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Table 1 Reported effects and impact—HTA committees

From: Effects and repercussions of local/hospital-based health technology assessment (HTA): a systematic review

Reference and country Methods/participants Type of committee (structured or unstructured (ad hoc)) Type of impact
Cram et al. 1997 USA[10] Survey/33 clinical engineering departments throughout the USA Not specified On decision-making (or management)
23/27 committees doing HTA are multidisciplinary   • Several respondents used HTA to cut costs and provide more standardization.
  • The HTA process was seen by some respondents as allowing broader input into decision-making processes.
On clinicians’ or other stakeholders’ perceptions
  • 20/25 (80%) who used an HTA system felt it was a useful tool.
  • Main problems perceived in HTA processes: internal politics; lack of understanding that could lead committees to make poor decisions
Luce and Brown 1995 USA[12] Interviews/48 participants from 30 organizations (hospitals, health maintenance organizations, and third-party payers) Not specified On decision-making (or management)
For hospitals: multidisciplinary committees; formulary committees; department chiefs   • Hospital decision makers used HTA almost exclusively for making purchasing decisions and as a means of controlling expenditures.
  • Decisions were based on financial assessment with little or no formal evaluation of changes in patient outcomes or medical practice patterns.
  • Purchase or non-purchase recommendations were rarely contravened by management and were distributed to relevant departments throughout the organization.
Financial
  • New technologies priced over a predetermined threshold (US $100,000 or $250,000) were all assessed prior to purchase.
Menon and Marshall 1990 Canada[9] Survey/50 (59.5%) teaching hospitals across Canada Structured: 23/50 On decision-making (or management)
  • 34/43 hospitals practicing HTA stated that information produced was used in making decisions about new technology acquisition.
On clinicians’ or other stakeholders’ perceptions
  • 76% of respondents thought that a formal management structure for HTA should exist in teaching hospitals.
Patail and Aranha 1995 USA[13] Case study/1 major teaching hospital Structured On decision-making (or management)
  • Of 16 technologies formally approved in 1988–1993, 13 were implemented.
  • HTA allowed engineers and decision makers not to take the information provided by manufacturers and vendors for granted.
Financial
  • Technologies over $500,000 were assessed.
Poulin et al. 2012 Canada[18] Case study of HTA program outcomes Structured On decision-making (or management)
  • Of the 68 technologies for which a HTA was requested, 15 were incomplete and dropped, 12 were approved, 3 were approved on an urgent/emergent basis, 21 were approved for “clinical audit” on a restricted basis, 14 were approved for research use only, and 3 were referred to additional review bodies.
  • Decisions based on local HTA program recommendations were rarely “yes” or “no”. Many technologies were given restricted approval, with full approval contingent on satisfying certain conditions such as clinical outcomes review, training protocol development, or funding.
Financial
  • Cost was the first reason to reject a technology, followed by health gain.
Rosenstein et al. 2003 USA[11] Survey/19 hospitals in western USA Structured: 42% On decision-making (or management)
Ad hoc: 48%   • 28% of HTA committees had direct responsibility for approval.
  • While committees did not have final decision-making power, their recommendations were appropriate and well integrated with the hospital’s overall mission and strategic plan.
Saaid 2011 Australia[17] Multicase study/4 hospitals (3 private for-profit, 1 public) 1/4 has a formal committee On decision-making (or management)
3/4 have a product review committee   • The impact of HTA as a support tool for decision makers was minimal.
  • Decisions in private for-profit hospitals were informal and driven by business strategy and cost-effectiveness of the technology.
  • For the public hospital, HTA was a requirement in decision-making, but the process was new.
On clinicians’ or other stakeholders’ perceptions
  • Ignorance/unfamiliarity with HTA.
Weingart 1995 USA[14] Case study/1 major teaching hospital Ad hoc On decision-making (or management)
  • The technology assessed was qualified as an engineering disaster for various reasons:
  • Decision makers did not go far enough in their discussions to evaluate the institutional strategy or strategic implications of the technology. They lacked expertise in assessing feasibility and profitability.
  • Members of the committee (only physicians) were too optimistic despite limited data.
  • The mandate of the committee was too narrow and did not include comparison with alternative technology.
      • The process was not structured enough (ad hoc structure), and there was no official strategic plan in place at the hospital.