HTAi 2021 Reports of Panels
Two comprehensive reports from panel sessions at the HTAi 2021 Annual Meeting address very different aspects of health system sustainability, discussing how HTA can be a catalyst for the appropriate use of technologies to drive efficiencies and make room for effective innovations.
Digital Health Technologies – Evidence Needed, Methods & Assessment for Policy Decisions
Digital health interventions need to be evaluated to determine if they can deliver on their promises of system efficiencies and improved outcomes, but health technology assessment (HTA) is currently underused for these technologies. This panel discussed whether current HTA methods are fit-for-purpose with these technologies.
Primary HTA research to evaluate digital health technologies using participatory approaches that involve staff and users to understand the clinical problem, in the evaluation and in implementation has proven to be valuable in Danish hospitals. Experience has shown that research designs need to be fit-for-purpose given the expected impact of the technology, and RCTs of clinical outcomes may not always be necessary. Instead, more emphasis needs to be placed on patients’ perspectives, such as empowerment to self-manage their condition, improved activities of daily living or reduced clinic travel times.
Traditional HTA methods for a critical assessment of bias, generalizability and uncertainties associated with digital health technologies are appropriate, but new skills and methods are needed to understand issues such as those relating to the use of technologies with adaptive algorithms within the health care systems. Furthermore, structure and processes, not just outcomes need to be considered. Collaboration needs to be enhanced to develop methodologies that take account of the diversity of technology readiness and infrastructure limitations in different health systems, particularly those in low-and-middle-income countries.
HTA needs to be developed further to deliver efficient primary research methods and secondary assessment approaches to evaluate digital health technologies in a manner that is fit-for-purpose for the technology, the health system and focuses on patient benefit.
Making Room for Disruptive Innovation – Priorities, Agility and Efficiency
The Covid-19 pandemic has created a synchronized sense of necessity to rapidly deploy innovations, requiring completely new and agile approaches to determine priorities for health care provision and organization, in a responsive, evidence-based and efficient manner. This panel considered how HTA could help health systems make room for disruptive innovations.
To free up resources for high-value innovations and create the most efficient and effective healthcare system, all stakeholders need to commit to using evidence and organizational change to optimize the use of existing technologies. In Australia, the review of the Medical Benefits Schedule has relied on HTA principles and processes to understand the uncertainties associated with high and low-value care. This has enabled the development of clear guidance for optimal delivery of care in terms of referral procedures, practitioner delivery and treatment settings, assisted by fiscal incentives.
Patients find health systems complex and disjointed and this inhibits optimization of their own care. Person-centred, value-based health care can be developed to improve population outcomes and equity to access of care, but this requires structured and systematic involvement of all stakeholders, including patients and HTA organizations.
At the conclusion of the meeting, the audience believed that to make room for disruptive innovation, stakeholders need to be involved in the life cycle of the technology development and evaluation, and holistic frameworks need to be used to determine the value of innovation throughout the full diffusion curve. On reflection, the panel wondered if this was leading to HTA 3.0.