President's Message

HTAi's bold initiatives a living tribute to Jill Sanders

This is an exciting time for HTAi. Our society has always been a forum for all those who produce and use HTA, and our membership is a rich global network for sharing information, experience, and expertise. Over the coming year, HTAi is investing in a set of bold new initiatives to make this network even stronger.

Through these initiatives, we will be working to increase our presence in selected regions around the world, and will emphasize and strengthen our work with other international organizations. Driven by HTAi's Strategic Plan, developed with and for our members, the Board has made a firm commitment to advancing HTAi as a truly global society.  

Improving communication with our members is an important part of this work. We will publish this newsletter quarterly, along with a monthly Bulletin of major headlines. If you would like to share your organization's news through the HTAi newsletter or bulletin, please contact our Secretariat.

As we move forward, we do so in memory of former Vice President Jill Sanders, who passed away in February. Jill was deeply committed to HTA and to our society, and our upcoming initiatives owe much to her vision and drive. HTAi will formally commemorate Jill's life and contributions, but as we mourn Jill I hope we continue to be inspired by her example and strive to make HTAi's work a living tribute to her vision and strength. 

HTAi Presdient Laura Sampietro-Colom

HTA Global spotlight

How HTA is beginning to reshape health services in Ireland

The Irish government recently legislated a formal role for HTA as a valuable tool to inform healthcare investment decisions, establishing the Health Information and Quality Authority (HIQA).

Although pharmacoeconomic assessments of new drugs for reimbursement on publicly funded schemes had been carried out prior to this, the Health Act of 2007 formally established HIQA as a key driver for quality, safety, accountability, and best use of resources in health and social services. Among other functions, this agency has responsibility for evaluating the "clinical and cost-effectiveness of health technologies including drugs" and providing advice to the Minister and agency charged with public health service delivery in Ireland.

HIQA has already produced two major reports on cancer, including HTAs of HPV vaccination to prevent cervical cancer and population-based screening for colorectal cancer. More recently an efficiency review of cancer screening services in Ireland has been published, examining use of resources to maximise the delivery of screening programmes. Informed by this work, the Minister for Health and Children in Ireland has announced the implementation this year of both the vaccination and the additional screening programmes, with the prospect of substantial benefits in terms of patient morbidity and mortality.

HTA output will increase significantly in 2010 and 2011, and already several projects are "in the pipeline."

The Authority was delighted to win the bid to host HTAi2010 in Dublin, and organisation of the annual meeting has enabled increased visibility and participation in the international HTA community.

HIQA very much looks forward to welcoming friends and colleagues to Dublin this summer to what promises to be a great opportunity to explore how best to maximise the value of HTA in driving improvements in health for all. . 

Emerging themes in HTA

Closing the loop: Resources for HTA and disinvestment 

Health systems face pressure to ensure efficiency and value for investment, and some have recognized the imperative to disinvest in technologies that are ineffective, have been superseded, or are no longer cost-effective.

HTAi has recently launched a new Interest Sub-Group (ISG) on Disinvestment, acknowledging the importance of disinvestment to users and producers of HTA. The ISG is a global forum for sharing knowledge on methods for prioritizing and assessing obsolete or low-added value technologies and on the practical application of disinvestment for health systems. The ISG will host a workshop and a panel at the HTAi Annual Meeting in Dublin in June 2010, and welcomes new members.

For public health systems, the attraction of disinvestment is obvious: facing cost pressures and limited resources, managers and policymakers need ways to identify obsolete technologies and inefficient spending.

Challenges

However, disinvestment presents challenges. Evidence for established technologies is often limited, with little incentive for new research.  Priority setting for disinvestment requires clear parameters. It may also be difficult to achieve the cost savings promised by disinvestment in real-world application — this requires mechanisms to support disinvestment in system-wide, hospital-based, and clinical decision-making.

Health systems have begun to address these challenges. Examples include the UK, where NICE works to reduce ineffective practice through "optimal practice reviews," and Spain, where the Galician HTA agency has developed an online tool for prioritization and the Basque Office for HTA has developed software to structure the disinvestment process in health systems. Adelaide HTA has been a leader in building capacity for disinvestment in Australia, and Canada and Norway have begun to explore frameworks for reassessment and disinvestment.

Key challenges for existing initiatives include identifying and prioritizing candidates for disinvestment and establishing the roles of various agents in the disinvestment process. Key lessons include opportunities for reinvestment and the need for incentives to promote the identification of candidates. In general, the process has been welcomed by clinicians and managers as a way to sustain health systems, encourage improvement, and promote innovation. 

For information about joining the HTAi Disinvestment Interest Sub-Group, please contact the Secretariat.

Update from the Policy Forum

Managed Entry Agreements: negotiating access to new technologies

The HTAi Policy Forum met in Washington from January 31 to February 2 to discuss the topic of Managed Entry Agreements.  These agreements between manufacturers and health care payers are emerging as a mechanism to provide rapid access to technologies when uncertainties exist about clinical or cost effectiveness in the real-world setting, when utilization may need to be carefully managed, or to constrain budget impact.

As a key meeting place for senior professionals working at the interface of HTA and decision-making, the Policy Forum discussed different types of Managed Entry Agreements, the reasons for using them, their practical application, advantages, disadvantages, and alternatives.

Addressing diverse challenges

Discussion confirmed that Managed Entry Agreements are used to address diverse challenges. For payers, these challenges might include factors like cost pressures, uncertainty about value or effectiveness, or questions about utilization. For manufacturers, they may address concerns about inappropriate utilization or difficulty collecting "real-world" data pre-approval and are hoped to provide earlier access to technology. However, the Agreements may be difficult to negotiate and increase the bureaucracy for all stakeholders, and a multitude of Agreements could prove untenable for either stakeholder.

As a result of this discussion, the Scientific Secretariat will develop principles for the use of Managed Entry Agreements with the Policy Forum and submit a manuscript to the International Journal of Technology Assessment in Health Care, HTAi's official journal.

New members and selection of a new Chair

The Policy Forum has instituted a new process for selection of members, and was delighted to welcome the following new members in February: Abbott, Bayer Schering Pharma, the Institute for Clinical and Economic Review (ICER), Sanofi-Aventis, and the Stryker Corporation. A call for new members to the Forum will be made in the summer.

During the Autumn a new process was also established to allow members to elect the Chair of the Policy Forum from their own membership or from HTAi as a whole. This has led to the election of Chris Henshall as Chair for a term of three years, beginning in June 2010.

The Policy Forum consists of senior professionals from public and private, for-profit and not-for-profit organizations, and meets twice yearly.

For more information: visit htai.org or contact info@htai.org.

INTEREST SUB-GROUP PROFILE

Information Resources: Optimizing retrieval methods for HTA

NEWS FROM INAHTA

Recent publications from INAHTA agencies

INAHTA is pleased to welcome the membership of Health Intervention and Technology Assessment Program (HITAP), Thailand's HTA agency.

The following publications are now available on the INAHTA website:

Extracorporeal Liver Support of Liver Failure by Means of Prometheus® System, AVALIA-T, Spain

Pharmaceutical and Non-Pharmaceutical Interventions for Alzheimer's Disease, a Rapid Assessment, KCE, Belgium 

Health Technology Assessment on the Net: A Guide to Internet Sources of Information, IHE, Canada

Click here for more publications

About  INAHTA:
The International Network of Agencies for Health Technology Assessment is a non-profit organization established in 1993.

All members are non-profit making organizations producing HTA and are linked to regional or national government.

International Journal of Technology Assessment in Health Care

IJTAHC: New look, highlights from new Policy section