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Outlining the Health Technology Assessment systems and structures in Ireland Mirn Ryan

Director of HTA

Outline of presentation

Some background
Establishment of HIQA and its roles

Current HTA structures and workplans


Other HTA activity in Ireland

How will HTA progress in Ireland?

Health Technology Assessment


Health Technology Assessment (HTA) is a multidisciplinary process that summarises information about the

Medical Social Economic Ethical Medicolegal Organisational issues


related to use of a health technology in a systematic, transparent, unbiased and robust manner

Health Technology Assessment


Objective:

To inform safe and effective health policies that are patient focussed and achieve best value

Health Information and Quality Authority: Functions


Setting Standards Monitoring Quality and Safety in Healthcare Inspecting Social Services Health Information Health Technology Assessment

Driving safer better care

Health Technology Assessment functions


The functions of the Authority are as follows.

- To evaluate the clinical and cost-effectiveness of health technologies including drugs and provide advice arising out of the evaluation to the Minister and the Executive
- To review and make recommendations as the Authority thinks fit in respect of the services, to ensure the best outcomes for the resources available

HTA for consumers/patients

rationing

Clinicans.

..a clinical purist?

..or a financial realist?

Economic evaluations are usually in the form of CEA or CUA.


Cost-effectiveness analysis (CEA) e.g. COST/LYG

Cost-utility analysis (CUA) e.g. COST/QALY

Types of HTA Conducted in Ireland


HTAs of national significance by HIQA
Rapid HTA: e.g. single technology assessment of pharmaceuticals by NCPE under HSE/IPHA agreement and guidelines in development

Mini-HTA: to inform local level decision-making?

Types of HTA Conducted in Ireland


HTAs of national significance by HIQA broad comprehensive HTA use of independent economic models informs national policy (Dept of Health) and national service (Health Service Executive) decisions Rapid HTA: under HSE/IPHA agreement and guidelines in development Mini-HTA: to inform local level decision-making

Vaccination against HPV to prevent cervical cancer


National Centre for Pharmacoeconomics commissioned to conduct HTA
Adaptation of the Danish model Girls aged 12 years: ICER 17,383/LYS 2008 National Immunisation Programme approved but then .

Budget impact matters even when a technology is deemed cost effective ?

Irish Times November 5th 2008

Health Technology Assessment of a Population-Based Colorectal Cancer Screening Programme in Ireland

CRC screening HTA: Domains


Clinical Effectiveness Cost-Effectiveness Ethics Resource requirements

Service delivery model by NCSS

HTA Findings
Faeco-immunochemical testing (FIT) the optimal strategy ICER 1,696/QALY Estimated: 15% reduction in incidence (160 cases per annum) 36% reduction in mortality (275 cases per annum) Significant additional resource requirements - per annum: 12,000 to 15,000 colonoscopies 800 surgeries (but, < pre-programme requirements by year 9)

Ethics: importance of an effective and comprehensive informed consent process, appropriately trained personnel, and robust quality assurance procedures in relation to the handling and communication of risks

associated with screening in asymptomatic individuals

The challenge
Conventional HTA performed; highly cost-effective Business model developed by NCSS Further issues of implementation and affordability

needed to be explored to overcome a potential obstacle


to adoption Could proposed new screening service be delivered within existing resources and services, without compromising their quality and safety?

Evaluation Findings
Use current infrastructure available in 8-12 existing specialist centres, using extended working day if necessary and increased colonoscopist numbers including Advanced Nurse Practitioners Significant opportunity for developing quality assured process in this smaller number of centres

Significant opportunity to use existing managerial/administrative capacity of the National Cancer Screening Service to reduce overall costs (e.g. in population register maintenance)
Leveraging existing infrastructure versus new build screening centres reduced overall costs significantly, with savings from this model estimated at: Capital expenditure: from 15m to 0 Implementation costs: from 7.2m to 2.2m Running costs: 3m-6m per annum saved

Colorectal cancer screening and

cervical cancer vaccine to start under Governments Cancer Control Programme


Minister for Health announces new details 15 January 2010

Types of HTA Conducted in Ireland


HTAs of national significance by HIQA

Rapid HTA
new pharmaceuticals on Community Drugs Schemes under agreement May support clinical guidelines in development

Mini-HTA: to inform local level decisionmaking

Scarcity means that choices must be made !

www.ncpe.ie

Expenditure on medicines in Ireland (Community Drugs Schemes 1991 - 2008) 2500 2000
Millions ()

1500 1000 500 0


91 992 993 994 995 996 997 998 999 000 001 002 003 004 005 006 007 008 9 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2

www.ncpe.ie

Targets to reduce expenditure across all aspects of the drugs supply chain
Pharmaceutical industry Post patent price reductions & reference pricing Community drugs schemes Wholesalers Reduced margins

Disinvestment

Pharmacists
Changing the reimbursement model

Prescribers
Generic prescribing Awareness of opportunity cost

Patients
Co-payments www.ncpe.ie

National Clinical Guidelines


National Clinical Effectiveness Committee

National guidelines
Standards set by HIQA Mandated by the Minister

Audit versus guidelines


Licensing versus standards Rapid HTA to support evidence base:
2nd HIV test in the third trimester
Antiretroviral therapy to prevent mother to child transmission

Types of HTA Conducted in Ireland


HTAs of national significance by HIQA

Rapid HTA
Mini-HTA: to inform local level decisionmaking
non-pharmaceuticals through PCCC, e.g., CF Physiotherapy Vest

technologies including drugs at local hospital level

HTA in 2011?
National HTA Policy Framework Focus on cost containment / disinvestment Clinical Effectiveness Guidelines

Role of HIQA
HTAs of national significance

Guideline development
Work with the health system to develop HTA capacity and methods Finalise prioritisation criteria and procedure Continue to collaborate with NCPE

Work with NCEC


Information resource and Horizon Scanning Strategy on stakeholder engagement in HTA Strategy on availability of cost data Irelands representative on international collaborations

International collaboration
EUnetHTA Joint Action 1
To facilitate efficient use of resources available for HTA, to create a sustainable system of HTA knowledge sharing, and to promote good practice in HTA methods and processes.
Stakeholder Forum

EUnetHTA Joint Action 2


2012 2014

European Directive on Cross-Border Healthcare (15.1) :


a voluntary network connecting national authorities or bodies responsible for health technology assessment designated by the Member States

Thank You

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