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HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

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Page 1: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

HTA Activities in Australia and New Zealand

Catherine VoutierCentre for Clinical Effectiveness

Page 2: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

The overview

An overview of Health Technology Assessment (HTA) in Australia and New Zealand. In this presentation, the organisations currently involved in HTA activities will be described, including a brief history, along with the various projects they are involved in.

Page 3: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

Why do clinical librarians need to know about HTA?

Many clinicians do not know the term or understand how it affects their decision-making

HTA also covers interventions where there may be a low level of evidence

HTA considers the context in which the intervention is to be utilised

Has a great impact in the development of other activities

Page 4: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

What is Health Technology Assessment (HTA)?

Systematic evaluation by interdisciplinary groups Explicit analytical frameworks drawing from a variety

of methods Properties, effects, and/or impacts of health care

technology (drugs, surgical techniques, tools etc) Direct, intended consequences of technologies Indirect, unintended consequences Its main purpose is to inform technology-related

policymaking in health care. HTA 101 Glossary National Information Center on Health Services Research and Health Care

Technology (NICHSR), NLM. http://www.nlm.nih.gov/nichsr/hta101/ta101014.html Accessed 23.06.06

Page 5: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

Evolution of HTA in Australasia

Pharmaceutical Benefits Advisory Committee (PBAC) – established 1954

National Health Technology Advisory Panel (NHTAP) – early 1980’s

Australian Health Technology Assessment Committee (AHTAC) – 1986

(Pharmaceutical Management Agency (PHARMAC) – 1993 (fully estab. 2000)

NZHTA established - 1997 Medical Services Advisory Committee (MSAC) - 1997/98 Other HTA groups begin forming

Page 6: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

NZHTA – New Zealand Health Technology Assessment

Established in 1997 by the New Zealand Ministry of Health to assist NZ Health and Disability Services

Produces a range of assessments such as systematic reviews, technical briefs, and horizon scanning for HealthPACT. Conducts assessments for MSAC, the Accident Compensation Corporation, NZ Guidelines Group and others

Involved in regional activities: Clinical Decision Support Unit, Clinical Practice Committee

Employs a medical librarian

Page 7: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness
Page 8: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

NZHTA Publications for MSAC

– Implantable cardioverter defibrillators for prevention of sudden cardiac death

– Cardiac resynchronisation therapy for severe heart failure

– The use of INR point-of-care testing in general practice

– CEA-Scan for imaging recurrence &/or metastases in patients with histologically demonstrated carcinoma of the colon or rectum

Page 9: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

Other NZHTA Publications

Technical ReviewsThe effectiveness of interventions to promote fruit and vegetable intake in school-aged children - April 2006Effective models of mental health service provision and workforce configuration in the primary care setting - Feb 2006

Systematic ReviewsSystematic review of the health effects of modified smokeless tobacco products - Feb 2007

Screening strategies for antenatal Down Syndrome screening. A systematic review of the literature - Nov 2006

Page 10: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

MSAC – Medical Services Advisory Committee

Established in 1997-98, the Committee advises the Minster of Health and Ageing of the cost-effectiveness, safety and effectiveness of new procedures and technologies presented for Medicare funding

Compliments the activities of:– Medicare Benefits Consultative Committee– Pathology Services Table Committee– Consultative Committee on Diagnostic Imaging

Page 11: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

MSAC – Terms of Reference

Advises the Minister on– Strength of evidence of new and emerging

technologies/procedures and to what extent public funding should be supported

– What technologies/procedures should be given interim funding in order to collect enough evidence to determine effectiveness

– Report references of new and emerging technologies and procedures

Undertake HTAs referred by the Australian Health Ministers’ Advisory Council (AHMAC) and report to same

Page 12: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness
Page 13: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

MSAC Review Cycle

Eligibility– The Department of Health and Ageing decides if

the application is eligible for assessment by MSAC

Assessment– MSAC contracts out the majority of HTAs. An

assessment protocol is developed and a specialist advisory panel is created to assist in the process

Page 14: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

MSAC Review Cycle

Formulation of Advice to the Minister– MSAC presents the assessment, Department opinion and

MSAC recommendations to the Minister

Decision– The Minister, with the material presented, either rejects or

accepts the recommendations. To date, all recommendations have been endorsed

Implementation– The appropriate committee decides on funding levels

Page 15: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

MSAC - Publications

Applications (under review)– Autologous cartilage implantation (ACI) – Hepatitis B DNA testing – Lumber non-fusion posterior stabilisation devices

Completed Assessments– Advanced breast biopsy instrumentation – Visual electrodiagnosis

Page 16: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

HealthPACT – MSAC subcommittee

HealthPACT – Health Policy Advisory Committee on Technology

– Terms of reference: to assist the introduction of new and emerging medical technologies into the public sector, provide a forum for national and international discussion, inform AHMAC, and supported by the National Horizon Scanning Unit. Comprises members from MSAC, ASERNIP-S, DoHA and the New Zealand Ministry of Health

– Is a key operator of the Australia and New Zealand Horizon Scanning Network (ANZHSN), an initiative of MSAC, the Australian Government Department of Health and Ageing and all Australian Health Ministers' Advisory Council (AHMAC) jurisdictions.

