scholarly journals Health technology assessment and mental health

2002 ◽  
Vol 26 (7) ◽  
pp. 243-245 ◽  
Author(s):  
Angus Mackay
Keyword(s):  
Mental Health ◽  
Cost Effectiveness ◽  
Clinical Excellence ◽  
Health Technology ◽  
Health Intervention ◽  
Health Improvement ◽  
Scottish Intercollegiate Guideline Network ◽  
Health Technologies ◽  
Clinical Procedures ◽  
Crude Approximation

In company with all other branches of the NHS, those concerned with mental health are currently the target of a plethora of standards, guidelines and derivatives thereof. In England and Wales, the responsibility for the production of national clinical guidelines rests with the National Institute for Clinical Excellence (NICE), and the Commission for Health Improvement (CHI) is charged with the monitoring of performance. In Scotland, the Scottish Intercollegiate Guideline Network (SIGN) and the Clinical Standards Board for Scotland (CSBS) undertake these respective responsibilities. However, NICE is also responsible for a rather different form of activity, and one that has forced it recurringly into the media limelight in the 2 years since its creation. This is the formulation of national advice on the clinical and cost-effectiveness of new and existing health technology. Health technology is a rather pedantic, if precisely defined, term that means essentially any health intervention and it includes medicines, devices, clinical procedures and even health care settings. Post-devolution and in the wake of the establishment of the Scottish Parliament, the Health Technology Board for Scotland (HTBS) was created by statute in April 2000. This organisation shares with NICE the responsibility for issuing advice on the clinical and cost-effectiveness of health technologies, in HTBS's case primarily to NHS Scotland. Therefore, two nationally-oriented organisations exist on either side of Hadrian's Wall, responsible to their respective Parliaments for providing authoritative opinions on whether or not a particular health intervention should be provided within the NHS. A crude approximation to the subject of this advice would be ‘value for money’. While, for reasons that will be explained, such a term is potentially misleading, it does serve to identify the basic elements of the need to which this activity is a response.

scholarly journals Health technology assessment in the United Kingdom

2009 ◽  
Vol 25 (S1) ◽  
pp. 178-181 ◽  
Author(s):  
Michael Drummond ◽  
David Banta
Keyword(s):  
Health Care ◽  
United Kingdom ◽  
Cost Effectiveness ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Clinical Excellence ◽  
Present Situation ◽  
Health Technology ◽  
The United Kingdom ◽  
Short Run

Objectives: The aim of this study was to describe generally the development and present situation with health technology assessment (HTA) in the United Kingdom.Methods: The methods used are a review of important materials that have described the development process and present situation, supplemented by some personal experiences.Results: The United Kingdom has been characterized historically as a country with a strong interest in evidence in health care, both clinical trials for efficacy and cost-effectiveness analyses. However, this evidence was not well-linked to the needs of the National Health Services (NHS) before formation of the NHS R&D Programme in 1991, The R&D Programme brought substantial resources into HTA and related activities, with the central aim of improving health care in Britain and increasing value for money. However, policy makers as well as staff of the R&D Programme were dissatisfied with the use of the HTA results in clinical and administrative practice. Therefore, the National Institute of Clinical Excellence (NICE) was formed in 1999. NICE issues guidance intended to influence practical decision making in health care at the national and local levels, based on efficacy information and, in some cases, economic analyses. NICE is now also seeking ways to maximize impacts on practice.Conclusions: The UK experience shows that information on clinical and cost-effectiveness may not be enough to change practice, at least in the short-run. Still, one may conclude that the United Kingdom now has one of the few most important and influential HTA programs in the world.

EVIDENCE, VALUES, AND DECISION MAKING

2014 ◽  
Vol 30 (2) ◽  
pp. 233-238 ◽  
Author(s):  
Michael D. Rawlins
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Observational Study ◽  
Social Values ◽  
Clinical Excellence ◽  
Health Technology ◽  
Evidence Base ◽  
Social Value ◽  
Value Judgments ◽  
Study Designs

Background: The evidence supporting the use of new, or established, interventions may be derived from either (or both) experimental or observational study designs. Although a rigorous examination of the evidence base for clinical and cost-effectiveness is essential, it is never sufficient, and those undertaking a health technology assessment (HTA) also have to exercise judgments.Methods: The basis for this discussion is largely from the author's experience as chairman of the national Institute for Health and Clinical Excellence (NICE).Results: The judgments necessary for HTA to make are twofold. Scientific judgments relate to the interpretation of the science. Social value judgments are concerned with the ethical principles, preferences, culture, and aspirations of society.Conclusions: How scientific and social value judgments might be most appropriately captured is a challenge for all HTA agencies. Although competent HTA bodies should be able to exercise scientific judgments they have no legitimacy to impose their own social values. These must ultimately be informed by the general public.

