Scientific Evidence in Health Technology Assessment Reports: An In-Depth Analysis of European Assessments on High-Risk Medical Devices

Background

The aim of this study was to examine the scientific evidence on clinical effectiveness and safety used in health technology assessments (HTAs) of high-risk medical devices (MDs) in Europe.

Unrelated Future Costs and Unrelated Future Benefits: Reflections on NICE Guide to the Methods of Technology Appraisal

In this editorial, we consider the vexing issue of ‘unrelated future costs’ (for example, the costs of caring for people with dementia or kidney failure after preventing their deaths from a heart attack). The National Institute of Health and Care Excellence (NICE) guidance is not to take such costs into account in technology appraisals. However, standard appraisal practice involves modelling the benefits of those unrelated technologies. We argue that there is a sound principled reason for including both the costs and benefits of unrelated care. Changing this practice would have material consequences for decisions about reimbursing particular technologies, and we urge future research to understand this better. Copyright © 2016 John Wiley & Sons, Ltd.     

全球卫生技术评估发展的历史与经验

通过回顾卫生技术评估在各国发展的历史,总结其中的成功经验,可以为进一步探索符合我国国情的卫生技术评估发展模式和道路提供参考.将卫生技术评估在世界的发展分为起步和成长两个阶段,在成长阶段分别从非政府支持项目与评估项目团队、政府支持项目与政府支持评估机构、政府评估机构与政府支持的第三方评估机构和国际交流与合作几个方面.梳理了卫生技术评估发展中运作模式的变化.从各国经验可得,卫生技术的评估需要政府的推动,评估的开展需要公开透明以促进质量的提升,而第三方评估机构的建立则有利于评估向更加公平独立、规范化的方向发展.     

Supporting the Development of Evidence-Informed Policy Options: An Economic Evaluation of Hypertension Management in Ghana

ObjectivesUniversal healthcare coverage in low- and middle-income countries requires challenging resource allocation decisions. Health technology assessment is one important tool to support such decision making. The International Decision Support Initiative worked with the Ghanaian Ministry of Health to strengthen health technology assessment capacity building, identifying hypertension as a priority topic area for a relevant case study.MethodsBased on guidance from a national technical working group of researchers and policy makers, an economic evaluation and budget impact analysis were undertaken for the main antihypertensive medicines used for uncomplicated, essential hypertension. The analysis aimed to address specific policy questions relevant to the National Health Insurance Scheme.ResultsThe evaluation found that first-line management of essential hypertension with diuretics has an incremental cost per disability-adjusted life-year avoided of GH¢ 276 ($179 in 2017, 4% of gross national income per capita) compared with no treatment. Calcium channel blockers were more effective than diuretics but at a higher incremental cost: GH¢ 11 061 per disability-adjusted life-year avoided ($7189 in 2017; 160% of gross national income per capita). Diuretics provide better health outcomes at a lower cost than angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or beta-blockers. Budget impact analysis highlighted the potential for cost saving through enhanced price negotiation and increased use of better-value drugs. We also illustrate how savings could be reinvested to improve population health.ConclusionsEconomic evaluation enabled decision makers to assess hypertension medicines in a Ghanaian context and estimate the impact of using such evidence to change policy. This study contributes to addressing challenges associated with the drive for universal healthcare coverage in the context of constrained budgets.     

探索科学合理的医用耗材定价机制简

介绍了我国医用耗材市场主要存在的问题和发达国家的定价机制，阐述了新形势下建立科学合理的医用耗材定价机制的必要性，同时探讨我国该如何建立科学有效的医用耗材定价机制，为决策者下一步制定定价机制提供参考依据。     

SURROGATE,FRIEND OR FOE? THE NEED FOR CASE STUDIES OF THE USE OF SURROGATE OUTCOMES IN COST‐EFFECTIVENESS ANALYSES

We comment on a recent article by Hawkins et al. presenting different analytic approaches for the inclusion of surrogate and final outcomes in cost‐effectiveness analyses. This methodological case study provides a timely and valuable contribution to build on the debate about the use of evidence based on surrogate outcomes in health technology assessment. Copyright © 2012 John Wiley & Sons, Ltd.