European network for Health Technology Assessment | JA2 2012-2015 | www.eunethta.eu
Introduction tothe HTA Core Model® and coreHTA information
EUnetHTA Training Course for Stakeholders
Rome, 29 Oct 2014
Kristian Lampe, THL/FINOHTA
European network for Health Technology Assessment | JA2 2012-2015 | www.eunethta.euEuropean network for Health Technology Assessment | JA2 2012-2015 | www.eunethta.eu
Background and purpose
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• To capture the shareable ”core” of HTA
• To enable production of structured HTAinformation and sharing the acquired knowledge
• To support joint HTA production
• To support local HTA production
Key aims of the HTA Core Model
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How do we perceive HTA,i.e. how to split the onion?
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What is the Core?- Two options for splitting the onion
Technology assessment in health care is amultidisciplinary field of policy analysis. It studies the
medical, social, ethical, and economic implications ofdevelopment, diffusion, and use of health technology.
(INAHTA 2005)
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What is TA / HTA? – back to basics
“The Congress hereby finds and declares that:
(a) As technology continues to change and expand rapidly, itsapplications are1. large and growing in scale; and2. increasingly extensive, pervasive, and critical in their impact,beneficial and adverse, on the natural and social environment.(b) Therefore, it is essential that, to the fullest extent possible, theconsequences of technological applications be anticipated,understood, and considered in determination of public policy onexisting and emerging national problems.”
Office of Technology Assessment Act, 1972http://www.princeton.edu/~ota/ns20/act_f.html
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E Draborg et al. Internationalcomparison of the definition and thepractical application of healthtechnology assessment. Int JTechnol Assess Health Care. 2005Winter;21(1):89-95.
433 HTA reports published 1989-2002 by 11 agencies in 9 countries
Great variation inHTA practice
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The Model
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Health problem and current use oftechnology
Technical characteristics
Ethical analysis
Organisational aspects
Legal aspects
Clinical effectiveness
Costs and economic evaluation
Safety
Domains of HTA
• Identified in previous EU projects,particularlyEUR-ASSESS and ECHTA/ECAHI
• Promote the multidisciplinary natureof HTA
Social aspects
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Clinical effectiveness
Topics
Health problem and current use oftechnology
Technical characteristics
Ethical analysis
Organisational aspects
Social aspects
Legal aspects
Costs and economic evaluation
Safety
Topic 1: Mortality
Topic 2: Morbidity
Topic 3 etc…
Clinical effectiveness
Issue 1: What is the effect of theintervention on overallmortality?
Issue 2: What is the effect of theintervention on mortality causedby the target disease?
Issue 3: etc…
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Three components of the HTA Core Model
HTA QUESTIONS(ONTOLOGY)
Questions that an HTAshould answer
METHODOLOGICALGUIDANCE
How to answerthe questions
REPORTINGSTRUCTURE
How to presentthe answers
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˗ A formal representation of the information contents of an HTA (e.g.”the effect of technology on reduction of symptoms”) andrelationships between various parts of the content
˗ Assessment elements as building blocks (each provides information on certain aspect of technology)
˗ Assessment elements are defined by
˗ 9 domains (wider angle of viewing, e.g. clinical effectiveness),
˗ topics within domains (more specific areas of investigation, and
˗ issues within topics (practical questions)
HTA Questions / Ontology
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˗ Assists in finding answers to questions defined by the ontology
˗ Different levels: domains, assessment elements, whole model / wholeHTA
˗ Domain-level guidance mostly as reviews of state-of-the-art methodology and links to detailed guidance
˗ Different strengths of guidance: tips, recommendations, standards
Methodological guidance
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˗ Standardized format for output of HTA information production
˗ In the form of collections containing
˗ General texts, e.g. introduction, summary
˗ Domain-level content, e.g methodology, discussion
˗ Result cards, each containing an answer to question (or answers to questions) defined by one assessment element (=combination domain-topic-issue)
˗ Appendices
˗ Core HTA information = any HTA information produced using the HTA Core Modeland published within the HTA Core Model Online
˗ Different types of collections (EUnetHTA/Other)
˗ EUnetHTA Core HTA = Extensive assessment, all domains included
˗ EUnetHTA Rapid HTA = Fast assessment, a selection of domains included
˗ Other = Based on users needs, e.g. single AE, single domain
˗ EUnetHTA collections do not contain recommendations
Reporting structure
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Core HTA information
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Production process in brief
1. Select the assessment elements to be included in the collection.
2. Translate the included issues each into one or more practical researchquestion(s).
3. Answer the questions using guidance within the Model.
4. Organise and present the answers according to the common reportingstructure.
5. RESULT: a structured collection of HTA information in whichinformation on a particular issue can be found at a standard location(whether in paper or electronic form).
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Core HTAs
• One type of core hta information collection
• Five pilot core HTAs produced until now within EunetHTA, sixthwill be ready soon. One further pilot commenced within WP4 ofEUnetHTA JA2.
• Intentionally built to “not look like a European HTA report”
• Serve primarily as a scientific basis for local (national, regional)reports
• Do not contain recommendations regarding the use (or non-use)of technologies
• Enable distributed production of HTA (e.g. different domains byseparate research groups)
• Easy sharing of produced information
• Easier than before to update only a selection of information
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INF
OR
MA
TIO
N
CollectionsServe also as project platforms
TO
OL
SCore HTA Structure 2012
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Official EUnetHTA
Other
Pool of structured HTAInformationResult cards (RC) based onassessment elements
Local products
HTA Core ModelOnline Tool & Service
Local Tools
RC RC RC RC RC
RC RC RC RC RC
RC RC RC RC RC
RC RC RC RC RC
RC RC RC RC RC
Core HTA
Rapid HTA
Core HTA
Rapid HTA
Full domain
Free set (≥ 1)
My collection
Full domain
Free set (≥ 1)
My collection
Primarily EUnetHTAjurisdiction
Primarily localjurisdiction
AUTOMATIC
L HTA
L RHTA
L HTA
L HTA
VOLUNTARY
LRHTA
Primarily EUnetHTAjurisdiction
Primarily localjurisdiction
L HTA
L RHTA
TAILORED
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• Currently published through the EUnetHTA main site at www.eunethta.eu
• Select ”Output” and filter by activity JA2-WP5 for most recent rapid HTAs
• Work in progress to include rapid HTAs in the HTA Core Model Online
Rapid assessments
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Thank you
This presentation arises from the EUnetHTA
Joint Action 2 which has received fundingfrom the European Union, in the framework ofthe Health Programme