Health technology assessment in Australia: a role for clinical registries?

2017 ◽  
Vol 41 (1) ◽  
pp. 19 ◽  
Author(s):  
Anna Mae Scott
Keyword(s):  
Cost Effectiveness ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Medical Procedures ◽  
Policy Decisions ◽  
Health Technologies ◽  
Clinical Registries ◽  
Public Subsidy

Objective Health technology assessment (HTA) is a process of assessing evidence to inform policy decisions about public subsidy of new drugs and medical procedures. Where evidence is uncertain but the technology itself is promising, funders may recommend funding on an interim basis. It is unknown whether evidence from clinical registries is used to resolve uncertainties identified in interim-funded decisions made by Australian HTA bodies. Therefore, the present study evaluated the role of evidence from clinical registries in resolving evidence uncertainties identified by the Medical Services Advisory Committee (MSAC). Methods All HTAs considered by MSAC between 1998 and 2015 were reviewed and assessments that recommended interim funding were identified. The MSAC website was searched to identify reassessments of these recommendations and sources of evidence used to resolve the uncertainties were identified. Results Of 173 HTA reports considered by MSAC, 17 (10%) contained an interim funding recommendation. Eight recommendations cited uncertainty around safety, 15 cited uncertainty around clinical effectiveness and 13 cited uncertainty around economics (cost-effectiveness and/or budget impact). Of the 17 interim funding recommendations, 11 (65%) have been reassessed. Only two reassessments relied on clinical registry evidence to resolve evidence gaps identified at the time of the interim funding recommendation. Conclusions Clinical registries are underused as a source of evidence for resolving uncertainties around promising new health technologies in Australia. An open dialogue between stakeholders on the role of registries in this context is needed. What is known about the topic? HTA is a process of assessing the evidence to inform policy decisions about public subsidy of new health technologies (e.g. pharmaceuticals, diagnostic tests, medical procedures). Where evidence is uncertain but the technology under evaluation is promising, funders may recommend the funding of the technology on a temporary basis while additional evidence is collected. Clinical registries have been suggested as a means of collecting additional evidence in these situations. What is does this paper add? It is currently unknown whether evidence from clinical registries is used to resolve uncertainties identified at the time that temporary (interim) funding decisions are made by Australia’s HTA bodies, in particular MSAC. The present study found that MSAC rarely relies on the interim funding mechanism (17/173 assessments). Of the 11 subsequent reassessments of interim recommendations, two relied on registry evidence to provide Australian-specific data for addressing uncertainties around long-term safety, effectiveness and cost-effectiveness. These findings suggest that clinical registries, although a feasible source of evidence for HTAs, are rarely used for this purpose. What are the implications for practitioners? Given the registries’ ability to resolve both a wider range of questions than those typically addressed by randomised control trials and applicability to a wider group of patients (and, hence, providing estimates of outcomes that are more generalisable), the potential of clinical registries to resolve HTA issues needs more attention from both researchers and decision makers. Stakeholder collaboration to define the evidence requirements for new technologies early in their development phase would be valuable to determine the potential role for clinical registries.

scholarly journals Cognitive–behavioural therapy for clozapine-resistant schizophrenia: the FOCUS RCT

2019 ◽  
Vol 23 (7) ◽  
pp. 1-144 ◽  
Author(s):  
Anthony P Morrison ◽  
Melissa Pyle ◽  
Andrew Gumley ◽  
Matthias Schwannauer ◽  
Douglas Turkington ◽  
...  
Keyword(s):  
Mental Health ◽  
Cost Effectiveness ◽  
Cognitive Behavioural Therapy ◽  
Primary Outcome ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Health Technology ◽  
Behavioural Therapy ◽  
Cognitive Behavioural ◽  
End Of Treatment

