Transferability of health technology assessments and economic evaluations: a systematic review of approaches for assessment and application

Abstract

Background:Health technology assessments (HTA) generally, and economic evaluations (EE) more specifically, have become an integral part of health care decision making around the world. However, these assessments are time consuming and expensive to conduct. Evaluation resources are scarce and therefore priorities need to be set for these assessments and the ability to use information from one country or region in another (geographic transferability) is an increasingly important consideration.Objectives:To review the existing approaches, systems, and tools for assessing the geographic transferability potential or guiding the conduct of transferring HTAs and EEs.Methods:A systematic literature review was conducted of several databases, supplemented with web searching, hand searching of journals, and bibliographic searching of identified articles. Systems, tools, checklists, and flow charts to assess, evaluate, or guide the conduct of transferability of HTAs and EEs were identified.Results:Of 282 references identified, 27 articles were reviewed in full text and of these, seven proposed unique systems, tools, checklists, or flow charts specifically for geographic transferability. All of the seven articles identified a checklist of transferability factors to consider, and most articles identified a subset of ‘critical’ factors for assessing transferability potential. Most of these critical factors related to study quality, transparency of methods, the level of reporting of methods and results, and the applicability of the treatment comparators to the target country. Some authors proposed a sequenced flow chart type approach, while others proposed an assessment of critical criteria first, followed by an assessment of other noncritical factors. Finally some authors proposed a quantitative score or index to measure transferability potential.Conclusion:Despite a number of publications on the topic, the proposed approaches and the factors used for assessing geographic transferability potential have varied substantially across the papers reviewed. Most promising is the identification of an extensive checklist of critical and noncritical factors in determining transferability potential, which may form the basis for consensus of a future tool. Due to the complexities of identifying appropriate weights for each of the noncritical factors, it is still uncertain whether the assessment and calculation of an overall transferability score or index will be practical or useful for transferability considerations in the future.

Strengthening and implementing health technology assessment and the decision-making process in the Region of the Americas

“…Thirty-nine percent of respondents indicated that there were no guidelines for conducting HTA in their countries, but 11% did not answer this question. Sixty-two percent said they used HTA reports that had been produced in other jurisdictions to help in their decisions, which agrees with findings from other authors (15)(16)(17)(18)(19)(20)(21). HTA work produced in different contexts is usually adapted to the local situation in order to be used in the decision-making process.…”

Long-term Cost-effectiveness of Endoscopic vs Open Vein Harvest for Coronary Artery Bypass Grafting

“…However, the additional money spent on EVH can be considered 'good value for money' as our analysis showed that EVH is cost-effective compared to OVH from the Danish healthcare system's perspective. To assess whether this result is transferable to other jurisdictions it is ideal to perform a formal evaluation using one of several tools to assess transferability [23][24][25]. It should be noted that the decision analytic model was informed with data from a meta-analysis which included published data from a variety of countries and that the results of the present economic evaluation therefore is likely to be generalizable to a number of jurisdictions.…”

Evidências econômicas de intervenções em saúde sob a perspectiva do sistema único de saúde: por que e para que produzi-las e utilizá-las?

“…Entretanto, apesar dos progressos na identificação de fatores críticos e não críticos para a transferibilidade das evidências econômicas, a identificação de uma lista extensa de fatores e as abordagens para a transferibilidade que envolvem uma complexa identificação dos pesos para cada um deles trazem incerteza sobre a praticidade e utilidade dos métodos desenvolvidos até o momento para considerações futuras sobre transferibilidade (Goeree et al, 2011).…”