The development of a HTA guideline for hospitals in cross-border regions – results from Work Package 5 of Euregio II

1. The development of a HTA guideline for
hospitals in cross-border regions –
results from Work Package 5 of Euregio II
Saskia Knies PhD
Department of International Health &
Department of Health Services Research
Maastricht University

2. Border regions and cross-border care
• Cross-border regions: two or more bordering
countries or regions (where healthcare is arranged
at regional level)
• Patients seeking healthcare abroad
– E.g. waiting lists, perceived quality of care, costs
of care, treatment available, strategic purchasing
by healthcare insurers/providers
• Hospital across border sometimes closer by than in
home country
• Strong cooperation in some euregios (regions with
bordering European countries)
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3. HTA in hospitals or local level
• Growing use of HTA on national level
• Several guidelines for HTA at hospitals, e.g.
Canada, Denmark and Sweden
• No HTA guideline for multiple countries or border
regions
• Why needed: support decision making process
while taking border region into account
• Main advantage: takes less time to complete than
national HTA study
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4. Requirements for HTA guideline for
cross-border regions
• For hospitals and other local healthcare institutions
• Inclusion of all elements of a HTA
• Target audience: healthcare professionals
• Simple to use with clear questions
• Should not take too much time to complete
• Taking cross-border situation into account
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5. Development of the guideline
Several steps:
1. Literature review
2. Interviewing local decision makers in cross-
border settings
3. Expert workshop in May 2010
4. Adjustments to mini-HTA guideline of DACEHTA
a. Divided into three sections
b. Questions deleted or rephrased
c. More sub-headings
d. Added questions
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6. Description of guideline
Aim: to support healthcare professionals who are
working in healthcare institutions in cross-border
settings
Three sections:
1. General questions for all institutions
2. For healthcare institutions without any
interaction with another healthcare institution
across the border
3. For healthcare institutions situated on two sides
of a border that are willing to cooperate
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7. Testing guideline using case studies
• Two different case studies both in hospital setting
• Analysing applicability in real framework
• Identifying missing topics in guideline
• Case studies at university hospitals of Maastricht
(MUMC+) and Aachen (UKA)
• Hospitals work closely together:
– Mostly top-clinical fields
– Share various activities and personnel
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8. Selection of case studies
• Consent for carrying out case studies from board of
directors of both hospitals
• Meeting with policy advisors on cross-border
cooperation of both hospitals
• Several cross-border projects going on
• Different types of decision problems selected
– Case study 1: mutual investments in
departments
– Case study 2: reimbursement and legal issues
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9. Case study 1: Nuclear Medicine
• Shared head of department for both hospitals
• Number of investments in equipment and facilities
requested to support further cooperation
• Investments will increase clinical and research
options for departments
• Substantial investments needed
• Considerations not only related to costs
• Outcome: shared investments of two hospitals will
benefit both hospitals
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10. Case study 2: Neurosurgery
• Deep Brain Stimulation (DBS)
• Experienced neurosurgeons at MUMC+, but no
neurosurgeon available at UKA
• Two questions:
– Possibility of operating Dutch patient in
Germany, because treatment is not
reimbursement in Netherlands
– Operating Dutch and German patients in either
MUMC+ or UKA depending on complexity of
surgery
• Number of legal and reimbursement issues
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11. Experiences with guideline
• General questions (section 1)
– Questions good to answer
– Description of current situation and nature of
request
• Cooperating hospitals (section 3)
– Questions more complicated
– Financial modelling for case study 1 needed
additional questions as not extensively included in
guideline
• Sometimes limited information available
• When is a question relevant or sufficiently answered
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12. Adjustments to guideline
• Questions deleted
– Questions combined into one question due to
large overlap
• Rephrasing questions
– Questions not clear and therefore difficult to
interpret
• Topics or questions added
– Questions from legal domain EUnetHTA Core
model
– Economics questions
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13. Conclusion
• Increasing cross-border cooperation in healthcare
• Increased use of HTA to support decision making at
local level
• First HTA guideline focusing on cross-border regions
• Taking differences into account between countries
– Reimbursement
– Legal issues
– Expectations and preferences of patients
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14. EUREGIO II partners
• Maastricht University, Dep. of International Health (The Netherlands) (project leader)
• Gesundheitsamt Kreis Heinsberg (Heinsberg, Germany)
• Euregio Rhein-Waal (ERW) (Kleve, Germany)
• Gesundheitsmanagement Burger-Wieland (Vienna, Austria)
• European Hospital and Healthcare Federation (HOPE) (Brussels, Belgium)
• Association of European Border Regions (AEBR) (Gronau, Germany)
• Landesinstitut für Gesundheit und Arbeit NRW (Düsseldorf/Bielefeld/Münster, Germany)
• Deutsches Institut für Medizin Dokumentation und Information (DIMDI) (Köln,
Germany)
• ECORYS Research Rotterdam (Rotterdam, The Netherlands)
• WHO Regional Office for Europe (Copenhagen, Denmark)
• Regione del Veneto, International Health Social Affaire Office Venice (Venice, Italy)
• Cooperation and Working Together (CAWT) (Londonderry, Ireland)
• Medical University Sofia, Faculty of Public Health (Sofia, Bulgaria)
• Center for Health Policies and Services (Bucharest, Romania)
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15. On behalf of all authors and everyone involved:
Saskia Knies1, 2, Gloria Lombardi3, Matt Commers1, Hans-Peter Dauben4,
Silvia Evers2, Kai Michelsen1, Wija Oortwijn5, Chibuzo Opara1, Helmut
Brand1
Affiliations
1.Department of International Health, Maastricht University, Maastricht,
the Netherlands
2.Department of Health Services Research, Maastricht University,
Maastricht, the Netherlands
3.HOPE – European Hospital and Healthcare Federation, Brussels,
Belgium
4.DIMDI - Deutsches Institut für Medizinische Dokumentation und
Information, Cologne, Germany
5.ECORYS Nederland B.V., Rotterdam, the Netherlands
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16. Thank you for your attention
This presentation arises from the project
“Solutions for improving health care
cooperation in border regions” (EUREGIO II)
which has received funding from the European
Union, in the framework of the Public Health
Programme (Grant Agreement No. 2007118).
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