Developing a How-to-Guide for Health Technology Reassessment: “The HTR Playbook”

Document Type : Original Article

Authors

1 Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

2 Health Technology Assessment Unit, O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada

3 Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia

4 Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia

5 Alberta Health Services, Calgary, AB, Canada

6 International Decision Support Initiative, London, UK

7 Global Health and Development Group, School of Public Health, Imperial College London, London, UK

Abstract

Background 
To develop a knowledge translation (KT) tool that will provide guidance to stakeholders actively planning or considering implementation of a health technology reassessment (HTR) initiative.

Methods 
The KT tool is an international and collaborative endeavour between HTR researchers in Canada, Australia, and the United Kingdom. Evidence from a meta-review of documented international HTR experiences and approaches provided the conceptual framing for the KT tool. The purpose, audience, format, and overall scope and content of the tool were established through iterative discussions and consensus. An initial version of the KT tool was beta-tested with an international community of relevant stakeholders (ie, potential users) at the Health Technology Assessment International 2018 annual meeting.

Results 
An open access workbook, referred to as the HTR playbook, was developed. As a KT tool, the HTR playbook is intended to simplify the complex HTR planning process by navigating users step-by-step through 6 strategic domains: characteristics of the candidate health technology (The Stats and Projections), stakeholders to engage (The Team), potential facilitators and/or barriers within the policy context (The Playing Field), strategic use of different levers and tools (The Offensive Plays), unintended consequences (The Defensive Plays), and metrics and methods for monitoring and evaluation (Winning the Game).

Conclusion 
The HTR playbook is intended to enhance a user’s ability to successfully complete a HTR by helping them systematically consider the different elements and approaches to achieve the right care for the patient population in question.