BackgroundClozapine (clozaril, Mylan Products Ltd) is a first-choice treatment for people with schizophrenia who have a poor response to standard antipsychotic medication. However, a significant number of patients who trial clozapine have an inadequate response and experience persistent symptoms, called clozapine-resistant schizophrenia (CRS). There is little evidence regarding the clinical effectiveness of pharmacological or psychological interventions for this population.ObjectivesTo evaluate the clinical effectiveness and cost-effectiveness of cognitive–behavioural therapy (CBT) for people with CRS and to identify factors predicting outcome.DesignThe Focusing on Clozapine Unresponsive Symptoms (FOCUS) trial was a parallel-group, randomised, outcome-blinded evaluation trial. Randomisation was undertaken using permuted blocks of random size via a web-based platform. Data were analysed on an intention-to-treat (ITT) basis, using random-effects regression adjusted for site, age, sex and baseline symptoms. Cost-effectiveness analyses were carried out to determine whether or not CBT was associated with a greater number of quality-adjusted life-years (QALYs) and higher costs than treatment as usual (TAU).SettingSecondary care mental health services in five cities in the UK.ParticipantsPeople with CRS aged ≥ 16 years, with anInternational Classification of Diseases, Tenth Revision (ICD-10) schizophrenia spectrum diagnoses and who are experiencing psychotic symptoms.InterventionsIndividual CBT included up to 30 hours of therapy delivered over 9 months. The comparator was TAU, which included care co-ordination from secondary care mental health services.Main outcome measuresThe primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score at 21 months and the primary secondary outcome was PANSS total score at the end of treatment (9 months post randomisation). The health benefit measure for the economic evaluation was the QALY, estimated from the EuroQol-5 Dimensions, five-level version (EQ-5D-5L), health status measure. Service use was measured to estimate costs.ResultsParticipants were allocated to CBT (n = 242) or TAU (n = 245). There was no significant difference between groups on the prespecified primary outcome [PANSS total score at 21 months was 0.89 points lower in the CBT arm than in the TAU arm, 95% confidence interval (CI) –3.32 to 1.55 points;p = 0.475], although PANSS total score at the end of treatment (9 months) was significantly lower in the CBT arm (–2.40 points, 95% CI –4.79 to –0.02 points;p = 0.049). CBT was associated with a net cost of £5378 (95% CI –£13,010 to £23,766) and a net QALY gain of 0.052 (95% CI 0.003 to 0.103 QALYs) compared with TAU. The cost-effectiveness acceptability analysis indicated a low likelihood that CBT was cost-effective, in the primary and sensitivity analyses (probability < 50%). In the CBT arm, 107 participants reported at least one adverse event (AE), whereas 104 participants in the TAU arm reported at least one AE (odds ratio 1.09, 95% CI 0.81 to 1.46;p = 0.58).ConclusionsCognitive–behavioural therapy for CRS was not superior to TAU on the primary outcome of total PANSS symptoms at 21 months, but was superior on total PANSS symptoms at 9 months (end of treatment). CBT was not found to be cost-effective in comparison with TAU. There was no suggestion that the addition of CBT to TAU caused adverse effects. Future work could investigate whether or not specific therapeutic techniques of CBT have value for some CRS individuals, how to identify those who may benefit and how to ensure that effects on symptoms can be sustained.Trial registrationCurrent Controlled Trials ISRCTN99672552.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 23, No. 7. See the NIHR Journals Library website for further project information.

Cost-Effectiveness Analysis and the Value for Money of Health Technologies

2012 ◽  
pp. 92-109
Author(s):  
Steven Simoens
Keyword(s):  
Cost Effectiveness ◽  
Health Technology ◽  
Cost Effectiveness Analysis ◽  
Value For Money ◽  
Health Technologies ◽  
Effectiveness Analysis ◽  
Ratio Approach ◽  
Alternative Approaches ◽  
Program Budgeting ◽  
Care Decision

Cost-effectiveness analysis serves as a tool to assess the value for money of a health technology. This chapter aims to review different approaches to assessing value for money of health technologies. First, the chapter discusses the methodological basis of the incremental cost-effectiveness ratio approach. Second, the chapter reviews alternative approaches such as the replacement approach, program budgeting and marginal analysis, the generalised optimisation framework, and multi-criteria decision analysis. This information will aid health care decision makers and researchers to interpret cost-effectiveness analyses and their results for the purpose of decision making.

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