Hospital Based Health Technology Assessment

World-Wide Survey
Hospital Based Health Technology Assessment Sub-Interest Group
 Interest Sub-Group
Hospital Based HTA

Hospital Based Health Technology Assessment

World-Wide Survey

SUMMARY

1. Purpose and structure of the document ........................................................................................4

2. Hospital Based HTA Interest Sub-Group ....................................................................................4

3. Objectives of the survey...............................................................................................................5

4. Background ..................................................................................................................................5
4.1 The Conceptual Model...............................................................................................................6

5. Methods........................................................................................................................................7
5.1 Sampling ....................................................................................................................................8
5.2 Questionnaire Template .............................................................................................................8

6. Results..........................................................................................................................................9
6.1 SECTION I : Description of institutions answering the survey................................................9
6.2 SECTION II: HTA models ......................................................................................................13
6.3 SECTION III : Competences and activities .............................................................................16
6.4 SECTION IV : Hospital HTA: training and external environment .........................................28

7. Discussion and Conclusion ........................................................................................................33

Acknowledgments..............................................................................................................................34

References ..........................................................................................................................................35

APPENDIX 1 – List of HB-HTA ISG’s organizations members......................................................36

APPENDIX 2 – List of responders (in alphabetical order) ...............................................................38

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 Interest Sub-Group
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About Authors

Americo Cicchetti, Ph.D.

Co-Chair Hospital Based HTA, Interest Sub Group,
Professor of Health Care Management,
Università Cattolica del Sacro Cuore, Faculty of Economics, Rome, Italy

Marco Marchetti, MD.

Co-Chair Hospital Based HTA, Interest Sub Group,
Director, Health Technology Assessment Unit, Policlinico universitario “A. Gemelli”, Rome, Italy

Rossella Dibidino, MS.

Researcher, Health Technology Assessment Unit, Policlinico universitario “A. Gemelli”,
Rome, Italy

Mirella Corio, MS.

Researcher, Health Technology Assessment Unit, Policlinico universitario “A. Gemelli”,
Rome, Italy

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 Interest Sub-Group
Hospital Based HTA

1. Purpose and structure of the document

The purpose of this document is to present final results of a survey performed within the Health
Technology Assessment International (HTAi) Interest Sub-Group (ISG) “Hospital Based Health
Technology Assessment” (HBHTA) during the year 2007.
The document is structured as follows. In the first section, origins, mission, organization, functions
and structure of the ISG are briefly presented. Then, the objectives of the survey are outlined in
details. The subsequent paragraph aims at clarifying the scientific background of the research and
the conceptual framework for the analysis is presented.
The fifth section is dedicated to the description of the research methodology with specific attention
devoted to sampling and survey’s questionnaire structure.
The results of the survey are presented in the sixth paragraph and they are articulated in four
different sub-sections: compliance; organizational models; competence and activities, training and
external environment. Last section is dedicated to some conclusions and a brief discussion.

2. Hospital Based HTA Interest Sub-Group

During the year 2006 an Interest Sub-Group (ISG) dedicated to the application of HTA logic and
tools at hospital level has been established within HTAi. The Sub group has been labelled “Hospital
Based HTA” (HBHTA).
The purpose of each Sub-group is to serve as a forum for focused discussions among HTAi’s
members with similar HTA-related interests.
So far, an ISG is a permanent international table of discussion on HTA themes that can be shared by
professionals and researchers all over the world. An ISG can also contribute to the cultural
enrichment of HTAi members in specific topic being able to provide a crucial impact on HTA
practice at an operational level.
HBHTA ISG’s mission is to gather professionals involved in the use of HTA logic at an
organization level in order to support both managerial and clinical decision-making processes.
HBHTA ISG’s members have firstly met in Adelaide during HTAi 2006 Annual Meeting. During
the first meeting participating members were able to share their perspective in the use of HTA logic
within health care organizations. The meeting ended up with the definition of priorities for future
joint actions and the mission of the ISG was shared among members.
In outlining future activities, a crucial issue has emerged. Even though transferring HTA from a
macro level to a meso level is quite a common process, a study on how HTA activities should be
introduced and implemented within hospitals and other health care organizations, was still not
available. Therefore, the ISG has hold as a priority to investigate different existing approaches on
the application of HTA logic and tools at an hospital level in different health care systems.

After Adelaide’s meeting a world-wide survey has been launched within ISG’s members in order to
investigate this emerging phenomenon. Preliminary results from this survey were presented during
the HTAi 2007 Annual Meeting in Barcelona and the group agreed to proceed to the completion of
the survey. A complete list of ISG’s members is attached to this document (see Appendix 1).

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3. Objectives of the survey

The main purpose of the world wide survey on HBHTA is to investigate the kind of application of
HTA logic, methods and tools within hospitals and other health care organizations in order to
support managerial decision making as well as clinical practice.
The working group firstly intended to provide a picture of different organizational approaches
followed in different institutional contexts designed explicitly to apply HTA within those
organizations directly involved in health care delivery.