Keywords


  1. Sevick K, Soril LJJ, MacKean G, Noseworthy TW, Clement Unpacking early experiences with health technology reassessment in a complex healthcare system. Int J Healthc Manag. 2020;13:2:156-162. doi:10.1080/20479700.2017.1337679
  2. Pant S, Boucher M, Frey N. Health Technology Reassessment: An Overview of Canadian and International Processes. Ottawa: Canadian Agency for Drugs & Technologies in Health (CADTH); 2019.
  3. Scott IA, Duckett SJ. In search of professional consensus in defining and reducing low-value care. Med J Aust. 2015;203(4):179-181. doi:5694/mja14.01664
  4. Elshaug AG, Rosenthal MB, Lavis JN, et al. Levers for addressing medical underuse and overuse: achieving high-value health care. Lancet. 2017;390(10090):191-202. doi:1016/s0140-6736(16)32586-7
  5. Colla CH, Mainor AJ, Hargreaves C, Sequist T, Morden N. Interventions aimed at reducing use of low-value health services: a systematic review. Med Care Res Rev. 2017;74(5):507-550. doi:1177/1077558716656970
  6. Elshaug AG, McWilliams JM, Landon BE. The value of low-value lists. JAMA. 2013;309(8):775-776. doi:1001/jama.2013.828
  7. McGinnis JM, Stuckhardt L, Saunders R, Smith M. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington, DC: National Academies Press; 2013.
  8. Expert Panel on effective ways of investing in Health (EXPH), Christian Anastasy PB, Barry M, et al. Defining Value in “Value-Based Healthcare.” Luxembourg: European Commission; 2019.
  9. Bryan S, Mitton C, Donaldson C. Breaking the addiction to technology adoption. Health Econ. 2014;23(4):379-383. doi:1002/hec.3034
  10. Mayer J, Nachtnebel A. Disinvesting from ineffective technologies: lessons learned from current programs. Int J Technol Assess Health Care. 2015;31(6):355-362. doi:1017/s0266462315000641
  11. Seo HJ, Park JJ, Lee SH. A systematic review on current status of health technology reassessment: insights for South Korea. Health Res Policy Syst. 2016;14(1):82. doi:1186/s12961-016-0152-x
  12. Niven DJ, Mrklas KJ, Holodinsky JK, et al. Towards understanding the de-adoption of low-value clinical practices: a scoping review. BMC Med. 2015;13:255. doi:1186/s12916-015-0488-z
  13. Leggett L, Noseworthy TW, Zarrabi M, Lorenzetti D, Sutherland LR, Clement FM. Health technology reassessment of non-drug technologies: current practices. Int J Technol Assess Health Care. 2012;28(3):220-227. doi:1017/s0266462312000438
  14. Noseworthy T, Clement F. Health technology reassessment: scope, methodology, & language. Int J Technol Assess Health Care. 2012;28(3):201-202. doi:1017/s0266462312000359
  15. MacKean G, Noseworthy T, Elshaug AG, et al. Health technology reassessment: the art of the possible. Int J Technol Assess Health Care. 2013;29(4):418-423. doi:1017/s0266462313000494
  16. Soril LJ, MacKean G, Noseworthy TW, Leggett LE, Clement FM. Achieving optimal technology use: a proposed model for health technology reassessment. SAGE Open Med. 2017;5:2050312117704861. doi:1177/2050312117704861
  17. Elshaug AG, Hiller JE, Tunis SR, Moss JR. Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices. Aust New Zealand Health Policy. 2007;4:23. doi:1186/1743-8462-4-23
  18. Haas M, Hall J, Viney R, Gallego G. Breaking up is hard to do: why disinvestment in medical technology is harder than investment. Aust Health Rev. 2012;36(2):148-152. doi:1071/ah11032
  19. Polisena J, Clifford T, Elshaug AG, Mitton C, Russell E, Skidmore B. Case studies that illustrate disinvestment and resource allocation decision-making processes in health care: a systematic review. Int J Technol Assess Health Care. 2013;29(2):174-184. doi:1017/s0266462313000068
  20. Daniels T, Williams I, Robinson S, Spence K. Tackling disinvestment in health care services. The views of resource allocators in the English NHS. J Health Organ Manag. 2013;27(6):762-780. doi:1108/jhom-11-2012-0225
  21. Moore AE, Straus SE, Kasperavicius D, et al. Knowledge translation tools in preventive health care. Can Fam Physician. 2017;63(11):853-858.
  22. Esmail R, Hanson H, Holroyd-Leduc J, Niven DJ, Clement F. Knowledge translation and health technology reassessment: identifying synergy. BMC Health Serv Res. 2018;18(1):674. doi:1186/s12913-018-3494-y
  23. Soril LJJ, Seixas BV, Mitton C, Bryan S, Clement FM. Moving low value care lists into action: prioritizing candidate health technologies for reassessment using administrative data. BMC Health Serv Res. 2018;18(1):640. doi:1186/s12913-018-3459-1
  24. Hodgetts K, Hiller JE, Street JM, et al. Disinvestment policy and the public funding of assisted reproductive technologies: outcomes of deliberative engagements with three key stakeholder groups. BMC Health Serv Res. 2014;14:204. doi:1186/1472-6963-14-204
  25. Chalmers K, Pearson SA, Badgery-Parker T, Brett J, Scott IA, Elshaug AG. Measuring 21 low-value hospital procedures: claims analysis of Australian private health insurance data (2010-2014). BMJ Open. 2019;9(3):e024142. doi:1136/bmjopen-2018-024142
  26. Schwartz AL, Landon BE, Elshaug AG, Chernew ME, McWilliams JM. Measuring low-value care in Medicare. JAMA Intern Med. 2014;174(7):1067-1076. doi:1001/jamainternmed.2014.1541
  27. Medicare Benefits Schedule Review Taskforce. An MBS for the 21st Century: Recommendations, learnings and Ideas for the future: Final report to the Minister for Health. https://www.health.gov.au/resources/publications/medicare-benefits-schedule-review-taskforce-final-report. Published December 2020.
  28. Glassman A, Giedion U, Smith PC. What's In, What's Out? Designing Benefits for Universal Health Coverage. Washington, DC: Center for Global Development; 2017.
  29. Isaranuwatchai W, Archer RA, Teerawattananon Y. Non-Communicable Disease Prevention: Best Buys, Wasted Buys and Contestable Buys. Open Book Publishers; 2019.
  30. Aromataris E, Fernandez R, Godfrey CM, Holly C, Khalil H, Tungpunkom P. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc. 2015;13(3):132-140. doi:1097/xeb.0000000000000055
  31. Soril LJJ, Niven DJ, Esmail R, Noseworthy TW, Clement FM. Untangling, unbundling, and moving forward: framing health technology reassessment in the changing conceptual landscape. Int J Technol Assess Health Care. 2018;34(2):212-217. doi:1017/s0266462318000120
  32. Choosing Wisely Canada. Recommendations and Resources, by Specialty. 2018. https://choosingwiselycanada.org/recommendations/.
  33. The Commonwealth Fund. International Health Care System Profiles. 2016. http://international.commonwealthfund.org. Accessed May 18, 2018.
  34. Esmail R, Hanson HM, Holroyd-Leduc J, et al. A scoping review of full-spectrum knowledge translation theories, models, and frameworks. Implement Sci. 2020;15(1):11. doi:1186/s13012-020-0964-5
  35. Calabrò GE, La Torre G, de Waure C, et al. Disinvestment in healthcare: an overview of HTA agencies and organizations activities at European level. BMC Health Serv Res. 2018;18(1):148. doi:1186/s12913-018-2941-0
  36. Elshaug AG, Moss JR, Littlejohns P, Karnon J, Merlin TL, Hiller JE. Identifying existing health care services that do not provide value for money. Med J Aust. 2009;190(5):269-273. doi:10.5694/j.1326-5377.2009.tb02394.x
  37. Choosing Wisely. The Choosing Wisely Lists. 2017. http://www.choosingwisely.org/doctor-patient-lists/. Accessed June 13, 2016.
Volume 11, Issue 11
November 2022
Pages 2525-2532
  • Receive Date: 10 March 2021
  • Revise Date: 29 October 2021
  • Accept Date: 28 December 2021
  • First Publish Date: 29 December 2021