HTA and evidence-based policy making: the Queensland Health experience
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HTA and evidence-based policy making: the Queensland Health experience
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HTA and evidence-based policy making: the Queensland Health experience
- 1. HTA and evidence-based policy making: the Queensland Health experience Hong Ju, Kaye Hewson HTA Team, Queensland Health, Australia Image Credits © Vasi.
- 2. Background • Primary healthcare agency to provide public health services for – over 4.5 million people – the State of Queensland (1.8 million km2), Australia
- 3. HTA Program Structure QPACT Health Economics Clinical Knowledge MNCQACT NQACT SQACT GCACT PaedACT
- 4. Submission of applications by clinicians (EOIs) Prioritisation of applications according to pre-defined criteria HTA Process HTA team conducts due diligence on shortlisted submissions QPACT makes evidence-based decision on the technologies • Staged approach – Stage I Policy recommendation • Evaluation • Decision-making – Stage II Piloting Field evaluation if uncertainty remains • Local data collection • System-wide policy Clinical audit data on: Clinical Trial data collection on: Clinical development Organisational Patient-related Economic Organisational Economic Policy decision on system-wide diffusion of the technology
- 5. Process – stage I Submission of applications by clinicians (EOIs) • Pre-implementation – Evaluation through Prioritisation of applications according to pre- defined criteria due diligence process HTA team conducts due diligence on – Evidence-based shortlisted submissions decision-making QPACT makes evidence-based decision on the technologies Policy recommendation
- 6. Process – stage II • Post-implementation QPACT makes evidence-based decision on the technologies – Local data collection Policy recommendation • Piloting Piloting Field evaluation • Field evaluation – Policy decision on system-wide Clinical audit Trial data data collection diffusion Clinical Clinical Organisational Patient-related Economic Organisational Economic Policy decision on system-wide diffusion of the technology
- 7. Outcomes • Assisted health administrators in prioritising their health technology agendas (QPACT) – 72 EOIs for new technologies received for evaluation – 23 were short-listed and went through due diligence process – 15 were funded for piloting – 3 undergoing field evaluation – 2 were evaluated through full HTA • Multiple rapid evidence scans for district committees to assist decision making • Gained trust and wide support from policy makers and clinicians • Increasingly used to support funding allocations
- 8. Conclusion • Evidence-based policy decision making requires a comprehensive approach • HTA is a valuable process to assist such policy development
- 9. Thank you! Any questions? HTA: secretariat_hta@health.qld.gov.au
Notes de l'éditeur
- Faced with rapidly escalating healthcare costs worldwide due to limited available resources and increased demands, health policy makers have increasingly relied on evidence-based policy-making for better resource allocation. QH is not exempted from the challenge. Here we report our experience using HTA in supporting policy decision-making in introducing new technologies.
- Queensland Health is the primary healthcare agency which provides public health services for over 4.5 million people spaning an area of almost 2 million km 2 in the State of Queensland, Australia, more than 3 times the size of Spain (505,992 km 2 ). Prior to 2009, there was no systematic and consistent approach in introducing new technologies in QH. Faced with rapidly escalating costs for healthcare with new health technologies being a significant contributor, a new model to introduce innovative health technologies into public healthcare system through a HTA program was established in 2009.
- The Queensland Policy and Advisory Committee for New Technology was established in 2009 to oversee the state-wide HTA program and provide advice to QLD government and Health Ministers. The committee is made up of clinicians from various disciplines, health administrators, and representatives from research division and national medical technology assessment agencies. In addition to QPACT, a number of sub-committees at health service district level were set up to monitor the uptake of technologies which are new to that district. The committees are supported by a multidisciplinary secretariat comprising personnel with key HTA skills listed here. During the assessment, a wide range of stakeholders are consulted including, but not limited to, capital Build, planning & Financing, clinical engineering and IT departments.
- The HTA process has been informed by the experience of similar assessment agencies both nationally and internationally; The flow chart demonstrates the sequence of events during the process which I’ll introduce separately in the following slides; A 2-staged approach was used in the process with the first stage focusing on evaluation of evidence to support decision-making (green part), and the second stage being local primary data collection in order to inform system-wide policy development later on (red part).
- The HTA process starts with technology funding applications in the form of EOIs, which will be short-listed according to a set of pre-defined inclusion criteria, eg meeting one of the government priorities of equitable access to services, improving patient flow, decreasing surgery waiting lists etc. Short-listed EOIs then proceed to full applications, on which the HTA team will conduct the evaluation through due diligence process adopting a rapid evidence assessment approach, covering areas including the burden of the disease and the clinical need, the clinical benefits, the economic evaluation, the feasibility of adoption, and the societal and ethical consideration of adopting the technology. During the due diligence process, relevant literature is critically assessed, a range of stakeholders are consulted to examine the feasibility issues of adopting the technology. Based on the due diligence, the committee makes evidence-based recommendations employing a deliberative decision-making approach, consistent with the five areas covered in the due diligence. Depending on the underlying evidence, the recommendations are generally classified into three categories: 1) do not fund, 2) fund for piloting if the evidence is generally positive; 3) fund for field evaluation if there is insufficient evidence on effectiveness, cost-effectiveness or feasibility issues for a promising technology. Positive recommendations will then be used to seek funding approval.
- Upon final funding approval, the technology is generally implemented into 1 or 2 site(s) to start the local data collection phase, which will cover the clinical, organisational, economic and patient-relevant outcomes in the “real-world” to allow future policy decision-making through Piloting for a period of time. Field evaluation The results from local setting will be feedback to the committee, and if positive outcomes are generated through the program, policy decision on the system-wide diffusion and appropriate funding of the technology can be made.
- Over the 2 years since the program has been running, it has assisted health administrators in prioritising health technology agendas both at the state and district levels, resulting in a more efficient use of the limited resources; State level (QPACT), 72 EOIs received, among them 15 funded for piloting and 3 undergoing filed evaluation. In addition, a wider impact of the HTA program has been realised including increased awareness of and confidence in the evaluation process from both clinicians and policy makers increasing use of HTA to support funding allocations, and greater collaboration from various stakeholders to fully understand the system impact of adopting new technologies.
- In conclusion, evidence-based policy decision on the uptake of innovative health technologies requires a comprehensive approach. The HTA program continues to evolve in Queensland Health, however our experience indicates that it is a valuable process to assist such policy development.