The role of health technology assessment in coverage decisions on newborn screening

Fischer, Katharina Elisabeth; Grosse, Scott D.; Rogowski, W.

doi:10.1017/s0266462311000468

Cited by 19 publications

(35 citation statements)

References 27 publications

(28 reference statements)

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“…The first focused on who makes the decision, and the second focused on the evidence on which the decision is made. The literature was consistent in its recommendation for an overarching, independent, multidisciplinary group providing recommendations to government (18, 24, 28). …”

Section: Resultsmentioning

confidence: 81%

“…The main technology discussed in the articles shows a shift through time from MS/MS toward discussing genetic technologies as the challenge for NBS: 3 of 13 articles until 2008 discuss mainly genetic technologies and 6 of 14 published since 2009 (Table S1 in Supplementary Material). Recent articles discussing MS/MS report on results from current screening programs or previous decision-making processes (18). The following outlines the results, stepping through the policy cycle.…”

Section: Resultsmentioning

confidence: 99%

“…The first is a structured approach focused on horizon scanning; the second approach is much more ad hoc and influenced by external drivers, such as advocacy (18–20). …”

Section: Resultsmentioning

confidence: 99%

“…Such an approach has been successfully used by several countries in agenda setting based on an objective threshold of criteria (18, 22). In horizon scanning, potential conditions are identified and recommended for further in-depth review, through initial assessment of criteria.…”

Section: Resultsmentioning

confidence: 99%

“…In this approach, conditions became the focus of an assessment for NBS in response to new technologies, broader disease definition, insight into pathophysiology, and advocacy (5, 23–26). In the past, NBS policy direction and program expansion have been strongly influenced by technological drivers, often evaluated ad hoc (18–20). …”

Section: Resultsmentioning

confidence: 99%

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Policy Making in Newborn Screening Needs a Structured and Transparent Approach

Jansen

Lister

Kranen

et al. 2017

Front. Public Health

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PurposeNewborn bloodspot screening (NBS) programs have expanded significantly in the past years and are expected to expand further with the emergence of genetic technologies. Historically, NBS expansion has often occurred following ad hoc consideration of conditions, instead of a structured and transparent approach. In this review, we explore issues pertinent to NBS policy making, through the lens of the policy cycle: (a) agenda setting, (b) policy advice, (c) policy decision, (d) implementation, and (e) evaluation.MethodsA literature search was conducted to gather information on the elements specific to NBS and its policy making process.ResultsThe review highlighted two approaches to nominate a condition: a structured approach through horizon scanning; and an ad hoc process. For assessment of a condition, there was unanimous support for a robust process based on criteria. While the need to assess harms and benefits was a repeated theme in the articles, there is no agreed-upon threshold for benefit in decision-making. Furthermore, the literature was consistent in its recommendation for an overarching, independent, multidisciplinary group providing recommendations to government. An implementation plan focusing on the different levels on which NBS operates and the information needed on each level is essential for successful implementation. Continuously monitoring, and improving a program is vital, particularly following the implementation of screening for a new condition. An advisory committee could advise on implementation, development, review, modification, and cessation of (parts of) NBS.ConclusionThe results highlight that there are a wave of issues facing NBS programs that policy makers must take into account when developing policy processes. What conditions to screen, and the technologies used in NBS, are both up for debate.

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Section: Resultsmentioning

confidence: 81%

Section: Resultsmentioning

confidence: 99%

“…The first is a structured approach focused on horizon scanning; the second approach is much more ad hoc and influenced by external drivers, such as advocacy (18–20). …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Policy Making in Newborn Screening Needs a Structured and Transparent Approach

Jansen

Lister

Kranen

et al. 2017

Front. Public Health

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An Economic Theory of the Fourth Hurdle

Rogowski

2012

Health Economics

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Third party payers' decision processes for financing health technologies ('fourth hurdle' processes) are subject to intensive descriptive empirical investigation. This paper addresses the need for a theoretical foundation of this research and develops a theoretical framework for analysing fourth hurdle processes from an economics perspective. On the basis of a decision-analytic framework and the theory of agents, fourth hurdle processes are described as sets of institutions to maximize the value derived from finite healthcare resources. Benefits are assumed to arise from the value of better information about and better implementation of the most cost-effective choice. Implementation is improved by decreased information asymmetries and better alignment of incentives. This decreases the effects of ex ante and ex post moral hazard on service provision. Potential indicators of high benefit include high costs associated with wrong decisions and large population sizes affected by the decision. The framework may serve as a basis both for further theoretical work, for example, on the appropriate degree of participation as well as further empirical work, for example, on comparative assessments of fourth hurdle processes. It needs to be complemented by frameworks for analysing fourth hurdle institutions developed by other disciplines such as bioethics or law.

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