HTA (public) Flashcards
what is hta
multidisciplinary process that uses explicit methods
to determine the value of a health technology at different points in its lifecycle
.
dimensions of value to be assessed
clinical effectiveness, safety, costs, and economic implications
additional dimensions of value that may be assessed
ethical, social, cultural, legal and organisational and environmental aspects.
how to do hta
Globalise the evidence
Localise the decision
how to localise the decision to sg?
- Selection of relevant comparator
- Cost-effectiveness in local context/health system
- Ethical issues
- Access issues
- Consumer preferences
- Workforce planning
- Training/credentialing users of technology
what does pico stand for
patient/population
intervention
comparator
outcome
what is CMA
If there is no significant difference in efficacy and safety, the cheapest option is
preferred i.e. cost minimisation analysis (CMA)
what is CEA
If a new technology is superior in outcomes but is likely to result in additional cost to
the health system, cost effectiveness analysis (CEA) is conducted.
what is ICER
Incremental cost-effectiveness ratio (ICER) – incremental change in costs divided by
incremental change in health outcomes of a new technology compared to the current
standard of care over a period of time
ICER =
CostA − CostB/EffectA − EffectB (incremental cost per unit outcome)
what outcome should be considered in hta?
1. Safety profile
2. Delays in progression
3. Improved compliance with the new technology
4. Lengthening of life
5. New mechanism of action
1,2,4
what are indirect treatment comparisons
making use of RCTs that have a common comparator
eg. RCT1: A and B
RCT2: B and C
to determine effectiveness between A and C
transitivity assumption
no systematic differences between available comparisons, control groups are sufficiently similar
minimal clinically important difference
smallest difference in score in domain of interest which patients perceive as beneficial
what is the health outcome of CUA
QALY
what does CEA consider
cost and health outcomes
2 components of CMA
equieffective doses (proposed medicine and comparator),
direct medicine cost (cost of proposed medicine vs cost of comparator)
what is bill size
patients out of pocket payment after subsidies
what is cost
Price at which the public healthcare institution (PHI) procures from manufacturer or distributor
what is charge
Price which includes any profit margins applied by the PHI (‘cost-plus’ model) and reflected on
patients’ bill
* This price is before any deductions for government subsidies, insurance payouts,
are societal costs included in CEA?
no
markov model assumption
future state depends only on the present state, ‘memoryless’
long time horizon benefit vs disadvantage
benefit: captures all health effects and costs
disadvantage: increases uncertainty
short cycle length benefit vs disadvantage
benefit: increases precision
disadvantage: reduces efficiency
what are utility weights
incorporates no. of life years and QOL
what are vignettes for measuring health
qualitative descriptions of health state to be valued
ways to measure health
- direct patient elicitation
- generic preference based measures of health
- disease specific measures of health
- vignettes/scenarios
price volume agreement benefit
payment back in rebates for spending above pre-negotiated caps
problems when countries uphold explicit CE threshold
- drugs with supposedly lower ICER get raised by companies to maximise profit
- lack of long term data to determine ICER
- ignores budget constraints
major criteria in decision making of drug subsidies
- clinical need
- overall benefit
- cost effectiveness
- cost of technology and estimated number of patients to benefit
characteristics of rwd
- observational
- unstructured and inconsistent due to variations in data entry
- large volume of data
- lack key endpoints for analysis
- subject to bias and measurement errors
