Technology Assessment in Hospitals: Lessons Learned From an Empirical Experiment

Foglia, Emanuela; Lettieri, Emanuele; Ferrario, Lucrezia; Porazzi, Emanuele; Garagiola, Elisabetta; Pagani, Roberta; Bonfanti, Marzia; Lazzarotti, Valentina; Manzini, Raffaella; Masella, Cristina; Croce, Davide

doi:10.1017/s0266462317000356

Cited by 17 publications

(16 citation statements)

References 23 publications

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“…The validation of the scientific evidence available on the topic was carried out by five experts (three HIV clinicians and two academic researchers, with an economic background. The professionals involved presented over ten years' experience in the specific healthcare sector), using the approach suggested by both the Critical Appraisal Skills Programme (CASP) checklist [19] for RCTs, and IMPAQHTA Model [20].…”

Section: Literature Reviewmentioning

confidence: 99%

HTA and HIV: The Case of Dual NRTI Backbones in the Italian Setting

Garagiola

Foglia

Ferrario

et al. 2020

IJERPH

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The aim of this study is to analyze the potential advantages of emtricitabine/tenofovir alafenamide (FTC/TAF) introduction, creating evidence-based information to orient strategies to reduce costs, thus preserving effectiveness and appropriateness. An Health Technology Assessment (HTA) was implemented in the years 2017–2018 comparing the dual backbones available in the Italian market: FTC/TAF, FTC/TDF (tenofovir disoproxil fumarate/emtricitabine) and ABC/3TC (abacavir/lamivudine). From an efficacy point of view, FTC/TAF ensured a higher percentage of virologic control and a better safety impact than FTC/TDF (improving the renal and bone safety profile, as well as the lipid picture). From an economic point of view, the results revealed a 4% cost saving for the Italian National Healthcare Service NHS with FTC/TAF introduction compared with the baseline scenario. Qualitative perceptions’ results showed that FTC/TAF would decrease the burden of adverse events management, increasing the accessibility of patients to healthcare providers (FTC/TAF: 0.95, FTC/TDF: 0.10, ABC/3TC: 0.28; p-value: 0.016) and social costs (FTC/TDF: −0.23, FTC/TAF: 1.04, ABC/3TC: 0.23; p-value < 0.001), improving patient quality of life (FTC/TDF: 0.31, FTC/TAF: 1.85, ABC/3TC: 0.38; p-value < 0.001). Healthcare services may consider the evidence provided by the present study as an opportunity to include HIV patients in a more adequate antiretroviral treatment arm, guaranteeing a personalized clinical pathway, thus becoming more efficient and effective over time.

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Section: Literature Reviewmentioning

confidence: 99%

HTA and HIV: The Case of Dual NRTI Backbones in the Italian Setting

Garagiola

Foglia

Ferrario

et al. 2020

IJERPH

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“…Besides the qualitative assessment of evidence deployed by means of the above mentioned New Castle–Ottawa Evaluation scale, the papers included in the HTA have been also evaluated, following a quantitative approach, proposed by the IMPAQHTA model 29. In particular, literature evidence was briefly evaluated, with regard to the quality, completeness, and replicability, of the results, all of which were measured based on a 4-level evaluation scale.…”

Section: Methodsmentioning

confidence: 99%

<p>HTA and innovative treatments evaluation: the case of metastatic castration-resistant prostate cancer</p>

