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Cross-national comparison of technology assessment processes

Published online by Cambridge University Press:  01 August 2004

Anna García-Altés
Affiliation:
Harvard School of Public Health Universitat Autònoma de Barcelona
Silvia Ondategui-Parra
Affiliation:
Harvard School of Public Health Brigham and Women's Hospital
Peter J. Neumann
Affiliation:
Harvard School of Public Health

Abstract

Objectives: To compare methods and results among four health technology assessment organizations in different countries.

Methods: All assessment reports published between 1999 and 2001 by VATAP (United States), NICE (United Kingdom), CCOHTA (Canada), and AETS (Spain), were reviewed. Detailed information about the organization, the technology assessed, the methods used, and the recommendations made were collected. A descriptive analysis of the variables, as well as comparisons of means and proportions, was performed.

Results: Sixty-one reports assessing seventy-six technologies were published: nine (11.8 percent) by VATAP, thirty-nine (51.3 percent) by NICE, twenty (26.3 percent) by CCOHTA, and eight (10.5 percent) by AETS. A total of 64.5 percent of the technologies assessed were related to a high prevalence disease in the corresponding country. Most of the assessments addressed treatments (73.7 percent) and were mostly drugs (56.6 percent) and devices (23.7 percent). Most organizations used reviews of effectiveness and economic evaluations (64.5 percent), systematic reviews (21.1 percent), and original economic evaluations (36.7 percent). In 38.1 percent, the technology was recommended; the rest of the cases had no formal recommendations.

Conclusions: Critical issues for future technology assessment efforts are making assessment processes more consistent, transparent, and evidence-based; formalizing the inclusion of economic and ethical considerations; and making more explicit the prioritization process for selecting technologies for assessment and reassessment.

