Amrita Institute of Medical Sciences, Kochi had organised the first International fellowship on Health Technology Assessment (HTA) from 9-16 December 2012, in association with Joanna Briggs Institute of Evidence Based Medicine, University of Adelaide, Australia with faculty from University of Toronto and University of Liverpool. This fellowship was privileged to have Healthcare Technology Innovation Centre, IIT Madras and National Accreditation Board of Hospitals & Health Care providers as technical collaborators.
118 participants from different parts of the country attended having varied backgrounds ranging from clinicians, hospital administrators, nursing, biomedical engineers, pharmacists etc. HTA has been practiced extensively in UK and US from macro level policy decision making to institution level application for best evidence based resource utilisation. It is a new and innovative concept and it was heartening to see that even India is ready with implementation of a useful objective tool in healthcare.
HTA is a multidisciplinary activity that systematically examines the safety, clinical efficacy and effectiveness, cost, cost-effectiveness, organisational implications, social consequences, legal and ethical considerations of the application of a health intervention/technology – usually a clinical or surgical intervention, drug or medical device. In UK, HTA broadly focuses on clinical effectiveness (how do the health outcomes of the technology compare with available treatment alternatives) and cost effectiveness (are these improvements in health outcomes commensurate with the additional costs of the technology.
The learning objectives of the eight day- structured course was: to impart training to the future torch bearers of healthcare professional on HTA, understand ethical, social and legal aspects of intervention selection, conduct systematic reviews to collect evidence for each interventions/ technology, do economic modelling and learn harm-benefit assessment and finally to do impact assessment of any new methods.
The course was inaugurated by Dr T Sundaraman, Executive Director of NHSRC who is very keen to start HTA at Ministry of Health and has already included HTA as one of the 12 priority items for the planning commission to look for. He gave insights into HTA’s application in government decision making which will help to come out of policy paralysis and allocate adequate resources for better equity and access. Dr Gayatri, Director NABH was the Guest of Honour, reiterated the importance of HTA in accreditation, patient safety and improving outcomes. Dr Mohanshankar, Director, HITC, IIT Madras, gave an explicit presentation of various innovative healthcare delivery work, which IIT Madras has initiated with healthcare industry. He also presented mobile eye clinic work done with Sankara Nethralaya. Dr Prem Nair, Medical Director, AIMS made important contribution of HTA at institutional level and AIMS is using this tool for early decision making.
Dr Sanjeev Singh, Medical Superintendent, AIMS presented about national database and how national and state benchmarks have been achieved for essential quality indicators and moderated the sessions. Dr Jitendar Sharma, Clinical faculty from University of Adelaide and NHSRC helped understanding application of HTA in today’s context in Indian Healthcare and quoted various success stories on HTA from other countries. He was also a facilitator for the whole course.
Dr Arun Patel, Consultant, NHS, UK taught regarding ethical and social applications and importanc at SCTIMST. Dr Jitendar and Dr Sanjeev took sessions on how to make healthcare safe using HTA as a tool and to do critical analysis of patient safety practices. They also introduced impact assessment templates for direct observation and application of eenewer technologies and always make that crucial decision on balancing cost v/s outcomes. Dr Anil Srivastava, Director Institute of Statistics taught basic principles of health statistics for non statisticians, data mining and data warehousing.
Dr Niranjan, Clinical Engineer from Sree Chitra talked about role of medical technology assessment in technology innovation and on methods of technology assessment in technology selection and surprised the audience with domestic production of medical devices happening at SCTIMST. Dr Jitendar and Dr Sanjeev took sessions on how to make healthcare safe using HTA as a tool and to do critical analysis of patient safety practices. They also introduced impact assessment templates for direct observation and application of evidence available in healthcare and use HTA for better effectiveness.
Dr Krishna Rao, Chief Healthcare Economics at PHFI took sessions on economic evaluation, role of ICER, QALY, DALY in healthcare; conducting cost effectiveness, measuring costs and effectFeand gave various group work on economic modeling in healthcare delivery. Dr Rumona Disckson, Chief HTA at University of Liverpool talked about overview of evidence synthesis, various randomised control trails, studies conducted for gathering best evidences and touched upon observational and diagnostic studies. Dr Prakesh Shah, Paediatric Intensivist from University of Toronto, shared his experience on defining research questions, developing a protocol, formats of scientific reviews, types of intervention, outcome measures, statistics on systematic reviews, search strategy and assessment of risks in healthcare practices.
Participants were very positive and participative. The feedback has been good and various requests were made to have joint groups to take HTA forward in India.
HTA offers an innovative basket of tools which can help policy makers decide which intervention/ technologies are effective and which are not, and define the most appropriate indications for their use. HTA is expected to eliminate interventions that are unsafe and ineffective or whose costs are too high compared with the benefits. HTA has to take into consideration all aspects namely ethical, social, legal, scientific review (evidence), cost effective analysis and impact assessment that might be influenced by the technology as well as those influencing the technology.
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