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Alberta Heritage Foundation
for Medical Research
Profile of an HTA programThe AHFMR Health Technology AssessmentUnit, 2002 - 2003
David Hailey
February 2004
IP-16 Information Paper
Profile of an HTA programThe AHFMR Health Technology Assessment Unit,
2002 - 2003
David Hailey
February 2004
Acknowledgment
The author wishes to thank the staff of the Health Technology Assessment Unit at the
Alberta Heritage Foundation for Medical Research for their assistance and input in the
preparation and finalization of this paper.
© Copyright Alberta Heritage Foundation for Medical Research, 2004
Comments relative to the information in this paper are welcome and should be sent to:
Director, Health Technology Assessment Unit
Alberta Heritage Foundation for Medical Research
1500 10104-103 AvenueEdmonton, AB T5J 4A7 CANADATel: (780) 423-5727 Fax: (780) 429-3501
E-mail: [email protected]
© Alberta Heritage Foundation for Medical Research, 2004
ISBN 1-896956-73-4 (Print)
ISBN 1-896956-75-0 (On-Line)
ISSN: 1706-7863
Alberta’s health technology assessment program has been established under the Health
Research Collaboration Agreement between the Alberta Heritage Foundation for
Medical Research and Alberta Health and Wellness.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment
l
Glossary
AHW: Alberta Health and Wellness
CCOHTA: Canadian Coordination Office for Health Technology Assessment
CHR: Calgary Health Region
CPG: Clinical practice guideline
EAP: Expert Advisory Panel (established by Alberta Health and Wellness)
HTA: Health technology assessment
HTAI: Health Technology Assessment Initiative
HTAU: Health Technology Assessment Unit
INAHTA: International Network of Agencies for Health Technology Assessment
IS: Information services
ISTAHC: International Society of Technology Assessment in Health Care
PTCA: Percutaneous transluminal coronary angioplasty
RCT: Randomized controlled trial
RHA: Regional Health Authority
WHO: World Health Organisation
WHO HEN: World Health Organisation Health Evidence Network
Alberta Heritage Foundation for Medical Research
Health Technology Assessment11
Digitized by the Internet Archive
in 2016
https://archive.org/details/profileofhtaprog00hail_0
Contents
Acknowledgment i
Glossary ii
Introduction 1
Approach 3
HTAU Products 4
Formulation of HTA Questions 6
Expected timelines 9
Type of technology/topic 10
Assessment Products 12
Allocation to different series 12
Issues addressed 12
Collaborators and contractors 16
Approaches taken 16
Timelines 17
Conclusions reached in HTA products 21
Dissemination 25
Impact of HTA products 29
Areas of impact 29
Level of impact 29
Indirect impact 29
Types of decisions 30
Resource and Educational Products 41
Governance 43
Resources and Staff 44
Synthesis 45
Discussion 49
Appendix A: Publication product series produced by the HTAU 53
Appendix B: Information Collection Form 54
References 58
Alberta Heritage Foundation for Medical Research iii
Health Technology Assessment
Profile of an HTA Program
The AHFMR Health Technology Assessment Unit, 2002 - 2003
Tables and Figures:
Figure 1: Determinants of effectiveness 1
Figure 2: Elements of Effectiveness 49
Table 1: Assessment products April 2002 to March 2003 4
Table 2: Resource and educational products, April 2002 to March 2003 5
Table 3: Sources of requests for HTA products 6
Table 4: Specification of HTA products 7
Table 5: Expected timelines for assessment reports 10
Table 6: Issues addressed in HTA products 13
Table 7: Eventual timelines for HTA products 18
Table 8: Conclusions reached in HTA products 21
Table 9: Approaches to dissemination of HTA products 26
Table 10: Areas of impact of HTA products 31
Table 11: Level of impact of HTA products 34
Table 12: Indirect impact of HTA products 38
Table 13: Types of decisions informed by HTA products 39
Table 14: Synthesis of HTA product activity 46
Alberta Heritage Foundation for Medical Research iv
Health Technology Assessment
Introduction
In 2003, the HTAU at the Alberta Heritage Foundation for Medical Research (AHFMR)published a paper in its HTA Initiatives series entitled 'Elements of effectiveness for health
technology assessment programs' l. The paper was intended to provide a basis for
discussion on the components of HTA programs and approaches to measuring their
effectiveness. It gave some consideration to better defining the role played by HTAagencies and the determinants of their effectiveness. These determinants are outlined in
Figure 1. In part, the paper was seen as a self assessment tool for HTA program
managers to help achieve continual improvement of activities.
Figure 1: Determinants of effectiveness
Staffand structure
ofHTA program
formulate
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Prevision
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teskle
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changes
to health care,
health outcomes
The HTAU has also been exploring ways to assess the impact of its products and has
published two recent reports on this topic which included responses to surveys of the
Unit's clients 2> 3.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment1
Profile of an HTA Program
The AHFMR Health Technology Assessment Unit, 2002 - 2003
This paper has been prepared to provide an overview of the outputs of the HTAU as an
aid to future management of HTA activities at the AHFMR, drawing on concepts
outlined in an earlier HTA Initiatives publication (HTAI 9 )1
. This is the first time that
this framework has been applied to an HTAU. In addition to its application to the
Alberta program, this paper forms part of an effort to help the international HTAcommunity come to grips with how HTA programs may be evaluated on a rigorous
and consistent basis. The paper is also intended to complement the previous papers on
HTA impact as a further approach to defining performance and accountability of
programs in a complex area that has still received relatively little attention.
The paper reviews the activity of the HTAU as reflected in the various products it
produced from 2002 to 2003, including the impact of these on decision makers in the
province, and identifies some areas for consideration in future management of the
HTAU.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment
2
Approach
The scope and other details of the project were discussed with HTAU staff in May and
June 2003 and subsequently confirmed with the Director of the HTAU. It was agreed
that the overview would be based on scrutiny of products completed from April 2002 to
March 2003 inclusive. All types of product from the Unit were considered down to
'Level D' QwikNotes or their equivalent (see Appendix A). Very brief and rapid
responses, such as "instant e-mail", were not included.
An information collection form was developed with input from HTAU staff (Appendix
B). Unit staff then used the form to provide details of the products for which they had
been responsible. Two rounds of follow-up requests for further information were
undertaken to clarify various points, including summaries of the conclusions reached in
assessments. Staff had the opportunity to correct and update material entered on the
information collection form.
