Your SlideShare is downloading. ×
  • Like
Hospital-based HTA: does it impact on medical technologies’ expenditure and consumption?
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Now you can save presentations on your phone or tablet

Available for both IPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Hospital-based HTA: does it impact on medical technologies’ expenditure and consumption?

  • 626 views
Published

Hospital-based HTA: does it impact on medical technologies’ expenditure and consumption?

Hospital-based HTA: does it impact on medical technologies’ expenditure and consumption?

Published in Health & Medicine
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
626
On SlideShare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
21
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Paola Roberta BoscoloPaola Roberta Boscolo, MSc *, Oriana Ciani, PhD student **, Aleksandra Torbica,Assitant Professor, PhD**Centre for Research on Health and Social Care Management, Bocconi University, Italy** Peninsula College of Medicine & Dentistry , University of Exeter 1 HTAi Conference - Bilbao - June 2012
  • 2.  Background Research questions and objectives Methods Results Conclusions 2 HTAi Conference - Bilbao - June 2012
  • 3.  HTA in Italy:  History: ▪ ‘80s: HTA started at the National Institute of Health, by clinical engineers who aimed at assuring a rational utilization of big ticket technologies while taking into account safety issues (Favaretti et al., 2009); ▪ ‘90s: HTA’s expansion in an “untargeted, uncoordinated” way (France, 2000), often without a clear priority setting stage; ▪ Early development of HTA is largely based on experimental approaches to the hospital-based technology assessment (HB HTA), which are argued to be the most important peculiarity of the country and (still) the real driver of the HTA movement (Catananti et al., 2005). Institutional model(s) Age.Na.S  At country level ▪ National “Clearing House”: Age.Na.s  At regional level H H ▪ 2o different models H  At local level ▪ Bottom up initiatives, not a reference model H H HTAi Conference - Bilbao - June 2012 3
  • 4. Hospital provision Formularies, tenders’ documentations, contracts Procurement Clinicians Commission Patients Forms/reports/hospitalRequests based on HTA Commission guidelinesknowledge, use, patients’outcomes, preferences, ... HTAi Conference - Bilbao - June 2012 4
  • 5.  How diffused HB HTA is in Italy?  To survey the diffusion and use of HTA practice in Italian hospitals Does HB HTA impact hospital decisions?  To propose a model to evaluate HTA at hospital level HTAi Conference - Bilbao - June 2012 5
  • 6. 1. Literature review2. Hospital survey3. Complementary data collection4. Database construction5. Statistical Analysis HTAi Conference - Bilbao - June 2012 6
  • 7. Facilitating factors at the healthcare PubMed, EBSCO, JSTORE organization level: • existing collaboration between theWhat in HTA could demand for the hospital and the HTA agency KEYWORDS:development of Hospital based • formalism in the organization  HTA organization administration; HTAHTA? organizational characteristics Reasons for HB HTA’s impact:• Organizational structure Facilitating factors at the professional• Processes study  • Selection of topics relevant to HTA Hospital based ; the Hospital’s administration level:• Patients’experiences/actions/perspectives  • Timeliness Hospital based HTA’s • high degree of autonomy of HTA’s impact; impact; evaluation of HTA • Formulation of policy reflecting specialists• Decentralization • importance of peers• Need to check for the adaptability community values by a local representative committee • collegial controlsof national/international studies at 170 TITLES • definition of professionalthe local level Titles and roles/responsibilities may influence abstracts selection physicians’ willingness to integrate 10 FULL TEXT HTA into practice MAIN MESSAGES: Factors Causes of HB Reasons for HB facilitating HTA’s diffusion HTA’s impact effectiveness and use of HB HTA HTAi Conference - Bilbao - June 2012 7
