Criteria for assessment of new technologies at the hospital level (mini-HTA) and the national level (HTA)

1. HTAi 2012
Bilbao, June 25th 2012
Criteria for assessment of new technologies at the
hospital level (mini-HTA) and the national level (HTA)
Helene Arentz-Hansen, Senior researcher PhD, Norwegian Knowledge Centre for the Health Services

2. The Norwegian health system
Northern Norway RHA
 Population: 5 millions
 4 Regional Health Authorities (RHA)
 27 Local Health Authorities
Central Norway RHA
Western Norway RHA
South-Eastern Norway RHA

3. National system for evaluation of new technologies
in the specialist health services
Reasons:
 Unequal practices for decision-making processes around
introduction of new technologies into the health care system
 Ensure equal access to established treatment
 Ensure reasonable use of health resources
 A need for evidence-based, systematic introduction of new
technologies
HTA and mini-HTA

4. HTA supports decision-making processes at the national
level when introducing new technologies
HTA-report
Policy
Clinical Assessing the Impact National
research literature assessment guidelines
Clinical effectiveness Ethics
Safety Legal aspects Clinical
Cost-effectiveness Patient perspective practice
etc.
22. oktober 2012

5. Mini-HTA will support decision-making processes when
introducing new health technologies at the hospital level
Mini-HTA
Policy
Clinical Assessing the Impact National
research literature assessment guidelines
Clinical effectiveness Organisation
Safety Ethics Clinical
Costs practice
Mini-HTA is performed locally and take a few days (~ 5 days)
22. oktober 2012

6. The Norwegian mini-HTA-form
The form is divided into 3 parts:
Part 1: Completed by the proposer
 physician, nurse, head of department etc.
Part 2: Completed by a peer reviewer
 An ”unbiased” person, for instance from another hospital
 Is the evaluation in part one performed satisfactorily?
Part 3: Recommendation for decision-maker
 Head of the department, managing director etc.
 Should the new technology be introduced into the health service?

7. Mini-HTA-form
Part 1: Completed by the proposer
Content:
1. About the new technology
2. The evidence (effectiveness, safety)
3. Ethics
4. Organisation
5. Costs
6. Summary and conclusions

8. Criteria for using mini-HTA prior to introduction of
new technologies in hospitals
1. When should mini-HTA be used?
2. When should mini-HTA not be used?

9. Criteria for using mini-HTA prior to introduction of
new technologies in hospitals (continued)
1. When should mini-HTA be used?
 Uncertainty or disagreement regarding effectiveness
or safety
 Ethical issues

10. Criteria for using mini-HTA prior to introduction of
new technologies in hospitals (continued)
2. When should mini-HTA not be used?
A) The effectiveness and safety are known. No ethical issues.
B) It is obvious that the evidence concerning effectiveness and
safety is limited
C) Type of technologies that should be evaluated at the national level
 Screening
 Highly specialised health care
 Drugs
 Health economic evaluations

11. How the results of the mini-HTA will be used as
a basis for further decisions
 If the effectiveness, safety and costs of the new technology are
acceptable
The hospital can decide to introduce the new technology

12. How the results of the mini-HTA will be used as
a basis for further decisions
 Uncertainty remains concerning effectiveness and safety
 Exceeding of financial or organisational limits
 Ethical considerations of general interest
 May lead to differences in services between hospitals
 Need for assessment of cost-effectiveness
The decision concerning introduction of the new technology should be
lifted to a regional or national level

13. The national mini-HTA-database

14. Summary
 A new system for evaluation of new
technologies in the Norwegian health service
will be introduced in 2012
 This system is based on Health Technology Assessment
as basis for decisions
Mini-HTA at the local level
HTA at the national level