Type
GENERAL ESSAYS
Copyright
© 2004 Cambridge University Press

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References

Agencia de evaluación de Tecnologías Sanitarias (AETS), Instituto de Salud Carlos III-Ministerio de Sanidad y Consumo. 2001. Tomografía por emisión de positrones (PET) con 18fdg en oncología clínica (revisión sistemática). Madrid: AETS-Instituto de Salud Carlos III
Agencia de evaluación de Tecnologías Sanitarias (AETS), Instituto de Salud Carlos III-Ministerio de Sanidad y Consumo. 2001. Efectividad de los apósitos especiales en el tratamiento de las úlceras. Madrid: AETS-Instituto de Salud Carlos III
Agencia de evaluación de Tecnologías Sanitarias (AETS), Instituto de Salud Carlos III-Ministerio de Sanidad y Consumo. 2001. Efectividad de las bombas de infusión de insulina. Madrid: AETS-Instituto de Salud Carlos III
Agencia de evaluación de Tecnologías Sanitarias (AETS), Instituto de Salud Carlos III-Ministerio de Sanidad y Consumo. 2001. Prótesis de hombro en indicaciones de procesos degenerativos o traumatológicos. Madrid: AETS-Instituto de Salud Carlos III
Agencia de evaluación de Tecnologías Sanitarias (AETS), Instituto de Salud Carlos III-Ministerio de Sanidad y Consumo. 2000. Braquiterapia para el tratamiento del cáncer ginecológico y de otras localizaciones. Madrid: AETS-Instituto de Salud Carlos III
Agencia de evaluación de Tecnologías Sanitarias (AETS), Instituto de Salud Carlos III-Ministerio de Sanidad y Consumo. 2000. Riesgos para la salud causados por implantes de silicona en general, con atención especial a los implantes mamarios. Madrid: AETS-Instituto de Salud Carlos III
Agencia de evaluación de Tecnologías Sanitarias (AETS), Instituto de Salud Carlos III-Ministerio de Sanidad y Consumo. 1999. Radioterapia Intraoperatoria. Madrid: AETS-Instituto de Salud Carlos III
Agencia de evaluación de Tecnologías Sanitarias (AETS), Instituto de Salud Carlos III-Ministerio de Sanidad y Consumo. 1999. Tomografía por Emisión de Positrones con Fluordeoxiglucosa FDG-PET en Neurología. Madrid: AETS-Instituto de Salud Carlos III
Agencia de evaluación de Tecnologías Sanitarias (AETS), Instituto de Salud Carlos III-Ministerio de Sanidad y Consumo. 1999. Catálogo 2000: Informes y Publicaciones de las Agencias Españolas de ETS. Madrid: AETS-Instituto de Salud Carlos III
Agencia de evaluación de Tecnologías Sanitarias (AETS), Instituto de Salud Carlos III-Ministerio de Sanidad y Consumo. 1999. Guía para la elaboración de Informes de Evaluación de Tecnologías Sanitarias. Madrid: AETS-Instituto de Salud Carlos III
Agencia de evaluación de Tecnologías Sanitarias (AETS), Instituto de Salud Carlos III-Ministerio de Sanidad y Consumo. 1999. Diagnóstico de lesiones mamarias detectadas en cribado poblacional de cáncer de mama mediante mamografía. Madrid: AETS-Instituto de Salud Carlos III
Alban A. The role of economic appraisal in Denmark. Soc Sci Med. 1994 38: 16471652.Google Scholar
Bagnall AM, Forbes C, Lewis R, Golder S, Kleijnen J. 2001. An update of a rapid and systematic review of the effectiveness and cost-effectiveness of the taxanes used in the treatment of advanced breast cancer. York: NHS Centre for Reviews and Dissemination, University of York
Banta HD, Perry S. A history of ISTAHC. A personal perspective on its first 10 years. Int J Technol Assess Health Care. 1997 13: 430453.Google Scholar
Bero LA, Grilli R, Grimshaw JM, et al. Closing the gap between research and practice: An overview of systematic reviews of interventions to promote the implementation of research findings. BMJ. 1998 327: 465468.Google Scholar
Brady B, McAuley L, Shukla VK. 2001. Economic evaluation of zanamivir for the treatment of influenza. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA) Technology report no 13.
Burls A, Clark W, Stewart T, et al. 2000. Zanamivir for the treatment of influenza in adults. Birmingham: Department of Public Health and Epidemiology, University of Birmingham
Busse R, Orvain J, Velasco M, et al. Best practice in undertaking and reporting health technology assessments: Working group 4 report. Int J Technol Assess Health Care. 1997 18: 361422.Google Scholar
Chilcott J, Wight J, Lloyd Jones M, Tappenden P. 2001. The clinical effectiveness and cost-effectiveness of pioglitazone for type 2 diabetes mellitus. Sheffield: University of Sheffield School of Health and Related Research, University of Sheffield
Clegg A, Bryant J, Nicholson T, et al. 2000. Clinical and cost-effectiveness of donepezil, rivastigmine and galantamine for Alzheimer's disease. Southampton: Rapid Reviews Team, Wessex Institute for Health Research and Development, University of Southampton