  • 8.  Objectives:  To assess HTA activities at the hospital level, on a sample of Italian hospitals, in terms of: ▪ Structure ▪ Role ▪ Outputs ▪ Linking with decision-making  To investigate potential and effective impacts of HTA principles’ implementation in the healthcare trusts. HTAi Conference - Bilbao - June 2012 8
  • 9.  Semi – structured questionnaire on:  Data on volumes and unitary expenditure of selected medical devices (i.e. hip prostheses, coronary stents) 2008 and 2009 data  HTA activities (e.g. institution of committees, role, expertise, outputs, relevance for local management). HTA organizational variables surveyed:  Presence of HTA Commissions  Type of activities conducted  Commissions’ members and competencies  HTA’s aims (perceived/declared)  HTA and other decision making processes links HTAi Conference - Bilbao - June 2012 9
  • 10.  46 health care 1 organizations located in 1 15 regions and one 3 5 Autonomous Province 3 provided data on: 6 2  Selected devices’ volumes 5 and expenditures (i.e.: 1 coronary stents) 2 4 1  HTA’s organizational characteristics 1 1 1 10 10 HTAi Conference - Bilbao - June 2012
  • 11.  Hospitals: North Center South TotalN. of Health careorganizations 21 12 13 46 ESTAV ASL AO IRCSS *Type of health careorganization 23 19 3 1Average size (n. of beds) 791 839 419 /min (n. of beds) 137 179 132 /max (n. of beds) 2004 1533 827 / *inter-hospital organization HTAi Conference - Bilbao - June 2012 11
  • 12.  Almost half of the hospitals have the commission: Processes Indicators for hospitals with HTA Commission: HTAi Conference - Bilbao - June 2012 12
  • 13.  Outputs Outputs N. of hospitals % Repertory update 13 59 Hospital guidelines 8 36 Evaluation form 14 64 Others 8 36 How many hospitals out of 22 give high importance (4 or 5) to different dimensions? Aspects N. of hospitals % Clinical 21 95 Economic 16 72 Organizational 9 40 Social 5 22 HTAi Conference - Bilbao - June 2012 13
  • 14.  How much are HTA principles used? Perceived importance of HTAs principles 20 16 N. of hospitals 15 13 10 9 6 5 2 0 1 2 3 4 5 Perceived importance (scale 1-5) Perceived importance - Mean (sd) Overall 2.5 (1.1) HTA Commission 3 (0.99) No HTA Commission 2.1 (1) HTAi Conference - Bilbao - June 2012 14
  • 15. Potential impact’s analysis Focus: Coronary Stents (DES & BMS) Measured dimensions: 1. Intensity of HTA activities (processes indicators) 2. Importance of HTA (overall and by aspect) 3. Total expenditure (BMS and DES) 4. Total volume of purchased units (BMS and DES) 5. Average unit expenditure (BMS and DES) HTAi Conference - Bilbao - June 2012 15
  • 16. 1. Statistically significant, positive correlation between “intensity” of HTA activities and level of importance of HTA overall (and in each of the 5 dimensions) 152. Correlations between variables reflecting expenditures/volumes of DES with data 14 Ln Spesa DES 2009 on HTA activities: 13 • Statistically significant, negative correlation 12 (although not very strong) between level of 11 importance of “economic” issues in HTA and 1 2 3 4 5 int_commazdm_aspettieconomicodm total expenditure of DES (log) ln_des_s09 Fitted values HTAi Conference - Bilbao - June 2012 16
  • 17. 17HTAi Conference - Bilbao - June 2012
  • 18. 1. HB in Italy, although based on experimental approaches, is quite diffused2. There are no clear impact’s evidences, but there may be certain relations between HTA procedural and organizational characteristics and its real use and efficacy3. Nowadays, high demand for cost containment policies may lead policy makers to consider HTA among “rationalization” instruments, somehow forgetting HTA foundations related to best resources allocation choices4. Future steps of research will concern the evaluation of other dimensions, that, even if more difficult to be evaluated than variation in expenditures and volumes, could probably tell more about HB HTA effects, providing reasons for its aware diffusion HTAi Conference - Bilbao - June 2012 18