Recommendations for the Implementation of Hospital Based HTA in Poland: Lessons Learned From International Experience

Abstract

Introduction: The main challenge of modern hospitals is purchasing medical technologies. Hospital-based health technology assessments (HB-HTAs) are used in healthcare facilities around the world to support management boards in providing relevant technologies for patients.Aim: This study was undertaken to update the existing body of knowledge on the characteristics of HB-HTA systems/models in the selected European countries. Insights gained from this study were used to provide an optimal approach for implementing HB-HTA in Poland.Materials and methods: Firstly, we carried out a systematic review in PubMed and embase. Secondly, we searched for gray literature via the AdHopHTA online handbook and the design book of the AdHopHTA project, as well as literature describing healthcare systems provided by the WHO. Then, we conducted in-depth interviews with HB-HTA experts from four countries. Finally, we selected ten countries from Europe and prepared frameworks for data collection and analyses.Results: The selected countries (Switzerland, Spain, France, Italy, Denmark, Finland, Sweden, the Netherlands, and Austria) are examples of decentralized or deconcentrated healthcare systems. In terms of HB-HTA, differences in organisational models (independent group, stand-alone, integrated-essential, integrated-specialised), type of financing (internally vs. externally), collaboration with an HTA National Agency and other stakeholders (e.g., Patients’ Associations) were identified. HB-HTA engages multi-skilled staff with various academic backgrounds and operates mainly on a voluntary basis.Conclusion: Strengths and weaknesses associated with various organisational models must be carefully considered in the context of support for decentralized or centralized models of implementation while embarking on HTA activities in Polish hospitals.

Using the Dynamic SWOT Analysis to Assess Options for Implementing the HB-HTA Model

“…Bottom-up models are highly decentralized, and are based on the assumption that hospitals increase their autonomy by making decisions regarding investment in health technologies, and they receive professional support from the HTA agency [ 4 ]. Decentralized models can be viewed by hospital managers as being advantageous because their role in the decision-making process is greater, while also being supported by scientific evidence [ 12 ]. On the other hand, centralized HB-HTA models rely on different assumptions about the hospital environment, with a greater role being occupied by central institutions, especially public payers, or governmental institutions, in the decision-making process regarding the assessment of innovative health technologies in hospitals [ 32 ].…”

“…Assessing and monitoring, which entails the measurement of the short- and long-term impacts of an HB-HTA model, is important in order to evaluate its overall performance, including costs and benefits [ 12 ]. The model’s functionality influences the implementation of innovative technologies at hospital facilities, and consequently, can have an impact on deciding to sustain the innovative technology in the hospital, and to scale up its use in other hospitals or even worldwide [ 13 , 14 , 15 ].…”

Possibilities of Implementing Hospital-Based Health Technology Assessment (HB-HTA) at the Level of Voivodeship Offices in Poland

“…Mostly, models in which regional or local institutions are responsible for evaluating reports from hospitals are used. Furthermore, scientific organizations such as universities and medical associations (associating physicians and other healthcare professionals) show particular interest in the methodology of evaluating investments and undertakings in hospitals [ 16 ]. The functioning of HB-HTA units as part of cooperation networks in many countries is based on the methodology prepared by doctors, academics, and healthcare managers.…”

HB-HTA as an implementation problem in Polish health policy

“…In order to correctly identify determinants of the HB HTA implementation process in the Polish healthcare system, we familiarized ourselves with the results of a study in which purposefully selected publications from the Medline (via PubMed), EMBASE, AdHopHTA, European Observatory on Health Systems, Healthcare Systems in Transition, and the WHO database were analyzed [26].…”

“…The selective literature review aimed to analyze organization and HB-HTA models in several countries, identify interactions between entities involved in the HB-HTA process, characterize stakeholders critical to the success of the HB-HTA solution (specifically identifying their roles and significance), and describe the relationships between entities (on supranational, national, regional levels) cooperating in processes related to the implementation of HB-HTA. The literature review, as we mentioned above, was supplemented with the analysis of the results of four in-depth interviews conducted with the participants of the AdHopHTA [26]. The purpose of the interviews with the AdHopHTA project partners from Austria, Denmark, France and Spain was to address the issue of the sustainability of HB-HTA solutions, the scope of modifications, the standards adopted as part of intra-or inter-institutional HB-HTA related measures, stakeholders driving and restraining the implementation and functioning of HB-HTA, the evaluation of the efficacy of the national healthcare system following the implementation of HB-HTA, and potential directions for the development of HB-HTA.…”