Cranovsky R, Matillon Y, Banta D. EUR-ASSESS project subgroup report on coverage. Int J Technol Assess Health Care. 1997 13: 287332.Google Scholar
Davies L, Coyle D, Drummond M, et al. The current status of economic appraisal of health technology in the European Community: Report of the network. Soc Sci Med. 1994 38: 16011607.Google Scholar
Dinnes J, Cave C, Huang S, Major K, Milne R. 2000. The effectiveness and cost-effectiveness of temozolomide for the treatment of recurrent malignant glioma. Southampton: Wessex Institute for Health Research and Development, University of Southampton
Einarson TR, Iskedjian M. 2001. Novel antipsychotics for patients with attention-deficit hyperactivity disorder: A systematic review. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA) Technology report no 17.
Eisenberg JM, Zarin D. Health technology assessment in the United States. Past, present, and future. Int J Technol Assess Health Care. 2002 18: 192198.Google Scholar
Forbes C, Shirran L, Bagnall AM, Duffy S, ter Riet G. 2001. A rapid and systematic review of the clinical effectiveness and cost effectiveness of topotecan for ovarian cancer. York: NHS Centre for Reviews and Dissemination, University of York
Garber S, Ridgely MS, Taylor RS, Meili R. 2000. Managed care and the evaluation and adoption of emerging medical technologies. Santa Monica: Rand
Granados A, Jonsson E, Banta HD, et al. EUR-ASSESS project subgroup on dissemination and evaluation of impact. Int J Technol Assess Health Care. 1997 13: 220286.Google Scholar
Granados A. [The evaluation of medical technologies]. Med Clin (Barc). 1995 104: 581585.Google Scholar
Hagenfeldt K, Asua J, Bellucci S, et al. Systems for routine information sharing in HTA: Working group 2 report. Int J Technol Assess Health Care. 2002 18: 273320.Google Scholar
Hailey DM, Crowe BL. The influence of health technology assessment on the diffusion of MRI in Australia. Int J Technol Assess Health Care. 1993 9: 522529.Google Scholar
Hailey DM. The influence of technology assessment by advisory bodies on health policy and practice. Health Policy. 1993 25: 243253.Google Scholar
Henshall C, Oortwijn W, Stevens A, Granados A, Banta D. Priority setting for health technology assessment. Theoretical considerations and practical approaches. Priority setting subgroup of the EUR-ASSESS Project. Int J Technol Assess Health Care. 1997 13: 144185.Google Scholar
Husereau DR, Brady B, McGeer A. 2001. Oseltamivir for the treatment of suspected influenza: A clinical and economic assessment. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA) Technology report no 21.
Institute of Medicine (IOM: Goodman C, ed.). 1988. Medical technology assessment directory. Washington: National Academy Press
Institute of Medicine (IOM: Mosteller F, ed.). 1985. Assessing medical technology. Washington: National Academy Press
Jacob R, McGregor M. Assessing the impact of health technology assessment. Int J Technol Assess Health Care. 1997 13: 6880.Google Scholar
Jobanputra P, Parry D, Fry-Smith A, Burls A. 2000. Effectiveness of autologous chondrocyte transplantation for hyaline cartilage defects in knees. Birmingham: West Midlands Development and Evaluation Service, The University of Birmingham
Lehoux P, Blume S. Technology assessment and the sociopolitics of health technologies. J Health Polit Policy Law. 2000 25: 10831120.Google Scholar
Lewis R, Whiting P, ter Riet G, O'Meara S, Glanville J. 2000. A rapid systematic review of the clinical effectiveness and cost-effectiveness of debriding agents in treating surgical wounds healing by secondary intention. York: NHS Centre for Reviews and Dissemination, University of York
Lister-Sharp D, McDonagh M, Saeed Khan K, Kleijnen J. 2000. A systematic review of the effectiveness and cost-effectiveness of the taxanes used in the treatment of advanced breast and ovarian cancer. York: NHS Centre for Reviews and Dissemination, University of York
Lord J, Paisley S, Taylor R. 2000. The clinical effectiveness and cost-effectiveness of rosiglitazone for type 2 diabetes mellitus. London: National Institute for Clinical Excellence
Lord J, Paisley S. 2000. The clinical effectiveness and cost-effectiveness of methylphenidate for hyperactivity in childhood. London: NICE Appraisals Group
McDonagh MS, Bachmann LM, Golder S, Kleijnen J, ver Riet G. 2000. A systematic review of the clinical effectiveness and cost effectiveness of glycoprotein IIb/IIIa antagonists in the medical management of unstable angina. York: NHS Centre for Reviews and Dissemination, The University of York
McGahan L, Noorani HZ. 2000. Surveillance mammography after treatment for primary breast cancer. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA)
