HTA in Hospitals

引自：http://www.cadth.ca/products/environmental-scanning/health-technology-update/htupdate-issue-13/hta-in-hospitals

The use of hospital-based health technology assessment (HTA) is growing in Canada. The desire for evidence-based decision-making and the need to sustain hospital budgets have created a demand for information on the efficacy, safety, costs, ethical, legal, and operational issues in the adoption of technologies. Hospital-based HTA, due to its proximity to the decision-maker and collaborative approach, has been shown to influence health policy and clinical practice.¹

In Quebec, hospital-based HTA is well-established within the network of five university hospital centres, and is now expanding at other university institutes and affiliated university centres (Table 1). Cardiac and rehabilitation centres in Montreal and Quebec are establishing HTA units. An HTA unit also exists at l’Hôpital du Sacré-Coeur de Montréal. A group of five health and social services centres — which are multidisciplinary institutions operating local community service centres, residential and long-term care centres, and may include general and specialized hospital centres — have formed a consortium (Consortium pour l’évaluation des technologies et des modes d’intervention en santé et services sociaux or CETMISSS) to share resources to promote HTA, provide training to managers and health care professionals, and to undertake HTA projects on topics related to primary care.

The mandate of Quebec’s university hospital HTA units are to conduct rigorous evaluations of medical devices, treatments, or delivery of health care services, and to develop policy recommendations relevant to their organizational context.^2,3 They are also involved in the training of researchers in evaluative methods, promoting a culture of evaluation, fostering networks, and disseminating knowledge. The units’ scientific staff work in collaboration with the institutions’ managers and health professionals throughout the evaluation process, from the selection and prioritization of topics, to collection and interpretation of evidence and the development of policy recommendations.^2,3 The HTA units are linked by various networks that encourage collaboration between researchers at the regional and provincial levels. For example, the CETMISSS is situated in the integrated university health network of the Université Laval and collaborates with the HTA unit of the Centre hospitalier universitaire de Québec (CHUQ). Leadership and support is also provided by the Agence d’évaluation des technologies et des modes d’intervention en santé (AETMIS). Funding to support HTA activities within Quebec’s health care centres has been allocated from within existing institutional operational budgets, with no additional sources of funding.

TABLE 1: Hospital-Based HTA Programs

Alberta

Health Technology Assessment and Innovation (HTAi) Program, Alberta Health Services

Ontario

London Health Sciences Centre

SickKids Hospital (http://pede.ccb.sickkids.ca/pede/task.jsp)

Quebec ― University Hospital Centres

Centre hospitalier de l’Université de Montréal (CHUM) (http://www.chumtl.qc.ca/notre-equipe/directions/detmis.fr.html)

Centre hospitalier universitaire de Sherbrooke (CHUS) (http://www.chus.qc.ca/fr/general/gen_informationnelles.asp#etmis)

Centre hospitalier universitaire de Québec (CHUQ) (http://www.chuq.qc.ca/fr/evaluation/uetmis/evaluation_uetmis.htm)

Centre hospitalier universitaire Sainte-Justine (CHU Sainte-Justine) (http://www.chu-sainte-justine.org/Pro/micro-portails.aspx?AxeID=16)

McGill University Health Centre (MUHC) (http://www.mcgill.ca/tau/)

Quebec ― Other Institutions With HTA Activities

Hôpital du Sacré-Coeur de Montréal (http://www.hscm.ca/evaluation-des-technologies-et-des-modes-dintervention-en-sante/index.html)

Montreal Heart Institute/Institut de Cardiologie de Montréal

Lindsay Rehabilitation Hospital /Institut de réadaptation (Gingras-Lindsay-de-Montréal (http://www.hopital-lindsay.qc.ca/)

Institut de réadaptation en déficience physique de Québec

Consortium pour l’évaluation des technologies et des modes d’intervention en santé et services sociaux (CETMISSS)

