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Sudigdo SastroasmoroHTA Committee, MOH RI

HTA in Indonesia:

Current progress

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Selected referencesBanta HD. A global perpective on health technology

assessment. Available from .!anitadayalitip.org"erreira #. Health technology assessment. $rinciples andpractical issues. Available from .medicaladvisors.co.%a&'las%iou $( #ar CD. )vidence*based practice or!boo!.Blac!ell $ubl. #assachusetts( +,,-.'oodman CS. HTA ,: Introduction to health technology

assessment. Bethesda( #D. /ational 0ibrary of #edicine12S34 +,5.Health )6uality )urope. 2nderstanding health technologyassessment 1HTA3. 7uly +,,8.Health technology assessment of medical devices. 9H

#edical device technical series. +,. 7CAH. Health care at the crossroads. Strategy forimproving the medical liability system and preventingpatient in;ury.available from.aacn.nche.edu&media&dpf&7CAH*,+.pdf  

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Problem in health care

=esearch: hat e can do

HTA: hich ones e can do

Clinical guidelines: hat e should do

$ractice: doing hat e should do

Clinical audits: did e do hat e

should do?

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Clinical 'overnance

@A frameor! through hich

/HS organi%ations areaccountable for continuouslyimproving the 6uality of their

services and safeguarding highstandards of care( by creating

an environment in hich

e>cellence in clinical care ill

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ClinicalGovernance

Clinicalaudits

Education Training

Ris! 

management

Account"abilit#

Research develo$ment

ClinicalE%ective"

ness

atient safety

Clinical audits

E&M' HTA Clinical guideline•

Clin pathays• Algorithms• $rotocols• $rocedures• Standing orders

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Search the

evidence

Criticallyappraise

the evidence

Formulate

in answerablequestion

Problem

in Practice

Recom-mendation(s)  The)B#Cycle

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9hat is .

 Technology

Health technology

Health technologyassessment

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 Technology

Health

technology

Health TechnologyAssessment

The application of scienticknowledge for practical purposes

 Any intervention that may be usedto promote health, to prevent,

diagnose, or treat disease or forrehabilitation or long-term care

Drugs, biologics, devices, medicalsurgical procedures, support

systems,organizational/managerial systems A systemic evaluation of

 properties, eects and impacts ofdifusion and use of !T" #t is amultidisciplinary process to

evaluate safety, e$cacy,eectiveness, social, economic,

organizational and ethical issues

Purpose

Scope

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$urposes of health

technology$romotion

$reventionDiagnosis

 Treatment

=ehabilitation0ong*term care

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$hysical nature

Drugs% beta*bloc!ers( antileu!emia

&iologics% vaccines( blood products( stem

cellsDevices% cardiac pacema!ers( CT scanners(#=I

'edical and surgical procedures: e.g.(psychotherapy( nutrition counseling(coronary angiography

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Attributes & aspects to beassessed

Safety

)Ecacy

)Fectiveness)conomic

Socio*cultural

)thical0egal*Institutional

=eligious

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9hat areas can HTAaddress?

  High volume * aFects many

  High ris! * medical( social(ethics

  High cost * unnecessary health

cost

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Types of economic analysis*ost-of-illness analysis +*#A% a determination

of the economic impact of an illness( e.g.(thalassemia( D#.*ost-minimization analysis +*'A% adetermination of the least costly among

alternative interventions that are assumed toproduce e6uivalent outcomes.*ost-eectiveness analysis +*A% acomparison of costs in monetary units ithoutcomes in 6uantitative non*monetaryunits( e.g.( reduced mortality or morbidity.*ost-benet analysis +*&A% compares costsand benets, both of which are .uantied incommon monetary units"

*ost-utility analysis +*A% a form of C)A

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#ethods in HTA

$rimary data Technical studies 1functionality(

validation3

)>pert 1and user3 opinion)pidemiological and observational studiesClinical trials=eal data on cost for economic analysisConsensus development

Secondary data: Integrative &literature synthesis 1meta*analysis3

Combined

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$revious HTA Indonesia:"lo 1+,,*+,,83

 Thorough assessment of literatures1#eta*analysis( =CTs( obs studies( caseseries( etc.3

Initial draft by HTA StaF $anel of e>perts: 2niversities($rofessional rgani%ations( therInstitutions & Individuals

