
• Short Form (36) Health Survey (SF-36)
• Sickness Impact Profile
Health
Technology
Assessment
• Measuring
Health
Outcomes
• 2. Quality of
Life
Measures
Health
Technology
Assessment
• Measuring
Health
Outcomes
• 2. Quality of
Life
Measures
Health
Technology
Assessment
• Measuring
Health
Outcomes
• 2. Quality of
Life
Measures
Health Technology Assessment
• Measuring Health Outcomes
• Health-Adjusted Life Years
• Quality-adjusted life years (QALYs)
• QALY = length of life X Quality weight
• Disability-adjusted life years (DALYs)
• DALY = years lived with disability + years of life lost
• Healthy-years equivalents (HYEs)
Health
Technology
Assessment
• Performance
of Screening
and
Diagnostic
Technologies
Health Technology Assessment
• Performance of Screening and Diagnostic
Technologies
• Outcomes:
• True positive
• True negative
• False positive
• False negative
Health Technology Assessment
• Performance of Screening and Diagnostic
Technologies
• Chain of Inquiry on effectiveness of diagnostic
technology:
• Technical capacity
• Diagnostic capacity
• Diagnostic impact
• Therapeutic impact
• Patient outcome
• Cost-effectiveness
Health Technology Assessment
• Timing of Assessment
• Expertise for Conducting HTA
• Health professionals, Managers of hospital, clinics,
nursing homes, etc, Pharmacists, Laboratory technicians,
Biomedical and clinical engineers, Patients and
community representatives, Epidemiologists,
Biostatisticians, Economists, Social scientists, Decision
scientists, Ethicists, Lawyers, Computer
scientists/programmer, Librarians/information
specialists
Health Technology Assessment
• Basic HTA Framework/steps in HTA process
• 1. Identify assessment topics
• 2.Specify the assessment problem or questions
• 3. Determine organizational locus or responsibility for
assessment
• 4. Retrieve available relevant evidence
• 5. Generate or collect new evidence (as appropriate)
• 6. Appraise/interpret quality of the evidence
• 7. Integrate/synthesize evidence
• 8. Formulate findings and recommendations
• 9. Disseminate findings and recommendations
• 10. Monitor impact
 Health Technology Assessment in
the Philippines
• Health technology Council:
• Core committee:
• ethicist, public health epidemiologist, health economist,
sociologist/anthropologist, clinical trial/research methods expert,
clinical epidemiologist/evidence-based medicine expert, medico-legal
expert, public health expert and citizen’s representative.
• 7 Subcommittees
• experts on medicines, vaccines, medical and surgical procedures,
clinical equipment and devices, preventive and promotive health,
traditional medicine and other health technologies
Health Technology Assessment in
the Philippines
• HTA contributes to the achievement of UHC by:
• Increasing transparency, accountability, and equity
• Institutionalizing priority setting mechanism on
health technology coverage
• Improving efficiency in allocation of resources
• Negotiating better prices of health technologies
Health Technology
Assessment in the Philippines

• Steps in HTA process:

1. Topic nomination
2. Topic Prioritization
3. Scoping and Protocol Development
4. Assessment
5. Evidence appraisal
6. Recommendation
7. Resolution
8. Decision
9. Dissemination
Health Technology Assessment in
the Philippines
• Mandatory Documentary Requirements:

Health Technology Document Requirements

Drugs and vaccines Certificate of Product Registration (CPR)
from Phil. FDA
Medical Devices Certificate of free sale (CFS)
Traditional and alternative healthcare Certification from PITAHC for traditional
products and practices medicine practices

Certification from FDA for Traditional

Medicine devices

Certification from FDA for herbal

medicines and traditionally used herbal
products
Health Technology Assessment in
the Philippines
• Criteria in making Recommendation:
• Responsiveness to disease magnitude, severity, and
equity
• Safety and effectiveness
• Household financial impact
• Cost-effectiveness
• Affordability and viability