Pilot project on mini-HTA in the Western Norway Regional Health Authority
3-page executive summary
As a follow-up on the National Health Plan for Norway (2007-2010), the regional health authorities are asked to review the decision-making processes around investments of expensive medical equipments and drugs. The goal is to establish common routines for such processes. As part of this work, the Norwegian Know-ledge Centre for the Health Services was asked by the Western Norway Regional Health Authority to develop a mini-HTA system applicable to the Norwegian health care system.
Mini-HTA is a tool designed to support decision-making processes and visualize consequences of introducing new health technologies into hospitals. Mini-HTA elucidates the best available research evidence and is meant to form a part of the decision basis when considering introducing a new health technology. The aim of the mini-HTA is to contribute to more uniform and evidence-based decision-making processes, within acceptable resource use in the organization.
The commission from the Western Norway Regional Health Authority was to develop a mini-HTA system applicable to the Norwegian health care system.
The objectives were as follows:
1. To prepare a report on existing international mini-HTA systems.
2. To develop a Norwegian version of a mini-HTA form and system.
3. To pilot test the mini-HTA form and system in a clinical setting in the Western Norway Regional Health Authority (Haukeland University Hospital and Stavanger University Hospital).
4. To arrange a conference on mini-HTA.
In this report we describe the preparation of the mini-HTA form, the pilot testing of the mini-HTA form and system in the Western Norway Regional Health Authority and the evaluation of the mini-HTA pilot project.
We have developed a Norwegian version of a mini-HTA form and system. To explore the performance of mini-HTA in a clinical setting, a pilot study was carried out at two university hospitals in the Western Norway Regional Health Authority. Six health technologies were evaluated in the pilot study, of which four were completed and two partially completed. Based on this pilot study, our conclusion is that the revised mini-HTA form can be used in its current form, although improvements might be necessary.
Concerning the mini-HTA system, we will emphasize the following elements as important to consider when introducing a mini-HTA into the health care system:
• Anchor the mini-HTA system in the management.
• Establish local resource groups for support functions (librarian, health-economist, and people with HTA expertise).
• Establish a national resource service which can coordinate the work on mini-HTA, contribute with methodological support and educate the resource groups.
• Allocate the responsibility for the literature search and cost estimates to the resource group.
• Specify how extensive the preparation of a mini-HTA should be, particular in terms of time and content.
• Establish good procedures for peer reviewing of completed mini-HTAs. Peer reviewer can either be a member of another local resource group or a clinician from another department or hospital.
• Ensure good information and clear communication about the purpose of mini-HTA and provide courses on mini-HTA.
• Establish a national database of on-going and completed mini-HTAs. The MedNytt database is suitable for this purpose.
• Clarify the role of mini-HTA in decision-making processes locally at the hospitals.
• Make guidelines for when mini-HTAs should be carried out at thelocal level, and criteria for which health technologies that should be evaluated at the national level.
• Mini-HTA can also be used for disinvestments of existing health technologies, but for this, a separate form more appropriate for that purpose should be developed.