The information was then used to provide summaries of various areas related to the
preparation and use of the products. Most of the details in the paper relate to
Formulation of HTA questions, HTA products. Dissemination, and Impact of HTA,which were 'Assessment Stream' issues identified in HTAI 9. Some consideration is
also given to Governance, Resources, Staff and Structure as well as Collaborative and
Contractual Inputs.
The Unit's products included both assessments and resource/educational publications.
These categories are discussed separately since the issues related to them are somewhatdifferent.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment3
HTAU Products
The nineteen assessment products completed from April 2002 to March 2003 are listed
by category in Table 1. Four of these were in the HTA series. There were also five
TechNotes, two HTA Initiatives reports, two Information Papers, two QwikNotes, and
four reviews that fell outside the regular HTAU series. The latter had a substantial
influence on the workload and operation of the Unit. One of the Initiatives reports was
prepared at the University of Alberta and published by the AHFMR in an effort to
further links with the Department of Public Health Sciences and raise the profile of
HTA in the province.
Table 2 lists the three educational/resource products completed during this period - the
latest update of an Information Paper and two publications in the HTA Initiatives
series.
Table 1: Assessment products April 2002 to March 2003
Health Technology Assessments
01 Brooks L, Leggett Tait P, Harstall C. Acupuncture: evidence from systematic reviews and meta-
analyses, May 2002
02 Ospina M, Harstall C. Prevalence of chronic pain: an overview, December 2002
03 Ospina M, Harstall C. Multidisciplinary pain programs for chronic pain: evidence from systematic
reviews, January 2003
04 Guo B, Scott A, Bowker S. Suicide prevention strategies: evidence from systematic reviews,
February 2003
TechNotes
05 Ospina M. Cryosurgery for prostate cancer, May 2002
06 Guo B. Intracoronary brachtherapy for the treatment of in-stent restenosis, May 2002
07 Guo B. Osteogenic protein-1 for fracture healing, November 2002
08 Scott A. Trigger point injections for non-malignant chronic pain, March 2003
09 Scott A. Treatment of thoracic insufficiency syndrome with the vertical expandable prosthetic
titanium rib, December 2002
HTA Initiatives
10 Hailey D. Minimally invasive hip arthroplasty, March 2003
1 1 Yoon P. Emergency department fast-track system, March 2003
Alberta Heritage Foundation for Medical Research
Health Technology Assessment4
Profile of an HTA Program
The AHFMR Health Technology Assessment Unit, 2002 - 2003
Table 1: Assessment products April 2002 to March 2003 (cont’d)
Information Papers
12 Hailey D. Stereotactic radiosurgery: an update, May 2002
13 Hailey D. Hyperbaric oxygen therapy - recent findings on evidence for its effectiveness, March
2003
QwikNotes
14 Guo B. Effectiveness of computerized physician order entry systems in reducing medication
errors, April 2002
15 Corabian P. Prolotherapy, June 2002
‘Customized Responses’ - reviews undertaken outside regular HTAU series
16 HTAU . A selected inventory of abstracts of Cochrane reviews on physiotherapy/physical therapy,
October 2002
17 HTAU. A selected inventory of abstracts of systematic reviews on chiropractic services, October
2002
18 HTAU . A selected inventory of abstracts of systematic reviews on podiatry services, October
2002
19 HTAU . A selected inventory of abstracts of systematic reviews on optometric sen/ices, October2002
Table 2: Resource and educational products, April 2002 to March 2003
20 Chan L, Topfer LA. Health technology assessment on the Net: a guide to internet sources of
information, June 2002 (Information Paper)
21 Hailey D. Local health technology assessment: a guide for health authorities, December 2002(HTA Initiative)
22 Hailey D. Elements of effectiveness of health technology assessment programs, March 2003(HTA Initiative)
Alberta Heritage Foundation for Medical Research
Health Technology Assessment5
Formulation of HTA Questions
Sources of requests for assessments are shown in Table 3. The pattern is similar to those
for previous years, with most products being developed in response to requests from
AHW and/or RHAs. All the HTA products were aimed at decision-makers within the
province. Two of them were also prepared with the aim of furthering HTA in Alberta.
Table 3: Sources of requests for HTA products
AHW RHAsa AHW +RHAs
OtherHTAb
Professional
body0University'
lift 1 ililllll
HTA report 1 3
TechNote 2 2 1
HTA initiatives 1 1
Information Paper 1 1
QwikNote 1 1
Customized Response 4
Totals 8 4
a. Includes the Alberta Mental Health Board
4 1 1 1
b. Calgary Health Technology Implementation Unit
c. College of Physicians and Surgeons of Alberta
d. University of Alberta, Department of Public Health Sciences
Information on the specification of the assessment products, including details of the
issues that were to be addressed, are given in Table 4. The responses provided by
HTAU staff indicated that project specifications were addressed mostly in terms of the
question or issue raised by the organization requesting the HTA. In all cases there was
discussion to confirm or clarify the nature of the request (often face to face, also by
telephone and e-mail). Most of the questions were framed in terms of evidence of
effectiveness or current status of various technologies, sometimes in association with
safety issues. Cost or access issues were mentioned less often. This is similar to the
pattern for other HTAU products in previous years.
In several cases, the product was a follow up to a previous assessment undertaken by
the HTAU or was intended as a precursor to further work on a topic.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment
6
Profile of an HTA Program
The AHFMR Health Technology Assessment Unit, 2002 - 2003
Table 4: Specification of HTA products
Product Question/issue
Health Technology Assessments
01 Acupuncture:
evidence from
systematic reviews
and meta-analyses
Current scientific evidence over the last five
years addressing the question ‘for which
conditions acupuncture has scientific support’
(effectiveness, for whom, by whom)
02 Prevalence of chronic
pain: an overview
What is the best available evidence on
prevalence estimates for pain not related to
cancer?
03 Multidisciplinary pain
programs for chronic
pain: evidence from
systematic reviews
Evidence on the efficacy/effectiveness/
efficiency of multidisciplinary pain programs
for non-malignant chronic pain and how do weestablish provincial needs for a multidiscipline
pain program?
04 Suicide prevention What suicide prevention strategy is effective?
strategies: evidence
from systematic
reviews
05 Cryosurgery for
prostate cancer
06 Intracoronary
brachytherapy
TechNotes
What is the status of cryosurgery for the
treatment of prostate cancer?
