Rapid health technology assessments (HTAs) fall within a continuum of assessment products, somewhere between “full HTAs” with a rigorous approach at all stages, and mini-HTAs (Reference Ehlers, Vestergaard and Kidholm2) or horizon scanning reports. There is a trade-off between providing relatively rapid advice to decision makers and losing the detail and assurance provided by use of a more comprehensive process.
From the decision-maker's perspective, rapid HTAs have the attraction of providing faster responses to questions than full assessments, contributing to a more rapid decision-making process. Rapid reviews can be highly responsive to the development of new technologies and techniques (Reference Ehlers, Vestergaard and Kidholm2).
There is still little published information on the influence of rapid HTAs. McGregor and Brophy have described the policy impact of sixteen within-hospital rapid HTAs in Quebec (Reference McGregor and Brophy4). Recommendations from all the assessments were incorporated into hospital policy, with estimated budget savings of $CD3 million per year. An earlier Canadian publication reported on the influence of twenty rapid HTAs on decisions related to coverage, capital funding, referral for treatment, and influence on routine practice. Fifteen of the rapid HTAs influenced decisions, three provided guidance or background information, and two had no apparent influence (Reference Hailey, Corabian, Harstall and Schneider3). An Australian report included comparison of rapid and full reviews but did not include consideration of the influence of these HTAs on policy and other decisions (Reference Watt, Cameron and Sturm5).
Rapid HTAs are undertaken by members of the International Network of Agencies for Health Technology Assessment (INAHTA), and the application and influence of such assessments are of interest to the network. The survey described here was carried out by an INAHTA working group to obtain preliminary information on the use and influence of these HTA products.
METHODS
A questionnaire and instructions on its use were prepared, drawing on previous documents for recording HTA impact that had been developed by INAHTA. Items covered in the questionnaire are shown in Table 1. The survey questionnaire and instructions were posted on the INAHTA Web site, and member agencies asked for responses regarding rapid HTAs that they had prepared during 2006. For the purposes of the survey, rapid HTAs were taken to be assessments that had been completed between 1 and 6 months after receiving a request, following the approach taken in a report on rapid versus full systematic reviews (Reference Watt, Cameron and Sturm5).
Table 1. Framework for Reporting on the Influence of Rapid HTA Reports
Note. Further details were invited for items B, F, H, I, and J.
HTA, health technology assessment.
RESULTS
Seven member agencies—AETMIS, CADTH, IHE (Canada), AETS (Spain), AHTA (Australia), DECIT/CGATS (Brazil), and VATAP (USA)—provided completed questionnaires on fifteen rapid HTAs. Nine of the rapid HTAs were prepared in 1–3 months and six of them in 3–6 months.
Most of the requests for rapid HTAs came from health ministries or departments. For one of the reports, there was also input to the request from a national parliament and five assessments were requested by a public sector service provider.
Table 2 summarizes the technologies addressed by the reports, types of decisions informed by the rapid HTAs, the direction of assessment findings, and influence on decisions. A wide variety of interventions was considered. There were several assessments of new technologies, but it was notable that there was interest also in older, widely distributed interventions.
Table 2. Findings and Influence of Rapid HTAs
HTAs, health technology assessments; HIV, human immunodeficiency virus; HPV, human papillomavirus; MS, multiple sclerosis.
The agencies provided twenty-two responses on the purposes of the fifteen rapid HTAs. The most common purpose (n = 8) was to inform coverage decisions. It is of interest that, even in this small sample of assessments, all other purpose categories given in the questionnaire attracted some responses.
Five of the HTAs supported use of the technology and current practice, while three reports had positive findings but indicated that there was a need for further data and appraisal. Five reports found there was insufficient evidence of efficacy and/or safety, and one found that a technology was not cost-effective. The remaining HTA found that there was no difference between competing products.
The most common indications of influence were consideration of the assessment by a decision maker, use of the HTA as reference material (both n = 10), and acceptance of recommendations or conclusions (n = 8). All of the rapid HTAs were considered by the agencies to have had some influence, with “Informed decisions” being the most common category. External opinions were available for nine of the HTAs and were consistent with the agencies' opinions.
DISCUSSION
This survey was undertaken using a relatively short questionnaire that was intended to obtain basic information on rapid HTAs and their use and influence. Following previous work within INAHTA, information on influence was placed in context, including details of where the question addressed by the HTA had come from, the purpose of the assessment, conclusions reached, and outcomes of the HTA as judged by subsequent actions affecting the health technology. More elaborate approaches would be needed to give a more detailed description of the role and influence of rapid assessments.
Nevertheless, responses to the survey provided some useful preliminary information on rapid HTAs from public sector programs and how they are being used. Rapid HTAs may often be requested on emerging technologies, but are frequently also applied to those that are well established. The survey indicated a range of purposes for rapid HTAs, including all the categories listed in Table 1. This resembles the findings of a Danish study that mini-HTAs were used for all forms of health technology and for many different purposes (Reference Ehlers, Vestergaard and Kidholm2).
Given the urgency and pressures associated with rapid HTAs, it is of some interest to confirm that such reports are at least considered by decision makers. The results of the INAHTA survey were reassuring on this point. Almost all the rapid HTAs had been used by the decision makers who requested them. “Use of HTA information as reference material” was given as an indication of influence for ten of the fifteen rapid HTAs in the survey. This seems consistent with reports on the requirements for those in policy and administrative areas for clear general descriptions of technology-related matters (1).
Results from this preliminary survey give a further indication that rapid HTAs are a useful form of HTA, helping to meet decision-makers' requirements for urgent advice on a wide range of topics.
CONTACT INFORMATION
David Hailey, MSc, PhD (dhailey@ozemail.com.au), Visiting Fellow, Centre for Online Health, University of Queensland; Senior Advisor, Institute of Health Economics, #1200, 10405 Jasper Avenue, Edmonton, Alberta T5 J 3N4, Canada