McGahan L. 2001. Behavioural interventions for preschool children with autism. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA) Technology report no 18.
Meads C, Cummins C, Jolly K, Hyde C, Burls A. 1999. Coronary artery stents in the treatment of ischaemic heart disease. Birmingham: West Midlands Development and Evaluation Service, Department of Public Health & Epidemiology, University of Birmingham
Metge CJ, Vercaigne LM, Carrie A, Sarveiya V, Zhanel GG. 2001. The new fluoroquinolones in community-acquired pneumonia: Clinical and economic perspectives. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA) Technology report no 20.
NICE. 2000. The appropriate use of proton pump inhibitors in the treatment of dyspepsia. London: National Institute for Clinical Excellence
NICE. 2000. The clinical effectiveness and cost-effectiveness of celecoxib, rofecoxib, meloxicam and etodolac (cox-II inhibitors) for rheumatoid arthritis and osteoarthritis. London: NICE Appraisal Team
Noorani H, McGahan L. 1999. Criteria for selection of adult recipients for heart, cadaveric kidney, and liver transplantation. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA)
Noorani H, Picot J. 2001. Assessment of videoconferencing in telehealth in Canada. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA) Technology report no 14.
Noorani HZ, Connolly SJ, Talajic M, et al. 2000. Implantable cardioverter defibrillator (ICD) therapy for sudden cardiac death. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA)
Noorani HZ, McGahan L. 1999. Predictive genetic testing for breast and prostate cancer. Ottawa, Canadian Coordinating Office for Health Technology Assessment (CCOHTA)
O'Meara S, Riemsma R, Shirran L, Mather L, ter Riet G. 2000. A systematic review of the clinical effectiveness and cost-effectiveness of sibutramine in the management of obesity. York: NHS Centre for Reviews and Dissemination, University of York
O'Meara S, Riemsma R, Shirran L, Mather L, ter Riet S. 2001. A systematic review of the clinical effectiveness and cost-effectiveness of orlistat in the management of obesity. York: NHS Centre for Reviews and Dissemination, University of York
Oortwijn WJ, Banta D, Vondeling H, Bouter L. Identification and priority setting for health technology assessment in The Netherlands: Actors and activities. Health Policy. 1999 47: 241253.Google Scholar
Oortwijn WJ, Vondeling H, Bouter L. The use of societal criteria in priority setting for health technology assessment. Int J Technol Assess Health Care. 1998 14: 226236.Google Scholar
Parkes J, Milne R, Bryant J. 2000. Implantable cardioverter defibrillator for cardiac arrhythmias. Southampton: The Rapid Reviews Team, National Coordinating Centre for Health Technology Assessment, University of Southampton
Paszat L, Grunfeld E, van Walraven C, et al. 2001. A population-based cohort study of surveillance mammography after treatment of primary breast cancer. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA) Technology report no 15.
Payne N, Beard S, Brocklebank D, et al. 2000. Clinical and cost effectiveness of inhaler devices for children with chronic asthma. Sheffield: Trent Institute for Health Services Research, School of Health & Related Research (ScHARR), The University of Sheffield
Payne N, Chilcott J, McGoogan E. 2000. Liquid-based cytology in cervical screening. Sheffield: The University of Sheffield
Perry S, Eliastam M. The National Center for Health Care Technology. JAMA. 1981 245: 25102511.Google Scholar
Perry S, Gardner E, Thamer M. Status of health technology assessment worldwide. Int J Technol Assess Health Care. 1997 13: 8198.Google Scholar
Perry S, Hanft R, Chrzanowski R. Report from the Australian Institute of Health and Welfare, Canberra, Health Technology division. Perceptions of Australian Health Technology Assessments: Report of a survey. Int J Technol Assess Health Care. 1993 9: 588590.Google Scholar
Perry S, Thamer M. Medical innovation and the critical role of health technology assessment. JAMA. 1999 282: 186918672.Google Scholar
Rettig RA. 1997. Health care in transition: Technology assessment in the private sector. Santa Monica: Rand
Schachter HM, Kovesi T, Ducharme F, et al. 2001. The challenges of early assessment: Leukotriene receptor antagonists. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA) Technology report no 19.
Scott DA, Clegg A, Sidhu M, Hewitson P, Waugh N. 2001. Clinical and cost-effectiveness of paclitaxel, docetaxel, gemcitabine and vinorelbine in lung cancer. Southampton: Rapid Reviews Team, Wessex Institute for Health Research and Development, University of Southampton
Shani S, Siebzehner MI, Luxenburg O, Shemer J. Setting priorities for the adoption of health technologies on a national level—the Israeli experience. Health Policy. 2000 54: 169185.Google Scholar