4. Background
HTA has been used worldwide in order to inform decision-making in health systems at different
levels by producing information on the clinical, economic, organizational, social and ethical
impacts of health technologies (Battista, 2006).
HTA has traditionally been focusing on informing policy-making at a macro level. Since the ‘80s,
health systems in developed countries established agencies devoted to produce scientific
information to address health-care policies. These agencies, networking in INAHTA, operate
alternatively at a national level (e.g. SBU, in Sweden) or at a region/province level (e.g. CAHTA, in
Cataluña). HTA methods and tools were developed to assess health technologies and their impact in
health care systems as a whole. More recently, an “organizational” perspective for the application of
HTA principles and methods has emerged.
Even if the decentralization of the application of HTA approach in hospitals is now considered as an
emerging phenomenon it is important to consider that one of the first HTA agencies in Europe has
been established at an “hospital” level. The CEDIT (Comité d’Evaluation et de Diffusion des
Innovations Technologiques), established in 1982, probably the first example of HTA Agency in
Europe, is an hospital-based agency for the assessment of medical technology.
The CEDIT, similarly to many other HTA units now active all around the world in hospitals, is
responsible for formulating advice for the Director General of the Assistance Publique-Hôpitaux de
Paris (AP-HP) on the opportunity, extent and way of diffusion of technological innovations in AP-
HP hospitals (Baffert et alii., 2005).
Later on, since nineties, international literature has reported some examples on how HTA methods
have been experimented, as a tool for decision-making at an "organisational" level (Marshall and
Menon, 1990; Luce and Brown, 1995; Battista et al. 2003; McGregor and Brophy, 2005; Ehelers et
alii, 2006). Over the last few years, an increasing need has emerged to transfer HTA’s methodology
to support managerial decision making at an hospital level, also supporting the definition of a
"technological strategy" for HCOs (Cicchetti, 2003).

This tendency is not the result of any reduced role for HTA as a support to policy decision making
(macro level), but it is related to the increasing consciousness that health technologies’ value should
be judged in connection with specific organizational contexts. The diffusion of the use of HTA
logic in hospitals and other HCOs, can be considered as a way for hospital managers to respond to
three different environmental “pressures”.

The first concerns the increasing "pressure" that health authorities are exercising on individual
health care organisations to improve the level of efficiency and effectiveness (micro-economic
efficiency) as a key to improve the efficiency of the entire system (macro-economic efficiency).
The pressure to create the abovementioned micro-economic efficiency has increased the
independence but also the responsibility of peripheral health care organizations. Hospitals are now
commonly operating under budget constraints and in many countries DRGs-like payment
mechanisms are applied. This evolution has led to a transfer of previously exclusively central
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Hospital Based HTA

competences (e.g. ministries of health, departments of health) to peripheral levels (hospitals and
other HCOs). Decisions related to health technologies (adoption, investment, etc.) are more and
more performed at an organizational level.

The second is related to the progressive acknowledgement of the relevance of the "context" factor.
Opportunities and advantages that can be drawn from the use of health technologies in the medical
field (elsewhere labelled as “value”), vary depending on resources and competences availability in
each health care organisation. For this reason if decision should be taken at an organizational level,
evidences and data should be also collected and analysed in the organizational context.

A third environmental pressure is related to the diffusion of evidence based medicine culture. Policy
makers, hospital managers, clinicians and other professionals are pushed to bring timely scientific
evidences into clinical practice and into organizational processes. A recent stream of literature in
health service research points out the relevance of organizational contexts in letting evidence be
transposed into real-world clinical practice (Bero et alii., 1998; Rosen and Gabbey, 1999). We can
assume that the development of an HTA function at an organizational level could help overcome
what has been labelled ‘organizational gap’ (Dopson et alii, 2005). Presenting the Montreal
University Hospital Consortium case study, McGregor and Brophy (2005) suggested that the
implementation of an in-house HTA unit can be useful to create a positive organizational context to
facilitate the use of scientific evidence to support both clinical practice and management decision-
making in hospitals.

As a result of this evolution, health care managers are more and more interested in identifying some
decision-making tools and technical methodologies to support decisions regarding relevant matters
such as the acquisition and the allocation of technological resources. The adoption of such HTA
perspective would provide HCOs not only with a tool for management but also with a solution for
the implementation of a clinical governance framework as a whole. This new perspective screening
the use of the HTA principles, methodologies and tools is being more and more labelled as hospital-
based HTA (HB-HTA) (Catananti et al., 2005).
Experiences of HB-HTA has been recently reported in literature from different countries such as
Canada (Mc Gregor & Brophy, 2005), Denmark (Ehlers, 2006) and Italy (Catananti et al. 2005).
Many other case studies have been reported during recent annual meetings of the Health
Technology Assessment International both in Rome (in 2005) and Adelaide (2006) from Andalucia
(Briones et al., 2005), Austria (Wild, 2005), Sweden (Rehnqvist, 2005), France (Baffert et al. 2005),
Switzerland (Wasserfallen, 2005; Zuellig, 2005) and Australia (Maddern, 2005).