The current status of the use of intracoronary
brachytherapy for patients with in-stent
restenosis after PTCA
07 Osteogenic protein-1 Regulatory status in Canada and the US for
for fracture healing patient groups; current practice in Canada;and evidence supporting its use and on
adverse effects
08 Trigger point Is trigger point injection effective for treating
injections for non- chronic pain? What is the feasibility of
malignant chronic pain delivering this procedure to patients in
regional communities?
Related HTAUproducts
Overview of the regulation
of acupuncture in Alberta
May 2001 - Information
Paper
One of two reports on the
suicide prevention project
QwikNote - February 2002TechNote - May 1998
Related to the HTA reports
on chronic pain
Alberta Heritage Foundation for Medical Research
Health Technology Assessment
7
Profile of an HTA Program
The AHFMR Health Technology Assessment Unit, 2002 2003
Table 4: Specification of HTA products (cont’d)109 Treatment of thoracic
insufficiency syndrome
with the prosthetic
titanium rib
Question/issue
TechNotes (cont’d)
Safety and efficacy/effectiveness of using a
vertical expandable prosthetic rib implant to
treat patients with thoracic insufficiency
syndrome. Is the procedure considered
experimental? What patient conditions are
eligible for this treatment and how manysurgeries/hospitalizations are needed over the
course of the treatment?
Related HTAU:
:
10 Minimally invasive hip
arthroplasty
11 Emergencydepartment fast-track
system
12 Stereotactic
radiosurgery: an
update
13 Hyperbaric oxygen
therapy - recent
findings
14 Effectiveness of
computerized
physician order entry
systems
15 Prolotherapy
HTA Initiatives
Proposed introduction of a new surgical
technique into CHR; interest in data on safety,
efficacy, cost
What does the literature say about the
effectiveness of emergency department fast-
track systems?
Information Papers
Current evidence on the effectiveness of
radiosurgery issues on out of province
referral, other indications for radiosurgery
Request from the College of Physicians and
Surgeons in relation to approvals given for
treatments by the private hyperbaric oxygentherapy service in Calgary. The College
wanted updated advice to take account of
recent studies reported in the literature.
QwikNotes
Is there any research evidence to show that
computerized physician order entry systems
reduce medication errors?
Proposed first stage in a
more extensive
assessment to be
coordinated by Calgary
Health Technology
Implementation Unit
Two previous HTAreports, one TechNoteand two Techscans(briefs), all used by AHW
Previous HTA on
hyperbaric oxygen
therapy in relation to
facilities in Alberta
The current status of prolotherapy TechNote March 1996
Update [brief] May 1998
Alberta Heritage Foundation for Medical Research
Health Technology Assessment
8
Profile of an HTA Program
The AHFMR Health Technology Assessment Unit, 2002 - 2003
Table 4: Specification of HTA products (cont’d)
Product Question/issue Related HTAUproducts
Customized Responses
16 Physiotherapy/
physical therapy
Is there any evidence of effectiveness of
community physical therapy/physiotherapy?
17 Chiropractic services Is there any evidence of effectiveness of
chiropractic services?
18 Podiatry services
19 Optometric services
What is the evidence regarding the
effectiveness of podiatry?
Is there any evidence of effectiveness of
optometric services?
Expected timelines
Expected timelines for the various products are shown in Table 5. The four HTAreports were each expected to take a year, as might be expected for reports that
incorporate major reviews. The timelines for the TechNotes varied from one to three
months, continuing the pattern for this type of product, though the initial timeline for
the cryosurgery publication was less than a month. As has been discussed elsewhere 4,
providing considered responses over such short time frames puts pressure on the
evaluation process. Requestors of TechNotes should provide very good justification for
expecting urgent responses. Both QwikNotes, as expected, had very short timelines.
The first HTA Initiative product was given a long timeline because of the expected
collaboration with the Calgary HTA program and the need to negotiate details.
Timelines for the second HTA Initiative refers to editing, review, and formatting of a
report that had already been prepared outside the Unit. A timeline of six months for
the first Information Paper was based on expected time needed to update previous
HTA reports on the topic in question. The similar timeline for the second paper
reflected the comparatively non-urgent nature of the request.
The reviews undertaken as customized responses all had a timeline of two months.
This was extremely demanding on the Unit's work program and resources.
Acceptability of very short timelines for urgent requests needs to be kept under review
so that the Unit does not become exposed to unreasonable demands. On the other
hand, the Unit has established an impressive record over the years in handling urgent
requests, and such activity has contributed substantially to its reputation.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment
9
Profile of an HTA Program
The AHFMR Health Technology Assessment Unit, 2002 - 2003
Type of technology/topic
A wide range of topics was addressed, both in terms of technologies and diseases/
conditions, continuing the pattern of a broadly-based HTA agenda, though with a focus
on non-pharmaceutical technologies.
Table 5: Expected timelines for assessment reports
Product Ex|
tin
Health Technology Assessments
01 Acupuncture: evidence from systematic reviews and meta-analyses
02 Prevalence of chronic pain: an overview
Length,
months
03 Multidisciplinary pain programs for chronic pain: evidence from
systematic reviews.
04 Suicide prevention strategies: evidence from systematic reviews.
TechNotes;
05 Cryosurgery for prostate cancer
06 Intracoronary brachytherapy
07 Osteogenic protein-1 for fracture healing
08 Trigger Point Injections for non-malignant chronic pain
09 Treatment of thoracic insufficiency syndrome with the prosthetic
titanium rib
10/00 - 10/01
5/01 - 5/02
5/01 - 5/02
2/01 - 2/02
1 /02 - 2/02,
extended to 4/02
4/02 - 5/02
10/02 - 12/02
10/02 - 12/02
10/02 - 12/02
HiHTA Initiatives
10 Minimally invasive hip arthroplasty 6/02 - late 02
1 1 Emergency department fast-track system 01/03 - 4/03
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Information Papers
12 Stereotactic radiosurgery: an update 10/01 - 4/02
1 3 Hyperbaric oxygen therapy - recent findings 1 0/02 - 4/03
12
12
12
12
1,3
1
2
2
2
5-6
3
6
6
Alberta Heritage Foundation for Medical Research
Health Technology Assessment
10
Profile of an HTA Program
The AHFMR Health Technology Assessment Unit, 2002 - 2003
Table 5: Expected timelines for assessment reports (cont’d)
Product
QwikNotes
Expected Length,
timeline months
14 Effectiveness of computerized physician order entry systems 4/02 - 4/02 <1
15 Prolotherapy 5/02 - 6/02 1
Customized Responses
16 Physiotherapy/physical therapy 10/02- 1/03 2
17 Chiropractic services 10/02-1/03 2
18 Podiatry services 10/02-1/03 2
19 Optometric services 10/02-1/03 2
Alberta Heritage Foundation for Medical ResearchHealth Technology Assessment
11
Assessment Products
Allocation to different series
Decisions to develop reports in the HTA, TechNote, and QwikNote series were
consistent with the expected complexity of the longer assessments and the perceived
urgency of advice for requestors of non-refereed reports. Two reports were published
in the HTA Initiatives series because of a wish to raise the profile of HTA in the
province and to document particular collaborative arrangements. One of the
Information Papers was a lengthy assessment report, following two previous HTAreports on the same topic. The other Information Paper was a brief review of findings
from recent HTA reports and reviews. The Customized Responses were made available
on the AHFMR web site as a non-standard group of reviews.
