Hostname: page-component-7c8c6479df-hgkh8 Total loading time: 0 Render date: 2024-03-29T06:06:32.265Z Has data issue: false hasContentIssue false

Framework for describing and classifying decision-making systems using technology assessment to determine the reimbursement of health technologies (fourth hurdle systems)

Published online by Cambridge University Press:  27 February 2006

John Hutton
Affiliation:
University of York and The MEDTAP Institute at UBC
Clare McGrath
Affiliation:
Pfizer Ltd.
Jean-Marc Frybourg
Affiliation:
Pfizer Ltd.
Mike Tremblay
Affiliation:
Tremblay Consulting International
Edward Bramley-Harker
Affiliation:
NERA Economic Consulting
Christopher Henshall
Affiliation:
The London School of Hygeine and Tropical Medicine and University of York

Abstract

Objectives: Australia, Canada, and many European countries now use various forms of health technology assessment (HTA) in decision making regarding the reimbursement of drugs and other health technologies. To achieve a better understanding of the potential for use of HTA in this context, an analytical framework was developed to describe and classify existing fourth hurdle systems.

Methods: Based on a review of published literature, and official documentation, the key aspects of a fourth hurdle system were identified at two levels: policy implementation and individual technology decision. Characteristics of the systems were grouped under four main headings: constitution and governance, objectives, use of evidence and decision processes, and accountability. The comprehensiveness and relevance of this framework was assessed by an independent group of experts in HTA. A pilot study was undertaken, using only published sources, to test the feasibility of obtaining the information needed to complete the framework.

Results: The framework was found to be sufficiently broad to encompass all the issues of interest regarding the systems, but the proportion of information available from published sources was variable between sections of the framework and between countries, with average availability of 45 percent.

Conclusions: The analytical framework will help researchers and policy-makers in individual countries to understand their own systems and will allow some preliminary sharing of experience between countries. More experience of its application is needed to judge whether it will provide the basis for more formal comparison of systems and whether it will determine the appropriateness for particular decision contexts.

Type
GENERAL ESSAYS
Copyright
© 2006 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Australian Commonwealth Department of Health, Housing, Community Services. 1992. Guidelines for the pharmaceutical industry on population of submissions to the Pharmaceutical Benefits Advisory Committee. Canberra: Government Publication
Baladi JF, Menon D, Otter N. 1998 Use of economic evaluation guidelines: 2 year's experience in Canada. Heath Econ. 7: 221227.Google Scholar
Banta D. 2003 The development of health technology assessment. Health Policy. 63: 121132.Google Scholar
Hjelmgren J, Berggren F, Andersson F. 2001 Health economic guidelines for economic evaluation of medical technologies and pharmaceuticals. Value Health. 4: 225250.Google Scholar
Institute of Medicine. 1985. Assessing Medical Technologies. Washington DC: National Academy Press
Jonsson E, Reiser S. 1985 Editor's Introduction. Int J Technol Assess Health Care. 1: 12.Google Scholar
Klarman H, Francis J, Rosenthal G. 1968 Efficient treatment of patients with kidney failure. Med Care. 6: 4854.Google Scholar
National Coordinating Centre for HTA. 1998. Annual Report of the NHS Heath technology assessment programme 1998. London: Department of Health
Lothgren M, Ratcliff M. 2004 Pharmaceutical industry's perspective on health technology assessment. Int J Techol Assess Health Care. 20: 97101.Google Scholar
Oliver E, Mossiales E, Robinson R. 2004 Health technology assessment and its influence on health care priority setting. Int J Technol Assess Health Care. 20: 110.Google Scholar
Ontario Ministry of Health. 1994. Ontario guidelines for economic analysis of pharmaceutical products. Toronto: Ontario Ministry of Health
Rutten F. 2004; Health technology assessment and policy from the economic perspective. Int J Technol Assess Health Care. 20: 6770.Google Scholar