The development of a HTA guideline for hospitals in cross-border regions – results from Work Package 5 of Euregio II

Saskia Knies PhDDepartment of International Health & Department of Health Services ResearchMaastricht University

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Border regions and cross-border care• Cross-border regions: two or more bordering countries or regions (where healthcare is arranged at regional level)

• Patients seeking healthcare abroad– E.g. waiting lists, perceived quality of care, costs of care, treatment available, strategic purchasing by healthcare insurers/providers

• Hospital across border sometimes closer by than in home country

• Strong cooperation in some euregios (regions with bordering European countries)

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HTA in hospitals or local level

• Growing use of HTA on national level • Several guidelines for HTA at hospitals, e.g. Canada, Denmark and Sweden

• No HTA guideline for multiple countries or border regions

• Why needed: support decision making process while taking border region into account

• Main advantage: takes less time to complete than national HTA study

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Requirements for HTA guideline for cross-border regions

• For hospitals and other local healthcare institutions

• Inclusion of all elements of a HTA

• Target audience: healthcare professionals• Simple to use with clear questions • Should not take too much time to complete • Taking cross-border situation into account

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Development of the guideline

Several steps:1. Literature review2. Interviewing local decision makers in

cross-border settings3. Expert workshop in May 20104. Adjustments to mini-HTA guideline of

DACEHTAa. Divided into three sections b. Questions deleted or rephrasedc. More sub-headings d. Added questions

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Description of guideline

Aim: to support healthcare professionals who are working in healthcare institutions in cross-border settings

Three sections:1. General questions for all institutions2. For healthcare institutions without any

interaction with another healthcare institution across the border

3. For healthcare institutions situated on two sides of a border that are willing to cooperate

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Testing guideline using case studies

• Two different case studies both in hospital setting

• Analysing applicability in real framework • Identifying missing topics in guideline

• Case studies at university hospitals of Maastricht (MUMC+) and Aachen (UKA)

• Hospitals work closely together:– Mostly top-clinical fields– Share various activities and personnel

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Selection of case studies

• Consent for carrying out case studies from board of directors of both hospitals

• Meeting with policy advisors on cross-border cooperation of both hospitals

• Several cross-border projects going on

• Different types of decision problems selected – Case study 1: mutual investments in departments

– Case study 2: reimbursement and legal issues

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Case study 1: Nuclear Medicine

• Shared head of department for both hospitals• Number of investments in equipment and facilities requested to support further cooperation

• Investments will increase clinical and research options for departments

• Substantial investments needed• Considerations not only related to costs• Outcome: shared investments of two hospitals will benefit both hospitals

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Case study 2: Neurosurgery

• Deep Brain Stimulation (DBS) • Experienced neurosurgeons at MUMC+, but no neurosurgeon available at UKA

• Two questions: – Possibility of operating Dutch patient in Germany, because treatment is not reimbursement in Netherlands

– Operating Dutch and German patients in either MUMC+ or UKA depending on complexity of surgery

• Number of legal and reimbursement issues

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Experiences with guideline

• General questions (section 1)– Questions good to answer– Description of current situation and nature of request

• Cooperating hospitals (section 3) – Questions more complicated– Financial modelling for case study 1 needed additional questions as not extensively included in guideline

• Sometimes limited information available • When is a question relevant or sufficiently answered

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Adjustments to guideline

• Questions deleted– Questions combined into one question due to large overlap

• Rephrasing questions– Questions not clear and therefore difficult to interpret

• Topics or questions added – Questions from legal domain EUnetHTA Core model

– Economics questions

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Conclusion

• Increasing cross-border cooperation in healthcare

• Increased use of HTA to support decision making at local level

• First HTA guideline focusing on cross-border regions

• Taking differences into account between countries– Reimbursement– Legal issues– Expectations and preferences of patients

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EUREGIO II partners• Maastricht University, Dep. of International Health (The Netherlands) (project

leader)

• Gesundheitsamt Kreis Heinsberg (Heinsberg, Germany)

• Euregio Rhein-Waal (ERW) (Kleve, Germany)

• Gesundheitsmanagement Burger-Wieland (Vienna, Austria)

• European Hospital and Healthcare Federation (HOPE) (Brussels, Belgium)

• Association of European Border Regions (AEBR) (Gronau, Germany)

• Landesinstitut für Gesundheit und Arbeit NRW (Düsseldorf/Bielefeld/Münster, Germany)

• Deutsches Institut für Medizin Dokumentation und Information (DIMDI) (Köln, Germany)

• ECORYS Research Rotterdam (Rotterdam, The Netherlands)

• WHO Regional Office for Europe (Copenhagen, Denmark)

• Regione del Veneto, International Health Social Affaire Office Venice (Venice, Italy)

• Cooperation and Working Together (CAWT) (Londonderry, Ireland)

• Medical University Sofia, Faculty of Public Health (Sofia, Bulgaria)

• Center for Health Policies and Services (Bucharest, Romania)

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On behalf of all authors and everyone involved:

Saskia Knies1, 2, Gloria Lombardi3, Matt Commers1, Hans-Peter Dauben4, Silvia Evers2, Kai Michelsen1, Wija Oortwijn5, Chibuzo Opara1, Helmut Brand1  Affiliations1.Department of International Health, Maastricht University, Maastricht, the Netherlands2.Department of Health Services Research, Maastricht University, Maastricht, the Netherlands3.HOPE – European Hospital and Healthcare Federation, Brussels, Belgium4.DIMDI - Deutsches Institut für Medizinische Dokumentation und Information, Cologne, Germany5.ECORYS Nederland B.V., Rotterdam, the Netherlands

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Thank you for your attention

This presentation arises from the project

“Solutions for improving health care cooperation in border regions” (EUREGIO

II)which has received funding from the

European Union, in the framework of the Public Health Programme (Grant

Agreement No. 2007118).