Some thought needs to be given to the allocation of reports to the particular series. The
products for 2002/2003 were spread over four printed series, for various reasons. This
might be confusing for users of HTAU products and unhelpful for dissemination.
Issues addressed
Issues addressed in HTAU products are indicated in Table 6. As in previous years,
safety, efficacy, and effectiveness were the most common topic areas. Eight products
made some reference to economic issues, though there were none that included
economic analysis. Four considered access issues; four Customized responses referred
to practice guidelines, and one HTA report was concerned with prevalence rates.
Unlike some assessments in previous years, there was no consideration of social or
ethical issues, though the HTA report on suicide prevention programs made somereference to social aspects.
Issues addressed in HTA products will of course depend on the questions that are being
asked. However, with some of the topics considered in the 2002/2003 products there
might have been an opportunity to broaden their scope by incorporating commentaryand perspective on social matters.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment
12
Table
6:
Issues
addressed
in
HTA
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Profile of an HTA Program
The AHFMR Health Technology Assessment Unit, 2002 - 2003
Collaborators and contractors
The HTA report on acupuncture was co-authored by a contractor who provided
important support in bringing this project to a conclusion. The products on chronic
pain were supported by input from an information sharing group that included
representation from AHW, CHR, and Capital Health Region. With the suicide
prevention program assessment, contact with Alberta Mental Health Board
representatives was related to formulation of the HTA question rather than to
collaboration. The HTA Initiatives report on the emergency department fast-track
system was written by a physician from the University of Alberta who had been a
participant in the Technology Assessment for Health Care course offered by the
Department of Public Health Sciences.
With the Customized Responses products, contracts were made with the College of
Physical Therapists of Alberta, the Alberta College of Optometrists, individuals from
the Associated Foot Clinic, and the College of Chiropractors of Alberta. The contractors
were used to review the selected abstracts. This was a useful approach to obtain
expertise in the subject areas and to assist the HTAU with its workload.
A librarian from the University of Calgary provided IS support for the project on
minimally invasive hip arthroplasty because of pressure on existing AHFMRarrangements and the collaboration with the Calgary HTA program. All reports in the
HTA Initiatives series were formatted and edited by an external contractor, maintaining
continuity in the production of this type of publication.
Approaches taken
Systematic reviews were undertaken for all the Health Technology Assessment reports.
One of these also had a narrative review component and in another there was analysis
of administrative and survey data. Systematic review with narrative commentary on
cost data was used for the Information Paper on radiosurgery.
Two of the TechNotes were said to be based on systematic review, two on narrative
review, and one on a mix of both approaches. Narrative review was used for the two
HTA Initiative products and the second Information Paper.
The approaches taken appear to have been appropriate and there are no obvious areas
of concern. The distinction between systematic and narrative review may not always be
entirely clear - even with the narrative reviews used for some products there wouldhave been careful consideration of selection criteria and appraisal of quality. A point
that deserves continuing attention is the depth of review and analysis needed to
appropriately answer the question that an HTA is addressing.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment16
Profile of an HTA Program
The AHFMR Health Technology Assessment Unit, 2002 - 2003
With the Customized Responses, the approach was to review selected abstracts of
systematic reviews on the different topics. This was a pragmatic approach adopted to
meet the time and scope pressures associated with these products. Abstract review wasalso used for the two QwikNotes.
There was external review of all HTA series reports, one Information Paper, the HTAInitiatives report on hip arthroplasty, and two TechNotes. With the four Customized
Responses there was external review of the articles selected. The number of reviewers
used varied from product to product. Detailed internal review by HTAU staff wasundertaken for all products.
Timelines
Table 7 gives details of actual timelines for the assessment products. Targets were metfor all the urgently required products (TechNotes, QwikNotes, and Customized
Responses). This was an impressive level of performance by the HTAU.
All of the HTA series reports took longer than expected. With the two on chronic pain,
delay was in part associated with the necessity to interact with an external group andwith time taken to define some aspects of the project. The project on acupuncture wasused as a Teaming experience' for a person on a short-term placement with the HTAU,and there were overheads associated with necessary mentoring. Protracted
negotiations with the client were needed with the project on suicide prevention
strategies.
It is not uncommon for more complex HTA projects to run over time; management of
factors contributing to delay will be an ongoing task. Provision of interim advice to
clients, as was undertaken for the products referred to here, may be helpful. However,an area that may need attention is the time taken for review and publication of longer
reports, which ran to five months for three of the HTA products.
The remaining products were completed as expected, other than a small overrun caused
by delay in starting the Information Paper on radiosurgery.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment17
Table
7:
Eventual
timelines
for
HTA
products
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for
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Health
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Table
7:
Eventual
timelines
for
HTA
products
(cont’d)
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Heritage
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Health
Technology
Assessment
Profile of an HTA Program
The AHFMR Health Technology Assessment Unit, 2002 - 2003
Conclusions reached in HTA products
Table 8 lists brief summaries of the conclusions reached in the various HTA products as
well as the questions or issues that they addressed. In most cases, the conclusions
reached appeared to match the questions asked, though occasionally some points were
not covered or additional issues were mentioned.
Table 8: Conclusions reached in HTA products
Product Question/Issue Conclusions “In a word”
01 Acupuncture:
evidence from
systematic
reviews and
meta-analyses
‘For which conditions
acupuncture has
scientific support’
(effectiveness, for
whom, by whom).
