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

1. Paola Roberta Boscolo
Paola 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
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2.  Background
 Research questions and objectives
 Methods
 Results
 Conclusions
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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
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4. Hospital provision
Formularies, tenders’
documentations, contracts
Procurement
Clinicians Commission
Patients
Forms/reports/hospital
Requests based on HTA Commission
guidelines
knowledge, use, patients’
outcomes, preferences, ...
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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
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6. 1. Literature review
2. Hospital survey
3. Complementary data collection
4. Database construction
5. Statistical Analysis
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7. Facilitating factors at the healthcare
PubMed, EBSCO, JSTORE organization level:
• existing collaboration between the
What in HTA could demand for the hospital and the HTA agency
KEYWORDS:
development of Hospital based • formalism in the organization
 HTA organization administration; HTA
HTA?
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 controls
of national/international studies at 170 TITLES • definition of professional
the 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
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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.
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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
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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
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11.  Hospitals:
North Center South Total
N. of Health care
organizations 21 12 13 46
ESTAV
ASL AO IRCSS *
Type of health care
organization 23 19 3 1
Average size (n. of beds) 791 839 419 /
min (n. of beds) 137 179 132 /
max (n. of beds) 2004 1533 827 /
*inter-hospital organization
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12.  Almost half of the hospitals have the commission:
 Processes Indicators for hospitals with HTA Commission:
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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
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14.  How much are HTA principles used?
Perceived importance of HTA's
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)
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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)
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2. Correlations between variables reflecting
expenditures/volumes of DES with data
14
Ln Spesa DES 2009
on HTA activities:
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• Statistically significant, negative correlation
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(although not very strong) between level of
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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
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17. 17
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18. 1. HB in Italy, although based on experimental approaches, is quite
diffused
2. There are no clear impact’s evidences, but there may be certain
relations between HTA procedural and organizational
characteristics and its real use and efficacy
3. 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 choices
4. 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
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