4.1 The Conceptual Model

On the base of examples and case studies reviewed within the ISG during meetings held in Adelaide
(2006) and Barcelona (2007) the ISG was able to acknowledge a significantly varied scenario of
applications of HTA at an HCO level.
HTA logic seems to be applicable in different fashions with many different organizational solutions
depending on institutional and other socio-economic factors characterizing the health care system in
different countries.
On the base of a collective reflection the group agreed to adopt a conceptual model that intends to
reduce the variability of organizational solutions for hospital based HTA that can be found in real
world. The model identifies four different groups, depending on (i) the focus of the action and on
(ii) the level of complexity of the organizational solution implemented for performing HTA
processes within hospitals. The performance of HTA related activities in a hospital can be oriented
to produce evidence for managerial decision making (e.g. decision of investment) and/or to support

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effective clinical practice. These functions could be then performed by individual professionals or
complex and multiprofessional organizational units. Considering the two variables, “focus of
action” and “organizational complexity” four different models for HB-HTA have been
conceptualized.

Figure 1: HTA organizational Models

Focus of Action

Managerial decision
Clinical Practice
making
(Q3)
(Q4)
‘Internal
‘HTA Unit’ model
Organizational

High Committee’ Model

Complexity

(Team-group-unit)

(Q1) (Q2)
Low
‘Ambassador’ Model ‘Mini-HTA’ Model
(Individual)

The HTA models are:

• Ambassador Model (Q1): clinicians recognized as ‘opinion leaders’ play the role of
ambassadors of the HTA “message” inside the HCOs. They may not take part to
assessments but play a key role in results diffusion within hospitals. In this quadrant fits the
case of the Swedish ambassadors (Rehnqvist, 2005).
• Mini HTA (Q2) : it is the case of Danish mini-HTA, in which single professionals
participate in the assessment process collecting data at organizational level to inform
decision makers at an higher level (Ehlers et al., 2006).
• Internal Committee (Q3): evidence is produced by multidisciplinary groups (called
internal committees) representing different perspectives and taking the responsibility of
reviewing evidences to issue recommendations useful hospital-wide. Usually documents are
produced on a peer-to-peer basis by professionals, who rarely work full time on HTA. The
model is commonly used in HMO in the U.S.A. and in some Canadian hospitals (Menon &
Marshall, 1990).
• HTA Unit (Q4): formal organizational structure based on specialized HTA personnel
working on a full time basis inside the Unit. This model represents the highest degree of
structure for hospital HTA (McGregor & Brobhy, 2005; Catananti et al., 2005).

5. Methods
Different approaches adopted in Hospital Based HTA are currently implemented at international
level. In order to identify and classify the existing HTA approaches at health care organization level
(tools, methods, organizational models), a literature review was performed.
Afterwards, the Hospital Based HTA World Wide Survey was developed in the context of HTAi
Hospital Based HTA Interest Sub Group activities .

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5.1 Sampling
The survey was submitted to the population of 64 members (individuals) of the HB-HTA Interest
Sub-Group active in 50 different health care organizations.
The list of responders is reported in Appendix 2.

5.2 Questionnaire Template

The Hospital Based HTA World Wide Survey was articulated in the following sections:
o General information:

identification and contact information of the responders;

organization profile;

delivering settings of the organization.
o Part I: Description of Health Care Organization:

mission of the HTA activities (to inform clinical practice and/or produce
information to support managerial decision making);

who performs HTA activities;

for whom HTA activities are performed;

formal and informal link with external organizations;
o Part II: Description of HTA activities within the HCO:

health technologies assessed;

HTA dimensions assessed (efficiency, efficacy, safety, etc.);

priority criteria;

stakeholders role.
o Part III: Description of the outputs:

kinds of produced reports;

tools of reports’ dissemination.
o Part IV: HTA Training activities:

participation in HTA training activities;

organization of HTA training activities.

The survey was performed from April 29th, 2007 to May 6th, 2008.
A descriptive analysis of gathered data was performed and is presented in the following section.
The questionnaire was structured to capture common characteristics among responders in terms of
organizational structures, processes, competences and outputs.
The organizational profile of each responding member was classified in one of the four HTA
models described above in the “Conceptual Model” section.

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6. Results
Results refer to data available on May 6th 2008.