Acupuncture appears effective for Conditional
dental and temporomandibular support, somepain and antiemesis. For all other applications.
indications it is no more effective
than the standard of care or the
evidence is too weak to drawconclusions.
02 Prevalence of
chronic pain: an
overview
Best available
evidence on
prevalence estimates
for pain not related to
cancer.
Reported chronic pain prevalence Limited useful
estimates vary widely (10.1% to evidence, need
55.2%) and severe chronic pain local data,
prevalence is 8% in children and11% in adults. Prospective
epidemiological studies should be
conducted to estimate the chronic
pain prevalence in Alberta.
03 Multidisciplinary
pain programs for
chronic pain:
evidence from
systematic
reviews
Evidence on the
efficacy/effectiveness/
efficiency of
multidisciplinary pain
programs for non-
malignant chronic pain
and how do weestablish provincial
needs for a
multidiscipline pain
program?
f1
Unclear which treatment (within
the multidisciplinary pain
programs) is responsible for the
observed improvements in chronic
pain patients or which kind of
patients do best under a particular
individualized treatment plan.
RHAs providing management of
chronic pain must establish
appropriate data collection
systems and assess both clinical
effectiveness of intervention
strategies and their efficiency.
Effectiveness
not established,
local studies
needed.
04 Suicide
prevention
strategies:
evidence from
systematic
reviews.
What suicide
prevention strategy is
effective?
No single strategy is effective in
reducing suicide rate. Thestrongest evidence indicated that
some prevention strategies,
including school-based suicide
prevention programs for high risk
students and psychological/
pharmacological treatment for
suicide attempters, appear
promising.
Limited
effectiveness for
some strategies,
efficacy not
established for
others.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment21
Profile of an HTA Program
The AHFMR Health Technology Assessment Unit, 2002 - 2003
Table 8: Conclusions reached in HTA products (cont’d)
05 Cryosurgery for
prostate cancer
06 Intracoronary
brachytherapy
07 Osteogenic
protein-1 for
fracture healing
08 Trigger point
injections for
non-malignant
chronic pain
09 Treatment of
thoracic
insufficiency
syndrome with
the prosthetic
titanium rib
Question/issue
What is the status of
cryosurgery for the
treatment of prostate
cancer?
The current status of
the use of
intracoronary
brachtherapy for
patients with in-stent
restenosis after PTCA.
Regulatory status in
Canada and the US for
patient groups; current
practice in Canada;
and evidence
supporting its use and
on adverse effects.
The efficacy/effectiveness of
cryosurgery in the management of
prostate cancer is still not
established.
Evidence from six RCTs suggests
that the technology is feasible and
safe as an adjunct to treatment of
in-stent restenosis, and reduces
short term restenosis rates.
However, late thrombosis mayminimize the long-term benefits.
Evidence from one RCTsuggested osteogenic protein-1
was safe and success rates whenused in conjunction with
intramedullary rod fixation were
comparable with those achieved
with autograft for the treatment of
tibial non-unions. It is indicated for
use in recalcitrant long bone non
unions where autograft is
unfeasible and alternative
treatment has failed.
Is trigger point injection
effective for treating
chronic pain? What is
the feasibility of
delivering this
procedure to patients
in regional
communities?
No definitive proof that trigger
point injection is more effective
than acupuncture or placebo. Not
known whether a lack of multi-
disciplinary pain managementprograms in regional areas limits
or encourages its use, or what
type of provider would achieve
best results.
Safety and efficacy/
effectiveness to treat
patients with thoracic
insufficiency
syndrome; whether
procedure is
experimental; patient
conditions eligible for
this treatment; numberof surgeries/
hospitalizations
needed during the
treatment.
No major safety issues were
I
identified; early efficacy outcomes
suggest that it may be a viable
treatment option for children with
thoracic insufficiency. However,
the procedure is costly and
requires frequent hospital visits for
extension and eventual
replacement of the device. Its
effect on pain and quality of life is
unknown.
Efficacy not
established.
Short term
safety andefficacy
established,
long term
efficacy unclear.
Appears to besafe and
effective
technology.
;
Efficacy not
established.
Emergingpromising
technology,
efficacy not
established.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment
22
Profile of an HTA Program
The AHFMR Health Technology Assessment Unit, 2002 - 2003
Table 8: Conclusions reached in HTA products (cont’d)
Product Question/Issue Conclusions
10 Minimally
invasive hip
arthroplasty
Proposed
introduction of a newsurgical technique;
interest in data on
safety, efficacy,
cost.
Offers the promise of lower
morbidity, shorter hospital stay,
cost savings, faster recovery.
However, further studies andexperience will be necessary to
establish its place in routine care.
11 Emergencydepartment fast-
track system
12 Stereotactic
radiosurgery: an
update
Effectiveness of
emergencydepartment fast-
track system.
Current evidence on
the effectiveness of
radiosurgery, taking
into consideration
out of province
referral and newerindications for SRS.
I
|
1
13 Hyperbaric
oxygen therapy -
recent findings
Updated advice oneffectiveness of
hyperbaric oxygentherapy in different
applications, to take
account of recent
studies reported in
the literature.
Emergency department fast-track
system, as an adjunct to
emergency departments, appears
to be efficient, cost-effective, safe
and satisfactory to patients. It
should incorporate timely andaccurate reporting of visits to
patients’ primary care physicians.
SRS should continue to be madeavailable to appropriately selected
patients with metastatic disease,
arteriovenous malformations andacoustic neuroma; it should not
be offered for treatment of
Parkinson’s disease, trigeminal
neuralgia or epilepsy. Anyreferral of patients for SRS should
be to centres of excellence, taking
account of other appropriate
treatment options.
There is support for use of
hyperbaric oxygen therapy for
decompression sickness, gasembolism, gas gangrene, carbon
monoxide poisoning,
osteoradionecrosis, diabetic
wounds, and necrotising soft
tissue infections. There is no
consensus on support for its usein osteomyelitis, thermal burns,
soft tissue radionecrosis,
compromised skin grafts, andmany other conditions.
“In a word”
Emergingpromising
technology, not
yet established.
Effective
technology
Conditional
support, someapplications.
