Health Technology Assessment in 6 Minutes



have you ever wondered why some drugs are made available to patients via healthcare services such as the NHS while others are not in this course we'll look at how healthcare organizations make decisions about whether we should have access to treatments and we'll focus on a key part of the information used in this decision-making process the educators for this course are based in the school of health and related research at the University of Sheffield and are experts in this kind of research the first thing to understand about health technology assessment or HTA is that it's not all about technology when we refer to HTA the technology in question could be any medical intervention including surgical interventions such as a heart bypass or hip replacement medical devices such as pacemakers or most commonly a pharmaceutical drug a systematic review is a very formulated process that we go through so it's been being done for about 20 years now and the aim is to try and find all the evidence the clinical evidence published or unpublished and that has been produced about a drug or an intervention it could be a psychological intervention it could be a pharmaceutical drug but we try and find all the available evidence and we do that by searching very large databases that are basically long lists of all the clinical trial data that there is out there all the experiments all the research that has been done and that data will then be used within the health technology assessment process sometimes it will go in and be used within the clinical effectiveness models that are built so it can be a key input into assessing whether a drug is cost-effective raishin is fundamental to HD air but not only that to decision-making throughout the NHS so hospitals general practitioners the Department of Health itself will all use economic evaluation to inform decisions so it's not solely used for health technology assessment in terms of precise definition for economic evaluation its evaluation of the costs and benefits of two or more alternative treatments so I look at typically the current treatment in terms of its costs and patient benefits and compare those to that of a new therapy in terms of costs and benefits modeling is about representing the real world in mathematical structures and statistical way in the context of health technology assessment what we use modeling for is to think about linking evidence together so usually in an H tau intervention and you want to understand as as either as a either as a company who's invented this or as an HT agency who's making a decision about it what its long-term effects and long-term cost-effectiveness is going to be against in compared against other treatments in the system what clinical trials are about of trying to compare different ways of treating the same problem trying to determine whether one way of treating typically a new way maybe a new drug or a new device or a new surgical procedure is better than what we do a standard practice at the moment the question is not just whether one treatment is better than another but how much better what is the incremental effectiveness of the new treatment over the existing treatment so in HTA we are very concerned to randomize patients to the treatments to carry out a randomized trial but then to measure the difference in the effectiveness rather than merely to determine whether there is a difference whether which you commend a new treatment or not to recommend it there are implications for two groups of patients there are patients who will receive the new treatment or won't depending on on the decision and there are those who would be affected by that decision in the wider NHS who may have their therapies withdrawn as a result of approving this new technology the media never report on the opportunity cost of a decision what would we be funding if we weren't in a fund this new treatment who is it who's going to lose out so if we fund the new treatment who are the patients who are going to have their therapy withdrawn somewhere else in the NHS who are the people who are going to die earlier as a result who are the people who are going to suffer more as a result potentially there are negative aspects to a positive decision so nice we'll make a recommendation to fund a drug or a new therapy if it costs less than about 20,000 pounds per quality adjusted life year now that's fine and that's based on an assumption that what's getting pushed out of the NHS to fund the new treatment is itself costing around 20,000 pounds per quality adjusted life year so we remain roughly in balance in terms of overall health the trouble is there's good evidence that what's getting pushed out is only costing 12 or 13 thousand pounds to get a quality which means that overall as we move forward we're going to become less and less efficient we're going to get less and less health for our money so positive decisions by nice can actually be bad for overall health you

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