Health Technology Assessment

Question 1

Define evidence based medicine (EBM), comparative effectiveness research (CER), and health technology assessment (HTA)?

Answer 1

Evidence Based Medicine
- the conscientious, explicit, and judicious use of current best evidence
in making decisions about the care of individual patients
- “does the treatment work?” and “what is the best treatment for this patient or patient group?” (also for CER!!!)

Comparative effectiveness Research:
- used differently by different groups
- seen as “head to head clinical trials” or “practical clinical trials” or “ comparison of alternative health care interventions using existing clinical and administrative data sources”

Health Technology Assessment:
- a multidisciplinary field of policy analysis, studying the medical, economic, social and
ethical implications of development, diffusion and use of health technology”

Question 2

How is HTA different from EBM and CER?

Question 3

Explain why Drummond et al. (2008) state that “HTA should include all relevant technologies”.

Answer 3

Because potential inefficiencies exist in all forms of healthcare, all health technologies should be potential candidates
for HTA. Otherwise, decision making concerning the use of resources is likely to be distorted

Question 4

Explain why Drummond et al. (2008) argue that evidence from randomized controlled trials (RCTs) should not be the only evidence included in an HTA evaluation.

Answer 4

problems with RCTs (practical limitations):
1. number of questions that can be examined
2. sample size
3. length of followup
4. inclusion of a broadly representative population
5. generalizability
6. subgroup analyses
7. types of outcomes assessed

For HTAs we need …
1. QUASI or NON-EXPERIMENTAL data and studies
2. rigorously conducted OBSERVATIONAL studies, with appropriate CONTROL FOR CONFOUNDING.
3. QUALITATIVE studies
4.integration of both endpoint and validated surrogate data
5. assessment of the incremental impact of and trade-offs among multiple clinical, economic and social outcomes in clinically relevant populations.

Question 5

Explain why Drummond et al. (2008) insist that “a full societal perspective should be considered when undertaking HTAs”.

Answer 5

• to optimize efficiency and societal benefit
• to avoid and identify potentially distorted clinical decisions and health policies resulting from adoption of narrower perspectives used by various healthcare system stakeholders.

Question 6

Explain why Drummond et al. (2008) propose that all key stakeholder groups should be actively engaged in conducting HTAs.

Answer 6

result in technology assessments of….
1. higher quality
2. widely accepted
3. stand a greater chance of being implemented.

-an open process will ENHANCE TRANSPARENCY and TRUST in the process as stakeholders develop a greater UNDERSTANDING of the criteria and standards used.