Conditional
support, someapplications.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment23
Profile of an HTA Program
The AHFMR Health Technology Assessment Unit, 2002 - 2003
Table 8: Conclusions reached in HTA products (cont’d)
Question/Issue
14 Effectiveness of
computerized
physician order
entry systems
(CPOE)
Is there any
research evidence
to show that
computerized
physician order
entry systemsreduce medication
errors?
Evidence from three RCTsindicated that medical errors
decreased after implementation of
CPOE system. CPOE systemsare likely most effective when part
of an electronic medical record
system allowing full access to a
patient’s clinical information.
Effective
technology.
15 Prolotherapy The current status of
prolotherapy.
Results of abstracts of three
RCTs noted - no conclusions
provided.
Ineffective
technology.
16 Physiotherapy/
physical therapy
17 Chiropractic
services
18 Podiatry services
19 Optometric services
Is there anyevidence of
effectiveness of
these services?
No overall conclusions,
documents summarized findings/
conclusions in reviewed
abstracts. However, available
data indicate that there is such
evidence.
;| ’
1
;
;
Widely usedhealth services,
essential in
numerousapplications.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment
24
Dissemination
Brief details of approaches taken to dissemination of HTA products are given in Table 9.
Paper copies of all products were sent to the primary targets and electronic copies of all
but three were e-mailed. There seemed to be direct discussion with the primary target
in relatively few cases. Discussion was ongoing for the chronic pain products and the
suicide prevention programs report, providing some offset against the long time
needed to complete the publications. A presentation was made on one of the
QwikNotes and there was some discussion with AHW regarding the Information Paper
on radiosurgery. Potentially this is an area that could be improved, with more active
follow-up, though it is appreciated that this is not always easy to arrange and that it
places further demands on resources.
Wider dissemination was carried out via the standard HTAU circulation list, the
AHFMR web site, the HTA database, and the INAHTA web site in many cases. There
were also several conference presentations and in some cases secondary circulation of
products by other organizations. The invitation to publish the chronic pain prevalence
report in the International Association for the Study of Pain Clinical Updates was useful
for the dissemination process. Requests for publications and citations in other agencies'
reports give an indication of visibility (and potential secondary impact).
In just one case - the report on the emergency department fast-track system - more
elaborate short-term dissemination arrangements were made, including involvement of
the AHFMR Communications, a news release to print and electronic media, and a
media interview. The opportunity for supporting dissemination of other HTA products
is an issue that merits discussion.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment25
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Heritage
Foundation
for
Medical
Research
Health
Technology
Assessment
Table
9:
Approaches
to
dissemination
of
HTA
products
(cont’d)
Product
Primary
Target
Wider
Dissemination
Paper
E-mai!
Discussion
Person(s)
Responsible
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Heritage
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Health
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Assessment
Impact of HTA products
Tables 10 to 13 give information related to the impact of the various assessment
products. For the most part, the information reflects the direct experience of HTAUstaff in managing individual projects, and in a number of cases there is also supporting
information through documents from clients and other organizations. The data
therefore give an important "snapshot" of the impact of the HTA program, but it
should be borne in mind that there is no detailed study, for example using survey
methodology, to substantiate all the information and opinion given here.
Areas of impact
Table 10 outlines the areas of impact of HTA studies, using the categories adopted for a
project on reporting the impact of HTA reports that is currently being undertaken by
INAHTA. Only one product had no apparent impact (though this was reviewed by an
external information group). All other products were at least considered by decision
makers. In six cases, conclusions or recommendations were accepted. Material from
five products was incorporated into policy documents and 14 assessments were used as
reference material. One HTA report was linked to changes in practice and six products
had other impacts, including input to future research on the technologies considered
and expectations of future collaborations with the HTAU.
Level of impact
Table 11 includes opinions of HTAU staff on the level of impact associated with the
HTA products and gives some supporting details. Two TechNotes on cryosurgery and
intracoronary brachytherapy were thought to have had major impact on subsequent
decisions on these technologies. A further fifteen products were considered to have
provided some input to decisions. Possibly this is a conservative view, as in several
cases there appeared to have been significant developments that flowed directly from
work done on the assessment products. In one case, the product received someconsideration by a decision maker and in one the impact was minimal. The details in
the table give an indication of action taken and use of the products by different
stakeholders in the province.
Indirect impact
Table 12 gives information on indirect impacts of eight HTA products. With four of
these there was some influence on other targets within Alberta, with likely influence onfuture policy or administrative decisions. Six products were accessed by organizations
outside Alberta and provided some input to HTA activities undertaken by other
agencies.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment29
Profile of an HTA Program
The AHFMR Health Technology Assessment Unit, 2002 - 2003
Types of decisions
Table 13 gives an indication of the types of decisions that were informed by the various
HTA products, using categories from the current INAHTA project. This draws on all
available information and does not necessarily reflect the exact questions or issues that
the HTA products were required to address. Coverage decisions were the most
common, related to 10 and possibly 11 products. In four cases there were capital
funding decisions, referral for treatment in two (possibly three), program operation in
seven, guideline formulation in two, influence on routine practice in three (possibly
four), and indications for further research in five. This summary reflects the range of
issues addressed by products from the HTAU.
Overall, the picture that emerges from this summary of impacts is encouraging. While
detail was sometimes limited, it seems clear that products from the HTAU had a useful
impact in most cases, and that often this was achieved by products with very tight
deadlines.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment
30
Considered
Conclusions/
Technology
HT
A
material
HTA
used
HTA
Other
by
decision
recommendations
met
program
incorporated
as
linked
to
maker
accepted
requirements
into
policy
reference
changes
documents
material
in
X X
Alberta
Heritage
Foundation
for
Medical
Research
Health
Technology
Assessment
Profile
of
an
HTA
Program
The
AHFMR
Health
Technology
Assessment
Unit,
2002
-
2003
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Table
11:
Level
of
impact
of
HTA
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Resource and Educational Products
1. The first of the three publications in this group was the latest version of"Health
technology assessment on the net", which was first published in 1999 and has been
updated annually since then.
This is a widely known publication that has proved to be a useful resource for those
working in HTA. It has been made available through the AHFMR web site and
through hard copy and numerous other outlets. These include conference
presentations (ISTAHC and the Canadian Health Libraries Association), the HTAcourse at the University of Alberta, the National Library of Medicine's Etext on
Health Technology Assessment Information Resources (links to the guide), and
through several other web sites, for example, the NeLH (National Electronic Library
of Health), ScHARR, DACEHTA (Denmark), VATAP (USA), and the Evidence-
Based Medicine group (Italy). The authors have been responsible for dissemination.