Shepherd J, Waugh N, Hewitson P. 2000. Combination therapy (interferon alfa and ribavirin) in the treatment of chronic hepatitis C. Southampton: Rapid Reviews Team, Wessex Institute for Health Research and Development, University of Southampton
Shukla VK, McAuley L. 2001. Novel antipsychotics in patients with bipolar disorder: A systematic review. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA) Technology report no 16.
Shukla VK, Otten N, Coyle D. 2000. Drug treatments for Alzheimer's disease. III. A review of pharmacoeconomic evaluations. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA) Technology report no 11.
Shukla VK, Otten N, Dubé C, Moher D. 2000. Use of cisapride in patients with non-ulcer dyspepsia: A meta-analysis of randomized trials. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA)
Shukla VK, Otten N. 1999. Insulin lispro: A critical evaluation. Otawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA)
Song F, O'Meara S, Wilson P, Kleijnen J, Golder S. 1999. The effectiveness and cost-effectiveness of the prophylactic removal of wisdom teeth. York: NHS Centre for Reviews and Dissemination, University of York
Stewart A, Sandercock J, Bryan S, et al. 2000. The clinical effectiveness and cost-effectiveness of riluzole for motor neurone disease. Birmingham: West Midlands Development and Evaluation Service, The University of Birmingham
Tappenden P, Chilcott J, O'Hagan T, et al. 2001. Cost effectiveness of beta interferons and glatiramer acetate in the management of multiple sclerosis. Sheffield: Centre for Bayesian Statistics in Health Economics, School of Health and Related Research (ScHARR), University of Sheffield
Taylor R. Pharmaceutical regulation: The early experience of the NHS National Institute for Clinical Excellence (NICE) appraisal process—where are we heading? Value Health. 2001 4: 811.Google Scholar
Taylor R. 2000. The effectiveness and cost-effectiveness of different prostheses for primary total hip replacement. London: NICE Appraisal Group
Taylor RS, Paisley S. 2000. The clinical and cost effectiveness of advances in hearing aid technology. London: National Institute for Clinical Excellence
Tunis SR, Kang JL. Improvements in Medicare coverage of new technology. Health Affairs. 2001 20: 8385.Google Scholar
VA Technology Assessment Program (VATAP). 2000. Computerized lower limb prostheses (Short Report). Boston: VA Technology Assessment Program
VA Technology Assessment Program (VATAP). 2000. Impacts of case management programs (Short Report). Boston: VA Technology Assessment Program
VA Technology Assessment Program (VATAP). 2000. Optical lens fabrication system (Short Report). Boston: VA Technology Assessment Program
VA Technology Assessment Program (VATAP). 1999. Positron emission tomography (Update). Boston: VA Technology Assessment Program
VA Technology Assessment Program (VATAP). 2000. Tablet Splitting (Short Report). Boston: VA Technology Assessment Program
VA Technology Assessment Program (VATAP). 2000. Treatment options for male erectile dysfunction: A systematic review of published studies of effectiveness. Boston: VA Technology Assessment Program
Vale L, McCormack K, Scott N, Grant A. 2000. Systematic review of the effectiveness and cost-effectiveness of laparoscopic versus open repair of inguinal hernia. Aberdeen: Health Services Research Unit and Health Economics Research Unit, University of Aberdeen
Vardulaki KA, Bennett-Lloyd BD, Parfitt J, et al. 2000. A systematic review of the effectiveness and cost-effectiveness of laparoscopic surgery for colorectal cancer. London: National Institute for Clinical Excellence
Wake B, Bryan S, Barton P, et al. 2001. Fluradarabine as second line therapy for b-cell chronic lymphocytic leukaemia. Birmingham: Department of Public Health and Epidemiology, and The Health Economics Facility, University of Birmingham
Ward S, Bansback N, Morris E, Calvert N. 2000. A review of the clinical and cost-effectiveness of gemcitabine for the treatment of pancreatic cancer. Sheffield: The School of Health and Related Research (ScHARR), University of Sheffield
Wolfson C, Moride Y, Perrault A, et al. 2000. Drug treatments for Alzheimer's disease. I. A comparative analysis of clinical trials. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA)
Wolfson C, Moride Y, Perrault A, et al. 2000. Drug treatments for Alzheimer's disease. 2. A review of outcome measures in clinical trials. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA)
World Health Organization. 1997–1999 World Health Statistics Annual, 25 February 2003. Available at: http://www3.who.int/whosis/mort/text/description.cfm?path=statistics,whsa,mort_info&language=english