6.1 SECTION I : Description of responding institutions

In this section of the document the characteristics of the responder institutions are described

Table 1. Answering rate by country

HB-HTA ISG
Responders/
Country Responders members
Members
No. % on total No.
Austria 1 3% 1 100%
Denmark 3 9% 3 100%
France 1 3% 2 50%
Germany 1 3% 1 100%
Italy 10 30% 17 59%
Europe
Poland 0 0 1 0%
Spain 1 3% 1 100%
Sweden 2 6% 2 100%
Switzerland 2 6% 2 100%
The Netherlands 1 3% 1 100%
North Canada 4 12% 9 44%
America USA 1 3% 1 100%
Argentina 0 0 1 0%
South Brazil 1 3% 2 50%
America Colombia 1 3% 2 50%
Mexico 1 3% 1 100%
Australia 2 6% 2 100%
Oceania
New Zealand 1 3% 1 100%
Total 33 100% 50 66%

According to the previous table, 67% (22 out of 33) of the responder institutions are set in Europe.
Results show a major participation of institutions set in Italy (10 out of 22) .
The distribution of responding institutions by geographical area are: 15% in North America
(Canada 12% and USA 3%), 9% in South America and 9% in Oceania
The overall response rate to the survey is 66% while institutions located in Austria, Denmark,
Germany, Spain, Sweden, and The Netherlands, USA, Mexico, Australia and New Zealand show a
100% answering rate.

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Graph 1. Country of responders

Responders (n=33)
Australia Denmark
Mexico 6% Austria 9%
3% 3%
New Zealand
3% France
Colombia 3%
3%
Brasil Germany
3% 3%
USA
3%

Canada
12%
Italy
31%
The Netherlands Spain
3% Switzerland
3%
6% Sweden
6%

Organization profile
The organization profile of the institutions was investigated. A unique profile for each institution
was identified by the authors for the 16 cases where different profile elements were reported.
In particular, when (Academy/University OR Research Institution) AND Teaching Hospital were
both answered, Teaching Hospital was selected by the authors.

Table 2. Organization profile

Organization profile No. % on 33 Hospital Based HTA is usually

Governmental agency 7 21.2 performed in Teaching Hospitals
HTA Body (39.4%), Governmental Agencies
Academia/University 4 12.1 (21.2%) and Public Health Care
Public Health Care Organization 5 15.2 Organizations. While autonomous HTA
Private Health Care Organization Bodies, Private Health Care
Teaching Hospital 13 39.4 Organizations and Professional
Research Institution 2 6.1 Associations do not perform HB-HTA.
Professional Association The answer “other” has been specified
Industry 1 3.0 as health surveillance agency.
Other 1 3.0
Total 33 100

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Graph 2. Organization profile

Organization profile (n=33)

Industry Other
3% 3% Governamental
Research Institution agency
6% 21%

Academia/University
12%

Teaching Hospital Public Health Care

40% Organization
15%

Delivery setting
The delivery setting of health care organizations affect the way HTA activities are performed.
Data related to the Hospital Based HTA ISG’s organizations delivery setting are showed in Table3.

Table 3. Delivery settings

Delivery setting No. % on 33

Hospital Care Network 11 33.3
Hospital 21 63.6
Practitioner Office 4 12.1
Ambulatory Care Clinic 12 36.4 Hospital (63.6% of HB-HTA ISG members) is
Behavioral Health 3 9.1 the prevailing setting followed by
Home Care 3 9.1 Ambulatory Care Clinic (36.4%) and Hospital
Nursing Home 2 6.1 Care Network (33.3%).
Subacute Care Setting 7 21.2 One of the two answers “other” was specified
Rehabilitation Setting 10 30.3 as “Health surveillance”.
Hospice 4 12.1
Clinical Laboratory 10 30.3
Other 2 6.1
Not specified 8 24.2
Total 97

For further analysis the delivery settings were aggregated according to the following categories:

• Hospital: including Hospital and Hospital Care Network;

• Outpatient setting: including Practitioner Office, Ambulatory Care Clinic, Behavioral Health
and Clinic Laboratory;
• Long Term Care (LTC): including Home Care, Nursing Home, Subacute Care Setting,
Rehabilitation Setting, and Hospice.

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Hospital Based HTA

Table 4 shows the delivery settings of the two prevailing organization profiles (Teaching Hospital
and Public Health Care Organization).

Table 4. Prevailing Organization Profiles and Delivery settings

Organization profiles
Delivery settings
Public HCO Teaching Hospital
Hospital 5 18
Outpatient settings 7 18
Long Term Care
(LTC) 9 12
Total 21 48

Teaching Hospitals operate mainly at inpatient and outpatient level, committing themselves to LTC
in 25% of cases. On the contrary Public HCOs are more focused on LTC (43%) and Outpatient
Settings (33%), while Hospital Care accounts for a 24%.

