Should the Norwegian public prenatalcare program include an ultrasoundscan in the first trimester?    Siv Cathrine Høymork...
Health care in Norway                 Mainly publicly provided and                  financed                 The public ...
National Council for Priority setting inHealth Care Established in 2007 by the Ministry of Health An advisory board for ...
Framework for priority setting The Priority Setting Regulation is founded on the Patient’s  Rights Act Three criteria sh...
The Council’s web-site:             www.kvalitetogprioritering.no
Should a publicly financed early(weeks 11-13) ultrasound scan beoffered to pregnant women?
Case processing in the Nationalcouncil, spring 2011 14.2.: case put forward 11.4.: case initially discussed in the      ...
An HTA working-group was established      Specialists in foetal medicine      Gynaecologist      Paediatrician      Mi...
Case handled in the National council onDecember 5th               Summary of the findings in the                HTA-repor...
Final resolution The Norwegian Council for Quality Improvement and Priority Setting in Health Care considers it essential ...
Final resolution - justification Pregnant women more satisfied - major objective within  prenatal care programme Better ...
Conclusion Despite the fact that the HTA revealed no health gain  for the mother or the foetus, the Council  recommended ...
Should the Norwegian public prenatal care program include an ultrasound scan in the first trimester?
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Should the Norwegian public prenatal care program include an ultrasound scan in the first trimester?

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Should the Norwegian public prenatal care program include an ultrasound scan in the first trimester?

Siv Cathrine Høymork, Hege Wang, Vigdis Lauvrak, Ånen Ringard
Secretariat for the National Council for Priority setting in Health Care
The Norwegian Knowledge Centre for the Health Services

Published in: Health & Medicine
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  • Her ville jeg unnlatt å lese og henvise til brosjyren vår om rådet. Jeg ville nok gjort en personlig refleksjon om at helsepersonell per se i liten grad er reflektert; knapt et rådsmedlem ser pasienter lenger. Dette er en endring fra foregående periode – rådet i modell a’la 2011 er enda mer topptungt enn det foregående.
  • Debatten om prioritering av helseressurser eller hvilke helsetjenester befolkningen skal tilbys, har pågått kontinuerlig fra midten av 80-tallet.Lønning 1- offentlig utredning fra 1987 og ti år seinere Lønning II, som definerte de tre såkalte prioriteringskriteriene: alvorlighet, effekt og kostnadseffektivitet. Disse er seinere inkorporert i pasientrettighetsloven med tilhørende forskriftAnimert rød sirkel: effekt av behandlingstiltak og kostnadseffektivitet er midt i kjernen av Kunnskapssenterets arbeid med å framskaffe grunnlag for beslutninger.
  • Should the Norwegian public prenatal care program include an ultrasound scan in the first trimester?

    1. 1. Should the Norwegian public prenatalcare program include an ultrasoundscan in the first trimester? Siv Cathrine Høymork, Hege Wang, Vigdis Lauvrak, Ånen Ringard Secretariat for the National Council for Priority setting in Health Care The Norwegian Knowledge Centre for the Health Services
    2. 2. Health care in Norway  Mainly publicly provided and financed  The public prenatal care program is free of any costs for the pregnant women
    3. 3. National Council for Priority setting inHealth Care Established in 2007 by the Ministry of Health An advisory board for assessing new technologies 26 members  Executives from the central health administration and regional health authorities  Executives from municipalities and their organisation  Leaders from patient associations  Representatives from universities and colleges Chaired by the Director-General of the Norwegian Directorate of Health; deputy chairperson is the Director-General of the Norwegian Institute of Public Health Secretariat at the Norwegian Knowledge Centre (the national HTA- institution)
    4. 4. Framework for priority setting The Priority Setting Regulation is founded on the Patient’s Rights Act Three criteria should be fulfilled:  Severity ”the patient will experience a certain reduction in prognosis with regard to life expectancy or a considerable reduction in quality of life if the provision of a health intervention is deferred”  Effectiveness ”the patient may expect to benefit from the health intervention”  Cost-effectiveness ”the expected costs are in a reasonable proportion to the effects”
    5. 5. The Council’s web-site: www.kvalitetogprioritering.no
    6. 6. Should a publicly financed early(weeks 11-13) ultrasound scan beoffered to pregnant women?
    7. 7. Case processing in the Nationalcouncil, spring 2011 14.2.: case put forward 11.4.: case initially discussed in the council  Not sufficient documentation to suggest that 2008 ultrasound provides health benefit to the mother and/or foetus  Case was to be further investigated, including an assessment of effects with respect to different medical conditions as well as health economic effects  Assessment was to be jointly conducted by the Directorate of Health, the Knowledge Centre and relevant professional groups. The case would subsequently be re-examined by the council.
    8. 8. An HTA working-group was established  Specialists in foetal medicine  Gynaecologist  Paediatrician  Midwife  Specialists in medical ethics  Norwegian Birth Registry  Systematic reviewers  Librarians  Health economists
    9. 9. Case handled in the National council onDecember 5th  Summary of the findings in the HTA-report from was presented:  No documented health benefit  More women satisfied with prenatal care  Fewer children with Down syndrome will be born  Rise in costs not evident
    10. 10. Final resolution The Norwegian Council for Quality Improvement and Priority Setting in Health Care considers it essential that the publicly provided prenatal care program should be assured, safe, and maintain a high professional standard. Routine ultrasound scans should be offered in weeks 11-13 and 17-19 in order to - ensure that the objectives of ultrasound scanning in pregnancy are attended to at the earliest possible opportunity - ensure that the examination meets professional standards Prior to implementation, the consequences regarding economics and priority setting should be evaluated by means of pilot testing.
    11. 11. Final resolution - justification Pregnant women more satisfied - major objective within prenatal care programme Better to be informed sooner rather than later if something is wrong Ensure high standards to avoid unnecessary waste of resources on follow-up Counteract the geographic and economic barriers to access Expenses not likely to rise Publicly provided programme in place in many other countries
    12. 12. Conclusion Despite the fact that the HTA revealed no health gain for the mother or the foetus, the Council recommended that an additional ultrasound scan should be offered in the prenatal care programme. The advice challenge the official criteria stated in the Priority Setting Regulation. The final decision will be made by the Parliament.

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