1. 6/23/2016Dr Rabia Kahveci1 The role and application of evidence in health care systems lacking HTA Assoc. Prof Dr Rabia Kahveci

2. 6/23/2016Dr Rabia Kahveci2 HTA in Turkey

3. 6/23/2016Dr Rabia Kahveci3 Towards HTA in Turkey, before 2012 Rapid growth in public healthcare spending …action in 2008-11… including budget caps for public hospitals, user fees and mandatory cuts in pharmaceutical prices. Universal health insurance Raised awareness and Capacity building in HTA.. By NGOs, academics, MoH, SSI The need for HTA was deeply felt and discussions around…. –Rationalizing decisions –Evidence base –Innovative approaches for reimbursement –Academic and NGO pressure –Pressure on industry –Role of global budgeting? –What about hospitals?

4. 6/23/2016Dr Rabia Kahveci4 HTA in Turkey, 2012-2013 HTA Departments in –Ministry of Health General Directorate of Health care Researches Agency for Drugs and Medical Devices –Social Security Institution –Ankara Numune Training and Research Hospital (ANHTA)

5. 6/23/2016Dr Rabia Kahveci5 HTA in Turkey, 2012-2013 www.anhhta.org

6. 6/23/2016Dr Rabia Kahveci6 What ANHTA did since February 2012..(till June 2013) Built up the HTA team, trainings Conferences and workshop participations, oral and poster presentations, invited talks Organized an international meeting and workshop Published a brochure on hospital-based HTA Published a guideline of hospital-based HTA Internal documentation and workplan 4 pilot projects started, two of them completed Be a part of an EU project, AdHopHTA

7. 6/23/2016Dr Rabia Kahveci7 Adopting Hospital Based Health Technology Assessment in EU Starting date: 1 September 2012 Period: 36 months Partners: Spain, Denmark, Switzerland, Turkey, Italy, Finland, Estonia, Austria, Norway AdHopHTA project aims at strengthening the use and impact of quality HTA results in hospital settings, making available pragmatic knowledge and tools to boost adoption of hospital based HTA initiatives. The project also aims at creating an adequate ecosystem where formal coordination among existing hospital based HTA initiatives and liaison with national and regional agencies will flourish.

8. 6/23/2016Dr Rabia Kahveci8 There were times without HTA….

9. 6/23/2016Dr Rabia Kahveci9 Pricing committees (pricing by MoH-reference pricing & discounting by SSI for pharmaceuticals) Reimbursement committees (pharmaceuticals and medical devices) Ad hoc committees on specific technology uptake Clinical guidelines (MoH, NGOs, Academies…) Committees for vaccination Purchasing departments in hospitals ………….. Are all decisions evidence-based? How do we know??

10. 6/23/2016Dr Rabia Kahveci10 Decision-making research has demonstrated that a decision maker's utility is highly subjective and may include variables, such as personal gain, risk tolerance, relevance to related events, and value of a decision to the organization. Policy makers are forming policy in response to and in conjunction with groups of individuals, all with individual objectives and biases. Group decisions tap into a wider knowledge base, generally create more information, and theoretically are more open to decision information examination. Group decision phenomena: such as groupthink and non-rational escalation of commitment, which exhibit cognitive decision-making behaviors that impede and prevent rational decision choices by groups. Groups are comprised of individuals. McCaughey and Bruning Implementation Science 2010, 5:39

11. 6/23/2016Dr Rabia Kahveci11 Diversity in health care systems Diversity in HTA agencies Diversity in decisions for certain technologies …..where the goal is the same rational decision making “understand the effects of health technologies on important health outcomes” Diversity in decision making processes

12. 6/23/2016Dr Rabia Kahveci12 Aging, New technologies Cultural changes, Expectations High expenditures Malpractice cases Increase in information sources … Look for effective and efficient healthcare delivery options HTA

13. 6/23/2016Dr Rabia Kahveci13 Evidence analysis Outcomes analysis (benefits and risks) Costs Cost-effectiveness Ethical, legal implications Policy culture Experiences Individual factors Priorities Organizational issues ….. FULL HTA Learning, Human resources, Costs, Time

14. 6/23/2016Dr Rabia Kahveci14 The risk of the technology must be known (Safety). The technology must be able to do what it is supposed to do (Efficacy). The technology must produce positive outcomes for the patient (Effectiveness). There must be a reasonable relationship between cost and effectiveness of the technology (Cost-Effectiveness) Definition of what works and what is affordable in HTA

15. 6/23/2016Dr Rabia Kahveci15 Evidence from research usually not tailor made for health policy makers To retrieve scientific evidence is time consuming and requires special skill To synthesize evidence is difficult

16. 6/23/2016Dr Rabia Kahveci16 Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. 1996. Evidence based medicine: what it is and what it isn't. BMJ 312: 71–2

17. 6/23/2016Dr Rabia Kahveci17 Current best evidence is up-to-date information from relevant, valid research about the effects of different forms of health care, the potential for harm from exposure to particular agents, the accuracy of diagnostic tests, and the predictive power of prognostic factors. Cochrane AL. Effectiveness and Efficiency : Random Reflections on Health Services. London: Nuffield Provincial Hospitals Trust, 1972.

18. 6/23/2016Dr Rabia Kahveci18 Clinical practice guidelines Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" (Institute of Medicine, 1990). They define the role of specific diagnostic and treatment modalities in the diagnosis and management of patients. The statements contain recommendations that are based on evidence from a rigorous systematic review and synthesis of the published medical literature. Who develops? Economists involved? Funding?

19. 6/23/2016Dr Rabia Kahveci19 Issues related to CPGs Quality of guidelines (time, human resources, funding, capacity, dissemination and uptake strategy) Integration of economical analysis into CPGs…clinical practice? or policy making? Role of CPGs in investment decisions

20. 6/23/2016Dr Rabia Kahveci20 Conclusions With or without HTA decisions are made everyday With or without HTA the first and most critical step is to have capacity to find and analyse evidence.

21. 6/23/2016Dr Rabia Kahveci21 Be aware of the learning needs Be aware that every setting is different Be aware that political will is important and must be directed to communication and collaboration Critical success factors

22. 6/23/2016Dr Rabia Kahveci22 THANK YOU rabiakahveci@gmail.com