Graph 3. Delivery settings and main organization profiles

Delivery settings of the main organization profiles (%)

Teaching
Organization profile

37,5 37,5 25
Hospital

Hospital
Outpatient settings
LTC

Public HCO 23,8 33,3 42,9

0% 20% 40% 60% 80% 100%

% delivery setting activities

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Hospital Based HTA

6.2 SECTION II: HTA models

HTA organizational models in connection with organization profile and HTA mission was studied.
Most institutions implemented an HTA function within their own organization (30 out of 33,
90.9%)
HTA activity has been defined as a systematic production of information related to an health
technology’s introduction/use/diffusion. The main object of the HTA activity is to produce
information to support decision-making processes. Scientific information comes from the
multidisciplinary evaluation of properties, effects, and clinical, social, ethical and economic
implications of health care technology.
HTA is conducted by interdisciplinary groups, whose members are partially or totally dedicated to
that activity.
All this information has been classified according to the HTA organizational models described in
“Background” section. In table 5 the distribution of HTA organizational models per country is
summarized.
Out of 33 responders, data are available for 30 organizations. In fact in 2 cases no data related to the
model was provided and in 1 case all four options were selected.
Where both ‘professional responsibility’ and ‘internal committee’ options were selected, the
responders were classified as ‘internal committee’. In one case that was specified ‘HTA unit on
demand’, it was considered as “HTA unit”.

Table 5. HTA organizational models and Country of responders

Country Hospital Based HTA : Four Models
Ambassador model Mini HTA Internal Committee HTA unit Total
Australia 0 0 0 2 2
Austria 0 0 0 1 1
Brasil 0 0 0 0 0
Canada 0 0 0 3 3
Colombia 1 0 0 0 1
Denmark 0 0 0 3 3
France 0 0 0 1 1
Germany 0 0 1 0 1
Italy 2 0 2 5 9
Mexico 0 0 1 0 1
New Zealand 0 0 1 0 1
Spain 0 0 1 0 1
Sweden 0 1 0 1 2
Switzerland 0 0 0 2 2
The Netherlands 0 0 0 1 1
USA 0 0 1 0 1
Total 3 1 7 19 30

Results regarding this section can be summarized in the following points:

While the literature review has outlined that the ”ambassador model” is mostly used in
Sweden, as a management and decision organizational tool, data from the survey show
that Ambassador Model counts 3 responds, located in Columbia and Italy. Swedish
responding institutions declare to adopt in one case a mini-HTA model and in the other
an HTA unit.
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Hospital Based HTA

The Mini-Hta model is a flexible decision support tool, which can be used by hospital
management both at a regional and at a local level when contemplating the introduction
of new health technology. Although this model has been developed by the Danish Centre
for Evaluation and Health Technology Assessment (DACEHTA) in cooperation with
local HTA environments, the Danish HCOs enrolled in the survey answered that they
adopted an HTA unit model.

The prevailing model is the ‘HTA unit’. It is reported by 63% of responders. This
organizational model is spread across the different countries and it is followed by the
‘Internal Committee’ model, which is present in 23% of the responding institutions.

Table 6 shows the association between the “organization profile” and the “organizational
complexity” dimension. The ‘HTA unit’ model is the prevailing solution in particular in the case of
teaching hospitals. Nine HTA units are active within teaching hospitals (47% of the established
units). Surveyed HCOs seems to prefer more complex organizational solutions (26 out of 30) where
structured HTA units or committees get the responsibility for performing HTA processes.

Table 6. Organization profile and organizational complexity

Organizational complexity
High Low
Organization profile Total
Team-group-unit Individual
Internal Ambassador
HTA unit Mini HTA
Committee Model
Governmental agency 1 4 1 0 6
Academia/University 0 1 2 0 3
Public Health Care Organization 2 2 0 0 4
Teaching hospital 3 9 0 1 13
Research institution 0 2 0 0 2
Industry 1 0 0 0 1
Other 0 1 0 0 1
Total 7 19 3 1 30
Errore. Il collegamento non è valido. Since HTA unit is the most spread organizational model to
perform HTA at HCOs level, the attention was focused on the organizational profile of HCOs
where HTA unit has been established to implement HTA approach. Graph 4 represents the
organizational profile, according to it, 9 HTA unit (47% of total Units) operates in a Teaching
Hospital.

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 Interest Sub-Group
Hospital Based HTA

Graph 4. Organization Profile of ISG members with a HTA unit

HTA Units and organzation profile of ISG members

teaching hospital 9

governamental agency 4

research institute 2

public health care organization 2

other 1

academia/university 1

industry 0

0 1 2 3 4 5 6 7 8 9 10
No.

Regarding the mission of HTA activity within hospitals and HCOs, each institution was asked to
choose among following options:

o HTA is mainly used to inform clinical practice or

o HTA is mainly used to support managerial decision making or
o HTA is used to both support clinical practice and managerial decision making

Collected data show that the majority of HCOs (76%) performs HTA in order to support both
clinical practice and managerial decision-making (Table 7). There is no relation between mission
and organizational complexity since both the majority of “Low organizational complexity” HTA
models (67%) and the majority of “High organizational complexity” HTA models (77%) are
associated with the same mission.