Page 17: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

PBAC- Pharmaceutical Benefits Advisory Committee

Established in 1954, PBAC advises the Minister of Health and Ageing on which pharmaceuticals and other products should attract pharmaceutical benefits

PBAC recommendations assess the effectiveness and cost of proposed benefits as well as possible restrictions and supply issues

PBAC recommendations (medicines only) are made available as Public Summary Documents (PSDs) on the Department of Health and Ageing website

Page 18: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

IMS Pricing & Market Access (P&MA)

Established in 1995 and part of IMS Health from 2005, P&MA (formerly known as M-TAG) provides services to PBAC, MSAC and various other bodies both local and international.

– Staff serve on an evaluation panel similar to MSAC for the Commonwealth Government

Main role is to present reimbursement applications to PBAC and to date, has supplied over 200 applications.

Employs a medical librarian

Page 19: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness
Page 20: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

HTAnalysts - Sydney

Similar services to IMS P&MA Public and private clients Specialises in

– PBAC reimbursement applications – MSAC applications for medical services, devices,

procedures and diagnostic tests Conducts clinical, basic and applied research http://www.htanalysts.com/index.htm

Page 21: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness
Page 22: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

ASERNIP-S

Australian Safety and Efficacy of New Interventional Procedures – Surgical– Supported by Australasian College of Surgeons

Assesses new and emerging surgical technologies & techniques via– Horizon Scanning– Systematic Reviews of the literature– Clinical and research audits/trials– Clinical guidelines

Page 23: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness
Page 24: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

ASERNIP-S Publications

Systematic reviews:– Surgical simulation: a systematic review (update),

August 2006 – Paravertebral blocks for anaesthesia and

analgesia: A Systematic Review, January 2006 NETS:

– Artificial cervical disc replacement(update)

– Injection snoreplasty

Page 25: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

AHTA - Adelaide Health Technology Assessment

Established in 2001, AHTA provides evidence-based assessments on a variety of technologies, services and procedures

Specialised systematic literature reviews for PBAC, MSAC, NICS, NHMRC and others

Guideline development Horizon scanning Information needs supported by the University

Library

Page 26: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness
Page 27: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

AHTA Publications

Systematic reviews– Vertebroplasty August 2005

Critical Appraisal– NHMRC review of “Clinical practice guidelines for stroke recovery

rehabilitation and recovery (National Stroke Foundation)”. June 2005.

– NHMRC GAR consultant review of “Management of diabetic retinopathy (Australian Diabetes Society)”. August 2003 – 2005

Horizon Scanning – Microvolt T-wave alternans for the determination of patients likely

to benefit from ICD therapy (Feb 2007)– Available from the Australian and New Zealand Horizon Scanning

Network, http://www.horizonscanning.gov.au/

Page 28: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

CCE – Centre for Clinical Effectiveness

CCE and the Australasian Cochrane Centre underwent organisational restructuring in early 2005. This resulted in the CCE HTA team moving to Cochrane. CCE HTA reports can still be found on the MSAC Publications web page.

Page 29: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

About me

Research Officer (Information) at CCE:– Searching/information retrieval – Assists staff in their research projects (this may include

appraising guidelines, copy editing, investigating copyright issues etc)

– Collaborates with other librarians on various projects

Questions? Please come to see me afterwards at break. I have a hearing impairment so I won’t be taking questions from the audience.

Page 30: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

Thank you

AcknowledgementsPip Dival and Sarah Sutton for inviting me to join

you here today, Becky Skidmore, Susan Bidwell (HTA librarians) and Janet Hiller (AHTA) – for their advice and encouragement.

Page 31: HTA Activities in Australia and New Zealand Catherine Voutier Centre for Clinical Effectiveness

Websites

NZHTA– http://nzhta.chmeds.ac.nz/index.htm

MSAC– http://www.msac.gov.au

AHTA– http://www.health.adelaide.edu.au/publichealth/consult/

health_technol_assess.html ASERNIP-S

– http://www.surgeons.org/Content/NavigationMenu/Research/ASERNIPS/default.htm

INAHTA– http://www.inhata.org

IMS P&MA– http://www.m-tag.net