WorkshopThe science and methodologies

behind HTA, diversity and commonality across the EU

Achieving more patient centred HTA in different countries

Terminology

• Patients

• Citizens

• Public

• Service users– etc

Rationale for HTA

• There are increasing expectations of what healthcare is available/provided

• Increasing demands on available budgets

• Decisions on what should be made available should be rational based on all available evidence

Health Technology Assessment (HTA)

• HTA is a multidisciplinary process that summarises information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner

Different types of HTA

• Assessment of available evidence to clarify the way a technology should be used

• Assessment of available evidence to determine whether there is enough evidence to support the use of a technology

• Assessment of available evidence of effectiveness and cost effectiveness to determine whether a technology offers value for money

Evidence used in HTA

• Clinical trials– Efficacy– Quality of life

• Economic evaluations

• Modelling

Clinical trials

• Get involved in the design of clinical trials so they measure what is important to patients

• Ensure trial populations are broadly relevant

• Help put the results of trials into the context of a patient’s life

Health related quality of life

• Help develop and test QOL tools so they reflect what matters to patients

• Try to ensure that disease specific tools are developed and validated– Reflect changes in priorities for patients at

different stages of illness

• Think about carers quality of life

Economic evaluations

• Cost– Incremental cost effectiveness ratio (ICER)– Cost utility analysis

• Cost per quality adjusted life year (QALY)

– Disability adjusted life year (DALY)

How is patient evidence incorporated into HTA?

• Patient input to trials

• Patient input to assessment reports

• Patient evidence

• Reviewing recommendations

• Making recommendations available in plain language

Challenges of involving patients in research

• Challenges experienced by patients• Contribution hindered by difficulties with access

and communication• Relationship (doctor supremacy, fear of

preferential care)• Tokenism (political correctness)• Anxieties of new role – unclear about role and

ability to contribute, perceived value of contribution, not appearing foolish, lack of familiarity with technical terms

Hewlett et al, 2006

Patient evidence

• Quantitative– Questionnaires/surveys– Patient Organisation databases

• Qualitative– Individual interviews– Focus groups discussions and interviews– Futures workshops– Blogs, etc

Patient perspective

• Use research that is

• – well planned and structured

• – systematic

• – reported clearly showing sources, methods, potential biases, assumptions and findings

3 fundamental issues affecting theme

3 core recommendations