Table 7. Mission and organizational complexity

Organizational complexity
High Low
Mission Total
Team-group-unit Individual
Internal Ambassador
HTA unit Mini HTA
Committee Model
Informing clinical practice 0 1 1 0 2
Only Supporting decision making
0 5 0 0 5
process
Informing clinical practice and
Both supporting decision making 7 13 1 1 22
process
Total 7 19 2 1 29

Regarding HTA units is evident that they are active to support both clinical practice and managerial
decision making. This condition is reported in 13 out of 19 cases (69%) (See Graph 5) .
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Hospital Based HTA

Graph5. HTA mission in HTA units

HTA mission in HTA units

5% to inform clinical
26% practice

69% to support
management decision-
making
both

All Internal Committees (7 cases according to Table 7) and the only Mini-HTA declare to pursue
both activities. Institutions that declared to be coherent with the “Ambassador Model” just in one
case attribute are active in producing information to support clinical practice and managerial
decision making.

6.3 SECTION III : Competences and activities

The objective of this section is to analyze different competences involved in hospital HTA activities
and explore the kind of output produced.

The following table (Table 8) reports the competences (epidemiologist, health economist etc.)
operating in each organization. It also specifies the frequency of full time or part time or consultant
contract arrangement adopted.

Table 8. Competences performing HB-HTA ISG members and contract arrangements

% full % part %
Organization with
time time consulting
Epidemiologist 18 27.8 55.6 16.7
Health economist 20 45.0 15.0 40.0
Biostatistician 13 15.4 30.8 53.8
Information specialist 16 37.5 31.3 31.3
Biomedical engineer 16 50.0 18.8 31.3
Sociologist 5 60.0 0.0 40.0
Clinician 27 29.6 48.1 22.2
Ethicist 9 11.1 0.0 88.9
Public health specialist 15 40.0 40.0 20.0
Management 22 40.9 36.4 22.7
Other: 14 50.0 28.6 21.4
Nurse, Pharmacist, Patient
Advocate, Psychologist,
Research assistant, Risk
Manager

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Hospital Based HTA

Data related to competences involved in HTA hospital activities are reported in the graph 6.

Most common professional competences present in surveyed HB-HTA functions are:

• Clinicians, available in 27 cases out of 33 (83%). They are mainly available on a part time
(48%) basis;
• Managers (67% of responders) with a prevalence of full time contracts;
• Health economist, mainly available at a full time basis or as consultants.
Sociologists and ethicists instead, numerically are a marginal category.
The item “other” comprises the following competences: nurse, pharmacist, patient advocates,
psychologist, research assistance, risk manager.

Graph 6. Professional competences used in HB-HTA

Professional profiles in HB-HTA

Clinician
Management
Health economist
Epidemiologist
Biomedical engineer
Information specialist
Public health specialist
Other
Biostatistician
Ethicist
Sociologist

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Graph 7 reports the committed time of each professional competence involved in HTA activity.
Ethicists operate mainly as consultants (89%), as well as biostatisticians (54% ). Health economists,
biomedical engineers and managers are more easily available on a full time contract basis.

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Hospital Based HTA

Graph 7. Dedicated time to HTA of each competence

Professional profiles in HB-HTA

Management
Public health specialist
Ethicist
Clinician
Sociologist
Biomedical engineer
Information specialist
Biostatistician
Health economist
Epidemiologist

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

% full time % part time % consulting

Technologies that are mostly assessed (number of always and often answers) by institutions are:

• Medical device (25)

• Biomedical equipments (20)
• Combined technologies 1 , Emerging technologies (17)
• Clinical procedures (16)

Graph 8 reports detailed frequencies (always or often, sometimes, rarely or never ) of technology
evaluation in 31 responders. Just in 8 cases “Other technologies” are considered but only two
responders specified the item “other” as diagnostic test (pathology) and laboratory tests.

1
An example of combined technology is represented by Drug Eluting Stent where a medical devices and drugs coexist.

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Graph 8. How often a given technology is evaluated

Evaluated Technologies

30

25
No. Of Institutions

20

15

10

0
Medical

Communication

Organizational

Other
equipments

Drugs

technologies

technologies
procedures
devices
Biomedical

Technologies
Combined

(CT) support

Emerging
procedures
Clinical

system
always often sometimes rarely never

In Graph 9 is possible to appreciate the kind of dimensions (domains) considered in the assessment
of technologies in this sample. Data are expressed as the percentage of organizations, on total
survey’s responders (33), that declare to consider each dimension in their assessment process.

Three dimensions are commonly assessed (above 80% of responders):

• Safety
• Organizational impact
• Efficacy.

Four dimensions are assessed by less than 50% of responders:

• Technical productivity
• Satisfaction
• Ethical issues
• Patient perspective.

The item “other” was specified by one responder as environmental.

19
 Interest Sub-Group
Hospital Based HTA

Graph 9. Assessed Dimensions

Assessed Dimensions

Safety

Efficacy

Budget impact

Patient perspective

Satisfaction

Other

0 10 20 30 40 50 60 70 80 90 100

A deeper analysis on activities performed was carried out, based on the variability of assessed
dimensions in relation to each studied technology.
This analysis was focused on the organizations assessing specific technologies (biomedical
instruments, medical devices, etc) with a reported frequency “often” OR “always” (Graph 10).

