1. HTA – Cost Containment or Quality Instrument? Bengt Jönsson Stockholm School of Economic

2. HTA – Cost Containment or Quality Instrument? Both and neither!

3. HTA and Health Economics “All effective health technologies should be free” –Archie Cochrane But –The introduction of new effective technology is faster than the increase in our ability to pay for them –Uncertainty about both effects and resource use for new technologies

4. Need for assessing cost- effectiveness as part of the HTA Cost-effectiveness look at the balance between cost and effectiveness Aims at selecting cost-effective use of technologies Two decision criteria –Maximize the health benefit from a given budget –Define optimal spending from a given threshold value for cost-effectiveness

5. Example 1 NICE appraisals Main criteria is cost per QALY gained from the intervention Budget defined as NHS/PSS cost No explicit threshold value, but the aim is to identify technologies/indications that gives good value for money

6. Example 1 NICE appraisals Will this improve quality –Depend how quality is defined –Depend on how the results of the appraisal are implemented Will it reduce costs –Yes, when technologies with high cost per QALY are kept out –No, when presenting evidence that technologies are cost-effective –Present evidence point to that the latter dominates

7. Example 2 Intervention thresholds in primary prevention Most people can benefit from a lower blood pressure and lipid levels How do we decide which to treat? Maximum willingness to pay for the benefit –50 000 Euro per QALY Let us assume the same relative risk reduction for everybody for lipid lowering Benefit will depend on absolute risk

8. Example 2 Intervention thresholds in primary prevention Cost-effectiveness will determine – intervention thresholds –How many persons are treated –The total budget Will this contain cost –Compared to what? –Will this improve quality? Yes, by treating those who benefit most

9. Conclusions HTA is mainly a tool for securing that we are make best possible use of available resources Important both when we have large and small resources available Help us to secure that we don’t waste resources –But will not necessary contain costs Quality will be improved if the results of HTA are properly implemented –HTA also gives us tools for making an appropriate trade off between quantity and quality, i.e. the need of the individual patient and the need of all patients