Bretoni¹,

Ferrario²,

Foglia³

2019

CEOR

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Purpose: To investigate the implications of the introduction of two hormonal therapies, abiraterone acetate + prednisone (AA+P) and enzalutamide (ENZA), for the treatment of naïve patients with metastatic castration-resistant prostate cancer (mCRPC) in the Italian setting. Methods: In 2017–2018, a Health Technology Assessment was conducted in Italy, considering the National Healthcare Service (NHS) perspective. Data were retrieved from literature evidence, economic evaluations, and qualitative questionnaires, considering the 9 EUnetHTA dimensions, and a final multi-criteria approach. Results: On the basis of mCRPC prevalence and incidence rates in Italy, the analysis considered 11,212 males eligible to either AA+P or ENZA treatments. Both drugs led to an improvement of the patients' overall survival, with respect to the standard of care, composed of docetaxel chemotherapy. However, AA+P showed a higher rate of drug-related moderate adverse events and a monitoring activities incidence superior to ENZA (+70%, p -value=0.00), which led to a major resources absorption (€ 1,056.02 vs € 316.25, p -value=0.00), whereas ENZA showed a better cost-effectiveness average value (CEV: 54,586.12 vs 57,624.15). Economic savings ranging from 1.46% to 1.61% emerged for the NHS, as well as organizational advantages, with fewer minutes required for the mCRPC management (AA+P: 815 mins vs ENZA: 500 mins). According to experts’ perceptions, based on a 7-item Likert scale (ranging from −3 to +3), similar results emerged on ethical and social impact (ENZA: 1.35 vs AA+P: 1.48, p -value>0.05), and on legal dimension (ENZA: 0.67 vs AA+P: 0.67, p -value>0.05), since both drugs improved the patients’ quality of life and received approval for use. High-level perceptions related to ENZA adoption emerged with regard to equity (ENZA: 0.69 vs AA+P: 0.25, p -value<0.05), since it is cortisone-free. Multi-criteria approach analysis highlighted a higher score of ENZA than comparator (0.79 vs 0.60, p -value=0.00). Conclusion: The evidence-based information underlined the advantages of ENZA and AA+P treatments as therapeutic options for mCRPC patients. In the appraisal phase, the higher score than the comparator suggested ENZA as the preferred treatment for mCRPC.

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“…Then, the efficacy of a certain intervention (“can it work?”) is a preliminary condition to test the effectiveness of the same intervention under usual clinical circumstances (“does it work in practice”?) [ 12 , 39 ].…”

Section: Resultsmentioning

confidence: 99%

“…An HTA is conducted considering 938 hip and knee JAs performed within the ERAS pathway from March to October 2018. The assessment is based on a hospital version [12] of the EUnetHTA Core Model [13], which includes all the dimensions required by the European framework [13]. The following domains were considered and further divided into appropriate sub-dimensions: i) general relevance of the ERAS pathway (the technology under evaluation); ii) safety; iii) efficacy; iv) economic and financial impact; v) equity; vi) legal aspects; vii) social and ethical impact; viii) organizational impact.…”

Section: Methodsmentioning

confidence: 99%

Introducing enhanced recovery after surgery in a high-volume orthopaedic hospital: a health technology assessment

Vanni

Foglia

Pennestrì

et al. 2020

BMC Health Serv Res

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Background: The number of patients undergoing joint arthroplasty is increasing worldwide. An Enhanced Recovery After Surgery (ERAS) pathway for hip and knee arthroplasty was introduced in an Italian high-volume research hospital in March 2018. Methods: The aim of this mixed methods observational study is to perform a health technology assessment (HTA) of the ERAS pathway, considering 938 procedures performed after its implementation, by means of a hospitalbased approach derived from the EUnetHTA (European Network for Health Technology Assessment) Core Model. The assessment process is based on dimensions of general relevance, safety, efficacy, effectiveness, economic and financial impact, equity, legal aspects, social and ethical impact, and organizational impact. A narrative review of the literature helped to identify general relevance, safety and efficacy factors, and a set of relevant sub-dimensions submitted to the evaluation of the professionals who use the technology through a 7-item Likert Scale. The economic and financial impact of the ERAS pathway on the hospital budget was supported by quantitative data collected from internal or national registries, employing economic modelling strategies to identify the amount of resources required to implement it. Results: The relevance of technology under assessment is recognized worldwide. A number of studies show accelerated pathways to dominate conventional approaches on pain reduction, functional recovery, prevention of complications, improvements in tolerability and quality of life, including fragile or vulnerable patients. Qualitative surveys on clinical and functional outcomes confirm most of these benefits. The ERAS pathway is associated with a reduced length of stay in comparison with the Italian hospitalization average for the same procedures, despite the poor spread of the pathway within the country may generate postcode inequalities. The economic analyses show how the resources invested in training activities are largely depreciated by benefits once the technology is permanently introduced, which may generate hospital cost savings of up to 2054,123.44 € per year. Conclusions: Galeazzi Hospital's ERAS pathway for hip and knee arthroplasty results preferable to traditional approaches following most of the HTA dimensions, and offers room for further improvement. The more comparable practices are shared, the before this potential improvement can be identified and addressed.

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Technology Assessment in Hospitals: Lessons Learned From an Empirical Experiment

Cited by 17 publications

References 23 publications

HTA and HIV: The Case of Dual NRTI Backbones in the Italian Setting

HTA and HIV: The Case of Dual NRTI Backbones in the Italian Setting

<p>HTA and innovative treatments evaluation: the case of metastatic castration-resistant prostate cancer</p>

Introducing enhanced recovery after surgery in a high-volume orthopaedic hospital: a health technology assessment

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