Graph 10. Assessed dimensions for each health technology

Biomedical equipments
0% 2% 4% 6% 8% 10% 12% 14% 16% For biomedical
equipment the
attention is focused
on safety,
organizational
impact and efficacy.
Satisfaction and
technical
productivity instead
are rarely
considered.
Safety Efficacy Effectiveness
.
Cost-effectiveness Technical productivity Budget impact
Organizational impact Ethical issues Patient perspective
Satisfaction Other

20
 Interest Sub-Group
Hospital Based HTA

Drugs
0% 2% 4% 6% 8% 10% 12% 14%
For drugs the
attention is focused
on safety, efficacy
and organizational
impact. Satisfaction
plays a non marginal
role. A neglected
dimension is
technical
productivity.
Safety Efficacy Effectiveness
Cost-effectiveness Technical productivity Budget impact
Organizational impact Ethical issues Patient perspective
Satisfaction Other

Medical devices Likewise, for

0% 2% 4% 6% 8% 10% 12% 14% medical devices, the
most common
dimensions are
safety, efficacy and
organizational
impact. Greater
attention is paid also
to budget impact.
Again technical
productivity is
rarely assessed, as
Safety Efficacy Effectiveness well as patient
Cost-effectiveness Technical productivity Budget impact satisfaction.
Organizational impact Ethical issues Patient perspective
Satisfaction Other

21
 Interest Sub-Group
Hospital Based HTA

Combined Technologies Safety,

0% 2% 4% 6% 8% 10% 12% 14% organizational
impact and efficacy
are evaluated most
frequently.
Technological
productivity,
compared to other
technologies, is
taken in higher
account for
combined
Safety Efficacy Effectiveness technologies.
Cost-effectiveness Technical productivity Budget impact
Organizational impact Ethical issues Patient perspective
Satisfaction Other

Clinical procedures For clinical

0% 2% 4% 6% 8% 10% 12% 14% procedures the most
distinguished result
is the lower value
given to the
technological
productivity.
Furthermore, safety
and efficacy are
followed by
effectiveness, cost-
Safety Efficacy Effectiveness effectiveness, budget
Cost-effectiveness Technical productivity Budget impact and organizational
Organizational impact Ethical issues Patient perspective impact dimensions.
Satisfaction Other

22
 Interest Sub-Group
Hospital Based HTA

Comunication Technologies (CT) support systems

0% 2% 4% 6% 8% 10% 12% 14% 16% Safety, efficacy,

budget and
organizational
impact are on the
same level of
importance. The
most neglected
dimension is again
technological
productivity. Ethical
issues and
Safety Efficacy Effectiveness satisfaction are at the
Cost-effectiveness Technical productivity Budget impact same level of
Organizational impact Ethical issues Patient perspective
diffusion.
Satisfaction Other

Organizational procedures For organizational

0% 2% 4% 6% 8% 10% 12% 14% procedures a
dominant role is
played by the
organizational
impact dimension. A
secondary role is
assigned to safety,
efficacy,
effectiveness, and
cost-effectiveness.
The less assessed
dimensions are
Safety Efficacy Effectiveness
Cost-effectiveness Technical productivity Budget impact
technological
Organizational impact Ethical issues Patient perspective productivity and
Satisfaction Other ethical issues.

23
 Interest Sub-Group
Hospital Based HTA

Emerging technologies
Finally for emerging
0% 2% 4% 6% 8% 10% 12% 14% technologies, again
safety and
organizational
impact are
commonly assessed,
while technological
productivity and
satisfaction are
neglected.

Safety Efficacy Effectiveness

Cost-effectiveness Technical productivity Budget impact
Organizational impact Ethical issues Patient perspective
Satisfaction Other

Another area of analysis was related to the prioritization criteria for HTA activities.
Prioritization criteria represent a critical point in the organization of HTA process. Each responder
was asked to rank the prioritization criteria, according to the relevance, from 1 (most relevant) to 6
(less relevant). Graph 11 reports the collected results through a Box-Whisker diagram.

Graph 11. Boxplot of prioritization criteria relevance in HB-HTA

Economic concern Clinical relevance

S
5
5

S
4
4

S
3
3

S
2
2

24
 Interest Sub-Group
Hospital Based HTA

Public health concern Political concern

6 6

5 5

4 4

3 3

2 2

Public and media concern Other

6 6

3
2

0
A

The following table summarizes the data represented in Graph 11. The most relevant criteria is
clinical relevance, followed by economic and public health concern. Less relevant criteria are other
(legal, ethical, organizational that were specified by a responder) and political concern.