Inputs and revisions via e*mail

full*team discussions( revisions

"inal draft and recommendations

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HTA Indonesia( +,,*+,,J

/o clear organi%ation

/o clear staF 

/o e>perience

/o guidelines

Budget allocation 1?3

 et K 5, HTA topics erecompleted

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)>amples

Lit < prophyla>is

Blood transfusion

$reoperativepreparation

Immunomodulator

sInuen%a vaccine

 Tonsillo*

adenoidectomy

Ciproo>acin

)S90

Hormone replacementtherapy

#anagement of

sinusitisC$D

0iposuction

Hearing screening

HTA I/D/)SIA +,,*+,,J

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Hospital*based HTA

HTA M International & /ational level

0ocal & Hospital*based:=ecommended

SpeciNc hospitals High technology SpeciNc mode of care

ther hospitals SpeciNc conditions #ay diFer from national HTA

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 Types of Hospital*based HTA

Ambassador #odel rgani%ation * Individual "ocus of action * Clinical practice

#ini*HTA #odel

rgani%ation * Individual "ocus of action * #anagerial decision

ma!ing

Internal Committee #odel rgani%ation * 'roup( Team( 2nit "ocus of action * Clinical practice

HTA 2nit #odel

rgani%ation * 2nit "ocus of action * #ana erial decision

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Managerialdecision

ma!ing

   O  r  g  a  n   i  (

  a   t   i  o  n  a   l

  c  o  m  $   l  e  )   i   t  #

*o+Individual-

HighTeam,

.nit-

Ambassador

Model

Mini HTAModel

InternalCommittee

Model

HTA.nit

Model

Clinical$ractice

  #odels in local & hospital*based

HTA

/ocus o0 action

C# Hospital Hospital based

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C# Hospital: Hospital*basedHTA

#odern dressing and s!in grafting in the

management of diabetic footChallenges to establish a HTA unit inCipto Hospital

ral presentation in HTA M Intl Congress( 9ashington(+,5

Cochlear implant in children

#egaprosthesis implant'amma !nife stereotactic radiosurgery0ong*acting antipsychotic in;ections

ral prest. HTA M Int Congress( slo( 7une( +,O

)chocardiography and the length of stay of congestiveheart failure 1Taian( +,53

+

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/ational HTA Committee

#H Decree( + April +,5)Fective August +,5

rgani%ational structure Chairman Secretary #embers

Secretariat

2nder the Secretary 'eneral & Centerfor Health "inancing and Security

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 7ob description

Developing concept and activities

Developing HTA 'uidelines

Accepting proposals fromsta!eholders

$riority setting the proposals

Developing ad hoc 0anel to e>ecuteHTA process

$roviding recommendations to the#H

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bstacles and ay*out

Currently e have no full*time staF All are part*timers ta!en from severaldirectorates in the #H( including

from /H=C 1e call them $ICs Mpersons*in*charge3

9or!shops on )B#( HTA( medical

riting- of the $ICs attended + ee! on*the*

 ;ob training in HITA$( Bang!o!

1"ebruary +,O3

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Ad hoc $anel

Ad hoc $anel is supposed to beestablished for each topic

Consists of: #ember1s3 of HTA Committee )>perts of $rofessional organi%ations Academia ther relevant personnel

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HTA Indonesia: "lo

 Topic selection 1HTAC3$re*proposal $IC3Ad*hoc $anel HTAC #ember1s3

Academia $rofessionals thers

$roposal 1$IC P $anel3"irst draft $IC3Discuss and revisions by email 1$anel3#onthly plenary meetings 1$anel3

"inali%e in *5 meetings 1$anel3

Person-in-Charge: Member of 

Secretariat who has attended

EBM, HTA, Medical Writing worsho!s

HTA Committee

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To!ic "HTAC#

Edit HTAC

Member"s# of HTAC Academia

Professionals

$thers

Panel

P%C"s#&irst draft

Emails, monthl'

meetingsPanel

&inal draft

Pre-!ro!osal

"P%C#Pro!osal

"Panel#

(o e)ternal

re*iewers

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$re*proposal1P&* + pages3

 Title

Submitted by ..