Requests for the document have been received from all over the world. For
example, NZHTA (New Zealand) has used the guide in their training; the Health
Council of the Netherlands has recommended the guide to their staff; the Singapore
Ministry of Health has requested copies; and the Newfoundland Ministry of Health
requested copies for staff members. In Alberta, the guide has been used by
librarians at the University of Alberta John Scott Health Sciences Library and
included in their Evidence-Based Healthcare Information Resources web page.
This is a useful, ongoing activity for the HTA program that requires only limited
resources to maintain. Overall, impact would be hard to assess but certainly
AHFMR is well known as a useful source of information in this area.
2. The first of the HTA Initiatives products "Local health technology assessment: a guidefor
health authorities" was developed to assist in building HTA capacity and competence
at the local level in Alberta. Staff in RHAs were the main target. The request for the
product came from the Director of HTA, with the report seen as being
complementary to other publications in this series. It was completed in 2002 (start
July, review November, published December).
This is a guideline covering elements of HTA, based on narrative review and
commentary. Dissemination was through standard circulation procedures plus
discussion by the author with staff at Foothills Hospital, Calgary and at a workshop.
Impact of this product is hard to assess. There was interest in the document from
the CHR, with verbal advice from the Department of Surgery that it had been
helpful in considering approaches to new technologies. There has also been interest
from individuals in Italy and the Philippines, via conference contacts. It is unclear,
Alberta Heritage Foundation for Medical Research
Health Technology Assessment41
Profile of fin HTA Program
The AHFMR Health Technology Assessment Unit, 2002 - 2003
from the information available, whether there has been any additional impact within
RHAs in Alberta, which were the main target for this product.
3. The suggestion for development of the final product, "Elements of effectiveness for
health technology assessment programs" came from discussion between the author and
the Director of HTA, and followed earlier work in this area at the Department of
Public Health Sciences, University of Alberta, which had been presented at an
ISTAHC meeting. The issue addressed is the factors that define and contribute to
the effectiveness of HTA programs. It was seen as a contribution to building HTAcompetence.
The project was started in September 2002 and published in March 2003. It is an
extended commentary with a focus on HTA program effectiveness. Drafts were
given to a number of HTA contacts in Canada and elsewhere but there was no
feedback during preparation.
The primary target for this work was really the HTAU, and the immediate
consequence is the present paper. In addition to dissemination through standard
circulation methods, the work has been presented at seminars and conferences.
General interest in the approach has been expressed by agencies in Canada, the
Netherlands, and Singapore, but there is as yet no specific indication of impact.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment
42
Governance
Little information on governance was provided in the responses from HTAU staff, and
issues in this area can be dealt with only to a limited extent in a project of this sort. Amore direct and detailed approach would be needed to explore relevant issues.
With all HTA products and activities of the HTAU, reports are prepared and submitted
to the Chief Executive Officer and the Trustees on a regular basis. Regular updates are
provided to the AHFMR Health Advisory Committee and Health Research Advisory
Committee. The committees also provide advice for future opportunities and activities.
With the Customized Responses, information provided indicated that the Chief
Executive Officer and Trustees of the AHFMR were informed of the initiation and
progress of the project. Their feedback/ directive was to proceed with the project but
with the understanding that other projects would be delayed.
A positive aspect was that the need for transparency and accountability was clearly
communicated between the AHFMR and the client. It was made clear that reports
prepared by HTAU would be released at some point in the future.
The only other area related to governance was a delay in finalizing a contract associated
with the project on radiosurgery.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment43
Resources and Staff
Detailed discussion of resources and staff issues are beyond the scope of this paper and
would require detailed local input and analysis. However, some points arise from the
information made available.
There were ten authors for the assessment products, six of whom were on short-term
placements or external to the HTAU. In general, assessors were involved with a range
of topics and most had a role in preparation of longer term products. The four
permanent assessors in the HTAU were all involved in the preparation of the
Customized Responses, which would have required a substantial commitment of their
time. The HTA Resource products had three authors.
IS support was provided by the AHFMR Librarian for 10 products and by other persons
for 12. These statistics reflect the continuing requirements of the HTA program and the
limited IS support directly available from the AHFMR. One person provided other
support, which included formatting and editing of draft reports, for all the Unit's
products. This is a situation that has been with the HTAU for some time and was an
issue raised in HTAI #9 ("Is there sufficient support to provide an efficient HTA program?")1
. A contractor provided formatting and design services for four products in the HTAInitiatives series, an arrangement that worked well.
This summary takes no account of the staff resources used in internal review and
technical editing of HTA products. This is a demanding area that forms part of the
routine operation of the HTAU and contributes considerably to the quality of its output.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment
44
Synthesis
Table 14 brings together information given previously on issues addressed, policy
areas, HTA findings, and opinion on impact, to give some synthesis of overall activity.
These details give a general picture of the HTA products and their impact. There is an
overall indication of questions that were addressed and assessment findings, and the
use made of these, giving assurance of appropriate activity for the HTAU use of
assessment to inform policy decisions.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment45
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Alberta
Heritage
Foundation
for
Medical
Research
Health
Technology
Assessment
Discussion
This paper brings together many details of the performance of the HTAU at the
AHFMR as reflected in the products that were completed from April 2002 to March
2003, though it is only a partial overview. The data and commentary are based on the
information provided by HTAU staff, the publication record, and impressions obtained
by the author through periodic contact with the Unit. Further information, for example
on resources, would be needed to give a comprehensive profile and would require
additional input from within the AHFMR. There has been no detailed review of the
individual products. Nor has there been any discussion of other HTAU activities, such
as presentations at seminars and conferences.
The available information shows that there was good performance from the HTAU,with particular strengths in some of the literature reviews and in responses to urgent
requests. Output of normal types of HTA products by core staff, particularly longer
term projects, was influenced by the work on the Customized Responses.
In HTAI #9 it was suggested that important elements for an HTA program, which
contribute to its continuity, are Need for HTA, Governance, Efficiency, Quality,
Coverage, and Impact (see Figure 2).
Figure 2: Elements of Effectiveness
Efficiency Governance
)
QualityContiunity Need for
Survival HTA
Coverage Impact
Alberta Heritage Foundation for Medical Research
Health Technology Assessment
49
The information available on the HTAU for its 2002/2003 products is encouraging on
these elements:
Needfor HTA: The services of the HTAU clearly continue to be in demand from
decision makers in Alberta health care. The Customized Responses provided a
diversion from expected HTA activities.
