Mini-HTA as a Tool for Evidence-Based Decision-Making in Not-For-Profit Private Hospitals: Preliminary Result. By Hafizah Besar Sa’aid School of Public Health Griffith University, Logan, QLD Email: hafizah.besarsaaid@griffithuni.edu.au

Structure of the presentation Introduction Methods Key Findings Conclusion 12/09/2018 HAFIZAH/GRIFFITH UNIVERSITY

Introduction Background Rapid growth of new health technologies led to better health care and higher quality of life. However, there are concerns over rising cost, effectiveness, safety and unproven technologies. Decision-makers are gate keepers for new technologies adoption in hospitals. Decision-makers have to make the best decisions based on available evidence. Health Technology Assessment (HTA) is a decision support tool to help decision-makers make decisions based on evidence. 12/09/2018 HAFIZAH/GRIFFITH UNIVERSITY

Introduction (Cont……) What is HTA? “HTA is the provision for health care decision-makers of high-quality research information on the cost, effectiveness and broader impact of health technologies; where technologies are not just high-tech `kit’, but all interventions offered to patients”. (Stevens, et al., 2003) 12/09/2018 HAFIZAH/GRIFFITH UNIVERSITY

Introduction (Cont..…) HTA usually is conducted by HTA agencies. Example of HTA agencies in Australia are TGA, MSAC, ASERNIP-S and a few more. However, there are concerns that their findings are not fully disseminated especially to decision-makers at hospital level. One of the proposed solutions to this issue is hospital based HTA or mini-HTA. 12/09/2018 HAFIZAH/GRIFFITH UNIVERSITY

The purpose and content of the proposal Introduction (Cont….) What is mini-HTA? A form or a check list concerning the prerequisites for and consequences of introducing a new health technology. Evidences are based on a systematic literature review. Used as a basis for decision making. The form: (DACEHTA 2005) The proposer The purpose and content of the proposal Technology Patient Organisation Economy 12/09/2018 HAFIZAH/GRIFFITH UNIVERSITY

Introduction (Cont….) Aims of this paper are to: describe current mechanism decision-makers use for introducing new health technologies in selected not-for-profit private hospitals South East Queensland. investigate the decision-makers perceptions of HTA and mini-HTA as a tool for evidence-based decision-making. 12/09/2018 HAFIZAH/GRIFFITH UNIVERSITY

Methods Research Sites Sampling Took place in South East Queensland, Australia. At three not-for-profit private hospitals. Sampling Convenience sampling based on recommendation from General Managers. Make a list of potential participants. Send letter of invitation. Set the interview times and places. 12/09/2018 HAFIZAH/GRIFFITH UNIVERSITY

Methods (Cont….) Data collection Analysis Four part interview guide was developed to gain perceptions on: Current decision making processes. Mechanism for evaluation process. Perception on health technology assessment. Suggestions for future improvement. Analysis Preliminary analysis Overview from transcriptions and interviewer’s notes. Not yet finalised. Thematic analysis using NVIVO will be used to translate the data into findings. 12/09/2018 HAFIZAH/GRIFFITH UNIVERSITY

Ethics Griffith University Human Ethics Committee. Written consent was obtained. Interviews were de-identified. Data were kept confidential. 12/09/2018 HAFIZAH/GRIFFITH UNIVERSITY

Key Findings (interim) Decision making processes Quite informal though they have a product review committee. Depending on cost of the technologies. Less then AUD50 thousand – department managers can make their own decision. More than AUD50 thousand – decide by the product review committee and endorse by the executive committee. For more expensive technologies e.g more than AUD100 thousand, the requester(s) must present a business case to the product review committee and the executive committee. No formal guideline for business case presented. 12/09/2018 HAFIZAH/GRIFFITH UNIVERSITY

Key Findings (Cont…) Evaluation Processes The most important criterion is the business strategy (need to be ahead in the market) and cost. Clinical effectiveness and safety are regarded as important but not the key criteria that led to decision. Doctors are the most important driver. Sources of information: the requester, other hospitals, and the suppliers (product vendors). No formal HTA process at hospital level. Product review form and business case analysis. 12/09/2018 HAFIZAH/GRIFFITH UNIVERSITY

Key Findings (Cont….) Perception of HTA Future improvement Not all decision makers aware about HTA. No decision makers know about mini-HTA. Those who know believe HTA can help them in making evidence-based decisions. Future improvement 90% of decision makers stated that formal evaluation would be good for decisions. Mini-HTA should be put into practice at hospital level. Timely and reliable evidences to make better informed decisions. 12/09/2018 HAFIZAH/GRIFFITH UNIVERSITY

Conclusion HTA is not well disseminated at institutional or hospital level in not-for-profit private institution in SE Queensland. Decision makers rely on requester(s) for information. HTA agencies and authority body must use more rigorous strategies to disseminate HTA to hospitals. Mini HTA should become a requirement for decision making processes for new health technologies. Hospitals should have more formal approach such as a formal HTA unit to evaluate new technologies. 12/09/2018 HAFIZAH/GRIFFITH UNIVERSITY

Acknowledgement My gratitude goes to: Griffith University, Australia Universiti Teknologi MARA, Malaysia The participants My supervisors: Prof Donald Stewart Dr Ian England 12/09/2018 HAFIZAH/GRIFFITH UNIVERSITY

References Gallego, G., Fowler, S., et al. (2008). "Decision makers' perceptions of health technology decision making and priority setting at the institutional level." Australian Health Review 32(3): 520-527. Hivon, M., Lehoux, P.,et al. (2005). "Use of health technology assessment in decision making: Coresponsibility of users and producers?" International Journal of Technology Assessment in Health Care 21(2): 268–275. Duckett, S. J. (2004). The Australian Health Care System. Oxford, Oxford University Press. International Network of Agencies for Health Technology Assessment (2008). Retrieved 20 November 2008, from http://www.inahta.org/HTA/. Lehoux, P., Denis, J.-L.,et al. (2003). Dissemination and use of health technology assessment in Canada: the perception of providers, healthcare administrators, patients and industry. Montreal, Universite de Montreal. Vestergaard, M., Ehlers, L., et al. (2005). Introduction to mini-HTA - a management and decision support tool for the hospital service. Danish Centre for Evaluation and Health Technology Asessment (DACEHTA). Copenhagen, The National Board of Health. Stevens, A., Milne, R., et al. (2003). "Health technology assessment: history and demand." Journal of Public Health Medicine 25(2): 98-101. Australian Government (2009). Review of health technology assessment in Australia: A discussion paper. Department of Health and Ageing. 12/09/2018 HAFIZAH/GRIFFITH UNIVERSITY

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