b;ectiveSynopsisly evidence

=eferences

Appendices Suggestion of Ad hoc

panel

ther relevant issues

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$oposal

Development of preproposal by $ICand Ad Hoc $anel

Include methods of Nnding primarydata especially for the purpose ofeconomic analyses

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"ormat of early draft

 Title

$roposed by ..Chapter * Introduction 9hy HTA is needed =esearch 6uestion1s3

b;ectives: general( speiNc#ethods: Search strategy Critical appraisals 0evels of evidence 'rades of

recommendations $rimary data collection

=esults and discussion

=eferences

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"inal =eport Title0ists of Tables( glossary( abbreviations(

foreords( etc)>ecutive summaryIntroduction:   7ustiNcation for HTA =esearch 6uestions $urpose: general( speciNc

#ethods:  Search strategy Statement on critical appraisals 0evels of evidence 'rades of recommendations $rimary data collection

=esults and discussionConclusions and recommendations=eferencesAppendices. Incl. Statement of conict of

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SS/E!/"#$-%&"P-'

Hierarchy of evidence

#eta*analysis of =CT

0arge =CT

Small =CT

/on*=andomi%ed trials

bservational studies

Case series & reports

Anecdotes( e>pert(

consensus

0evel

0evel +

0evel

0evel 5

A

B

C

=ec

1eight o0 Scienti2cScrutin#

"or complete description see .cebm.net

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0aporan a!hir

Sedapat mung!in berupa scienticdocument 

$enulisan sesuai !aidah ilmiah:ring!as( ;elas( leng!ap 1BCC * brief,clear, complete3

Hindar!an plagiarisme

$usta!a muta!hir

$erhati!an e;aan( frasa( !alimat(paragraf 

$enulisan sitasi dan daftar usta!a

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Berapa lama per topi!?

Denmar! Topi! besar : +,, halaman( (O M +(O

tahun Sedang: ,, halaman( * (O tahun

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Biayanya?

Dr. Charles Sha M /IC): ;uta 2SD &topi!

Dr. ot 1HITA$ M Thailand3: ;uta2SD & tahun( untu! 5, topi!( l!. ,, ;uta & topi!

=SC# 1Hospital*based HTA3: 5,, ;uta & 5 topi!

2nit HTA 1+,,*+,,83 * Q, ;uta &

topi!

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Info tambahan

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Initial HTA topics

9e are no conducting HTA on +topics:

SildenaNl for the treatment of

pulmonary hypertension 1$H3 $roposed by patient association

)conomic analysis of continuousambulatory peritoneal dialysis 1CA$D3vs. hemodialysis $roposed by professional organi%ation #ore than 8, of patients ith )S=D are

managed by hemodialysis

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$roblems encountered

"or )S=D treatment: collection ofprimary data needed for economicanalysis

)S=D treatment can only done in largerhospitals /ot available in many provinces &

districts( esp. in remote area Calculation of indirect costs etc. may be

confusing

"or sildenaNl:

 The drug is oF*label for the treatment of

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$ICs meeting to discuss the progress1ee!ly3

$lenary meeting ith $anel 1monthly3

 The + topics are e>pected to be Nnali%edin 7uly

August M December +,O M 5 topics

+,R M , topics

Capacity building: attendinginternational or!shops( conferences

rgani%ational aspects: recruitment for

full*staF and appropriate funding plans

=ecent activities and plans

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"inal =eport

So much as possible as a scienticdocument 

$rinciples of scientiNc riting: BCC M1brief, clear, complete3

Avoid plagiarism

=ecent references

9ords( spelling( phrases( sentences(paragraphs

Citation and references

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International collaboration andsupports

PATH 1$rogram for Appropriate Technologyin Health3 * Seattle

3ICE 1/ational Institute for Health andCare )>cellence3 International * 0ondon

HITAP 1Health Intervention and Technology Assessment $rogram3 *Bang!o!

1HOAIPHSS 1Australia*Indonesia $artnershipfor Health System Strengthening3

HTAi 1Health Technology Assessment

International3

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"orms of supports

Discussions

Consultations

9or!shops

n*the*;ob training for $ICs inBang!o! 1$ATH and HITA$3

Invitations to ;oin internationalconferences

Study tour to /IC)

StaEng and administrative issues

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e are not the Nrst

But ill be one of the best