HTA Collab for Ghana and its usefulness.

1. Health Technology Assessment and
evidence-informed decision making
Derek Cutler, MSc
NICE International

2. Burden of
chronic
disease and
ageing
populations
Users’
expectations
and the promise
of universal
coverage
Growth in
technologies –
expanding
marketplace
Finite budgets
and financial
pressures
Policy and
practice
Health systems
everywhere are
under pressure…

3. We cannot afford everything
that is clinically effective
“The NHS, just like every other healthcare
system in the world—public or private—has to
set priorities and make choices. The issue is
not whether there are choices to be made, but
how those choices are made. There is not a
service in the world, defence, education or
health, where this is not the case.”
UK Parliamentary Health Committee

4. What is Health Technology
Assessment?
“A multi-disciplinary field of policy analysis that examines
the medical, economic, social and ethical implications of
the incremental value, diffusion and use of a medical
technology in health care.”
Medical technology: “Any intervention that may be used to
promote health, to prevent, diagnose or treat disease or for
rehabilitation or long-term care. This includes
pharmaceuticals, devices, procedures and organizational
systems used in health care.”
INAHTA (International Network of Agencies for Health Technology Assessment)

5. HTA as a tool
• Not a ‘cure all’ for all system inefficiencies and problems
• But, combined with inclusive, transparent processes can
confer legitimacy on decisions
• Particularly important in the case of ‘no’ decisions and
saving money to reinvest and to expand coverage

6. Comparative clinical and cost-
effectiveness
1. How well does the technology/intervention work compared to
standard practice in OUR healthcare system? Health gain can be
estimated using quality adjusted life years (QALYs)
2. How much does the technology/intervention cost compared to
standard practice in OUR healthcare system?
• cost of technology, monitoring, length of inpatient or outpatient stay,
costs of treating adverse events
3. Incremental cost effectiveness can be calculated by comparing (1)
and (2)
Difference in costs
Difference in effect

7. Cost-effectiveness and…
ADVISORY GROUP
DECISIONS Non-utilitarian
criteria: ethics,
equity, rights
Legal and
policy
constraints
Practicalities of
implementation
Extent of
uncertainty
Cost-
effectiveness

8. Process

9. Summary
• HTA: a useful tool for policy makers to assess the
value of a range of health technologies, including
drugs, medical devices and disease prevention
interventions; and help maximise the impact of finite
healthcare budgets
• A means of legitimising disinvestment decisions, and
saving money to reinvest and expand coverage
• Countries starting out in HTA should not wait for ‘full’
capacity to do HTA, but rather concentrate on using
the policy need to drive capacity building