Governance: Values appear to have been upheld. The nature and degree of interaction
of governance with the HTA program is not clear from the information available.
Continued support to ensure that requests from government are reasonable and
realistic 1 appears essential in view of pressures on the HTAU that arose during this
period.
Efficiency: Efficiency in terms of handling short-term requests was high. Efficiency
with longer term activities is less easy to assess, in part because of the involvement of
other agencies. Overall output was a product every 2.4 weeks, an HTA product every 3
weeks, and a longer HTA product every 7.4 weeks. These rates seem very acceptable.
Quality: Quality of products was not considered in any detail for this paper. Quality of
reviews appeared to be very good. Ongoing consideration on the relationship of HTAproduct content to formulation of HTA questions would be useful.
Coverage: A broad range of topics was addressed in the Unit's products, continuing the
pattern from previous years. The balance between follow-up assessments and newtopics will continue to be an issue to monitor.
Impact: Many products had a useful impact on decision making.
Some areas that deserve consideration in future management of the HTAU are listed
below. Several of them are issues that have been around for some time and may need
ongoing management rather than definitive resolution.
• Balance of long-term and short-term projects. Most of the products for 2002/2003 were
either long-term assessments or responses to urgent requests. There was not muchmiddle ground.
• Allocation to series. HTA products were spread over four printed series, for various
reasons. This might be confusing for users of HTAU products.
• Acceptability of very short timelines for "urgent" requests needs to be kept under
review so that the Unit does not become exposed to unreasonable demands.
• The time taken for review and printing of longer reports should be monitored.
• The levels of analysis needed in assessment products to appropriately address the
questions or issues raised should be kept under review.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment
50
• There may be an opportunity to usefully broaden the scope of assessment activities,
for example through consideration of social issues.
• The resource products are a useful component of the Unit's output, but it is hard to
judge their overall impact.
• The limited support from within the AHFMR for dissemination activities is an issue
that requires discussion.
• Support staff resources for the HTAU are modest. This appears to be an area of
vulnerability.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment51
Profile of an HTA ProgramThe AHFMR Health Technology Assessment Unit, 2002 - 2003
Appendices
Appendix A: Publication product series produced by the
HTAU
Health Technology Assessments: Comprehensive appraisals of health technologies;
providing a synthesis of data from the literature or reporting on empirical studies.
Subject to external review.
TechNotes: Brief responses to requests for rapid advice, with limited analysis. These
are not subject to external review.
Information Papers: Publications providing information on health technology topics.
No assessments.
Health Technology Assessment Initiatives: Publications with the primary aim of
introducing and integrating an applied HTA process into a RHA's program operations.
QwikNotes: Very rapid responses to urgent requests, with limited assessment,
provided electronically.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment53
Appendix B: Information Collection Form
HTAU profile, 2003
Title: AHFMR contact:
Origin of request:
FORMULATION OF THE QUESTION
Date of request:
What was the question/issue?
Expected timeline:
Was there discussion to
confirm issue/approach?
Any relationship to other
reports (AHFMR or other?)
HTA PRODUCT
Type (series) Reason for this type of report?
Authors:
Any external collaboration?
IS support: Other support:
(indicate who, why, role)
Was collaboration through contract, other agency, free advice/
input, other?
Start date: Review date: Publication date:
Approach [tick one or more]:
- systematic review
- narrative review
- admin, data analysis
- cost/economic analysis
Issues addressed [tick one or Reviewers:
more]:
- safety
- efficacy
- effectiveness
- survey- economic impact
- other- access
- social
- ethical
- other
Alberta Heritage Foundation for Medical Research 54Health Technology Assessment
Profile of an HTA Program
The AHFMR Health Technology Assessment Unit, 2002 - 2003
Report title
DISSEMINATION
Approach for primary target: Mail paper copy
Approaches for wider
dissemination
Face to face discussion
Longer dialog
Other
Standard circulation list,
newsletter, web site
HTA database
INAHTA web site
Media release/conference
Meeting/seminar
Conference presentation
Other
Persons involved in
dissemination
Author(s) (Details)
Other HTAU
Other AHFMR
External to AHFMR
GOVERNANCE, RESOURCES, STAFF & STRUCTURE
Any information or issues regarding this HTA related to Governance (e.g. CEO, Board of Trustees,
Minister), Resources, Staff and Structure of HTAU?
Alberta Heritage Foundation for Medical Research
Health Technology Assessment
55
Profile of an HTA Program
The AHFMR Health Technology Assessment Unit, 2002 - 2003
Report title
General opinion on impact
(GIVE DATE FOR THISENTRY)
What were main indications of
impact?
Were there any indications of
impact on other organizations
or individuals?
Have there been any requests
for follow up HTA work on this
topic?
IMPACT
1 . Minimal Was there any impact on the maintarget?
2. Some consideration of
HTA
3. Some input to decisions
4. Major influence ondecisions
[Tick one or more] (Details)
1 . No apparent impact
2. HTA considered bydecision - maker
3. HTA recommendations/
conclusions accepted
4. HTA demonstrated that
technology met specific
program requirements
5. HTA material incorporated
into policy or administrative
documents
6. HTA information used as
reference material
7. HTA linked to changes in
practice
8. Other [please specify]
(Details)
Alberta Heritage Foundation for Medical Research
Health Technology Assessment
56
References
References
1. Hailey D. Elements ofeffectiveness for Health Technology Assessment programs.
Edmonton: Alberta Heritage Foundation for Medical Research. HTA Initiative #9,
March 2003.
2. TurnKey Management Consulting. A study of the impact of 2000-2001 HTA products.
Edmonton: Alberta Heritage Foundation for Medical Research. Information Paper
IP-11, January 2002.
3. Howard Research and Instructional Systems Inc. A Study of the impact of2001-2002
Health Technology Assessment products. Tinal Report. Edmonton: Alberta Heritage
Foundation for Medical Research. Information Paper IP-15, June 2003.
4. Hailey D, Corabian P, Harstall C, Schneider W. The use and impact of rapid
health technology assessments. International Journal of Technology Assessment in
Health Care 2000; 16(2):651-56.
Alberta Heritage Foundation for Medical Research
Health Technology Assessment58
Bibliotheque nationale du Canada