The HTA units have had a substantial impact on local policy decisions. Between 2002 and 2007, the policy recommendations of 25 of 27 reports produced by the McGill University Health Centre (MUHC) technology assessment unit have been accepted and incorporated into hospital policy.⁴ Rejection or limited acceptance of 19 technologies resulted in an estimated savings of C$12.8 million, and adoption of six new technologies increased expenditures by C$1.0 million.⁴ Operating costs for the technology assessment unit totalled $1.2 million over the five-year period.⁴ The HTA unit at CHUQ reported high satisfaction with the technology assessment process among clinicians who requested an assessment or were involved in a working group.⁵ The clinicians also reported that the evaluations made an impact on their practice. Sixty-nine per cent of recommendations from two reports were accepted resulting in annual cost savings of $460,000.⁵ The MUHC HTA unit reported that the evaluations were completed within three to four months.¹ Success of the program was related to the timeliness, relevance to local decision-makers, and the formulation of policy that reflected the community’s values.¹

Alberta is in the process of enhancing the provincial program for technology assessment. The amalgamation of the province’s nine health regions, mental health, cancer, addictions, and emergency medical services into one health care delivery entity, Alberta Health Services, has created an opportunity for an integrated approach encompassing the spectrum of care. In collaboration with Alberta Health and Wellness, Alberta Health Services is developing the Health Technology Assessment and Innovation (HTAI) program that will encourage the use of health technology assessments to make decisions at an operational level. The HTAI program will complement the provincial government’s Alberta Health Technologies Decision Process, which evaluates and approves technologies that require provincial or national review.

The HTAI program’s goals are to stimulate the uptake of innovative technologies with proven clinical and cost-effectiveness, explore opportunities to support access to technologies through evidence development, and discourage the use of obsolete or proven ineffective technologies. The program will evaluate technologies ― excluding drugs and information systems — used in health promotion, disease prevention, screening, diagnosis, therapy, rehabilitation, and end-of-life care. The proposed process will include identification and prioritization of technologies, commissioning the production of assessments, incorporation of contextual conditions, development of recommendations, and submission to the Alberta Health Services’ budgetary and decision-making process. The process will also include evaluating the impact of approved technologies and whether or not they achieved the results intended. The program will build on the existing expertise in HTA available in Alberta, including hospital-based units in Calgary and Edmonton, as well as the Institute of Health Economics, the University of Calgary, and the University of Alberta. Development and implementation of the HTAI Program is planned for 2010-2011.

Ontario has two groups undertaking hospital-based HTA ― the High Impact Technology Evaluation Centre (HiTEC) at the London Health Sciences Centre and Technology Assessment at SickKids (TASK), a research institute-based unit at Toronto’s Hospital for Sick Children (SickKids).⁶ TASK is funded mainly by research grants, and conducts methodological research and economic evaluations in pediatrics, in addition to HTA. It undertakes HTA activities based on consultation with hospital administrators and clinicians.

At other institutions without a formal technology assessment unit, HTA is nonetheless incorporated into technology decisions. For example, Vancouver General Hospital is in the process of standardizing the equipment and products used in surgical services. Working in collaboration with surgeons and administrators, the hospital is developing a standardized process to reduce the number and variety of products purchased, and has incorporated evidence review into its decision-making. HTA is used to addressing budget pressures without sacrificing quality of care.

Reports produced by hospital-based HTA units are often available on their units’ websites and some are indexed in the Centre for Reviews and Dissemination database (http://www.crd.york.ac.uk/crdweb/).

Références

1. McGregor M, et al. Int J Technol Assess Health Care 2005; 21(2):263-267.

2. What is the Technology Assessment Unit? McGill Technology Assessment Unit, MUHC 2010.http://www.mcgill.ca/tau/objective/

3.  Mission. Centre hospitalier universitaire de Québec. http://www.chuq.qc.ca/fr/evaluation/uetmis/mission/

4.  Arnoldo J, et al. Impact of TAU reports. McGill Technology Assessment Unit, MUHC 2008.http://www.mcgill.ca/files/tau/FINAL_TAU_IMPACT_REPORT_FEB_2008.pdf

5.  Rapport annuel 2008-2009. Centre hospitalier universitaire de Québec 2010. http://www.chuq.qc.ca/NR/rdonlyres/8EC83C28-401A-4BD5-9AF6-317B72E218F1/0/rapport_annuel_uetmis_2008_2009.pdf

6.  Battista RN, et al. Int J Technol Assess Health Care. 2009 Jul;25 Suppl 1:53-60.