Table 9. Prioritization criteria relevance

Relevance
Criteria to prioritize (1=most relevant, 6=less relevant)
HTA activities 25° 75°
Median percentile percentile
Economic concern 2 1 3
Clinic relevance 1 1 1
Public health concern 2 1 3
Political concern 3 2 4
Public and media concern 4 3 5
Other 6 3 6

25
 Interest Sub-Group
Hospital Based HTA

Finally, HTA production in 2006 was investigated. Each organization was asked to report the
number of documents produced according to the following list of different outputs:

Assessment reports2: full comprehensive reports resulting from the process of assessment,
based on systematic scientific evidence review, focused on aspects such as efficacy, safety,
effectiveness and efficiency of medical technologies, designed to adapt the assessment to the
analyzed health scenario and depending on the requirements of the commissioning organization.

Technical queries1: short reports generated by assessment processes when the commissioning
or requesting party needs to obtain an answer in a short time.

Quick response service1: brief reports which respond quickly and concisely to very specific
queries.

Issues in Emerging technologies3: bulletins highlighting technologies that are not widely
spread in the country.

Pre-assessment2: based on a limited literature review.

Biomedical equipments investment plan: annual or long term Investment Plan for biomedical
equipments, based on HTA principles; it also establishes internal allocation of technological
resources.

Clinical practice guidelines.

The most common produced outputs in 2006 (Table 10) were:

• assessment reports (a mean of 6 reports was produced by 19 institutions);

• technical queries, (a mean of 22 documents produced by 13 institutions , but with a
strong outlier of 206 queries produced in 2006)
• quick response service, produced by 13 members with an annual mean of 8.6.

Other outputs are less commonly produced (lower values in column ‘Yes’). Clinical practice
guidelines were realized by 9 members with an high productivity (a mean of 17 guidelines and a
median of 4 in 2006). .

Table 10. HTA output produced in 2006

Number of Number of outputs produced in 2006
Production of outputs organization Mean Median Minimu Maximu
producing outputs m m

Assessment reports 19 5.6 5 0 17

Technical queries 13 22.0 5 0 206
Quick response service 13 8.6 9 0 30
Issues on emerging technologies 7 4.9 2 1 10
Pre-assessment 9 10.3 4 0 50
Biomedical equipments investment 8 3.6 1 1 19
plan
Clinical practice guidelines 9 16.8 4 0 84
Others 1 1

Graph 12 reports graphically the information on the HTA production in 2006 representing both the
number of members realizing each type of output and mean number produced in a year.
2
EUnetHTA project definitions.
3
CADTH definitions.

26
 Interest Sub-Group
Hospital Based HTA

Graph 12. HTA Outputs per type and production level in 2006

HTA outputs 2006

Yes Mean

Assessment reports
25

20
Others Technical queries
15

10

Clinical practice guidelines 0 Quick response service

Biomedical equipments investment

Issues on emerging technologies
plan

Pre-assessment

27
 Interest Sub-Group
Hospital Based HTA

6.4 SECTION IV : Hospital HTA: training and external environment

The analysis investigated also dissemination tools, “target users”, professional training process of
professionals involved in HB-HTA activities and link existing with external institutions.

“Target users” refers to the people/organizations for which the HTA activities are carried out. To
identify the main target users of HTA activities, it was asked to report the relevance of a list of
potential users as percentage on total users. According to data provided, internal users
(clinicians/managers) were the main target users.

In Graph 13 is evident the strong relevance recognized to internal users. Indeed, in mean internal
users’ relevance is 52.6%, followed by hospitals (11.1%) and national/regional HTA bodies
(10.8%).

Graph 13. Main target users of HTA activities

Target Users of HTA activities

Industry 0,9%
Other 0,9%
National/regional
HTA bodies 10,8%
Internal users 52,6%
Other health care
organizations 4,1%

Hospitals 11,1%

A collaborative
network for HTA
3,9%

Graph 14 reports the same kind of information for each organization profile, as described in Table
2. Teaching hospitals recognize a key role to internal users (clinicians and managers), research
institutions considered one of their main users the hospitals. Industry is focused on national/regional
HTA bodies.

28
 Interest Sub-Group
Hospital Based HTA

Graph 14. Target user mean relevance per organization profile

Mean relevance of users per organization profile

%
0 10 20 30 40 50 60 70 80 90 100

governamental agency

academia/university

public health care organization

teaching hospital

research institute

industry

other

Internal users A collaborative network for HTA

Hospitals Other health care organizations
National/regional HTA bodies Industry
Other

Dissemination of HTA documents was realized through different tools. The most exploited mean of
dissemination (see Graph 15) are workshops, adopted by 52% (17 out of 33) of responders.
Websites are used by the 45%. While newsletters are produced by 10 members of HB-HTA ISG
members.
Many organizations used other tools to disseminate their knowledge not listed in the questionnaire;
examples of these tools are: hardcopies of recommendations and reports; written report; appropriate
committees and clinicians; monthly seminars with journalists and administration; discussions with
professionals, clinicians and decision-makers; internal conferences; direct distribution of produced
documents.

29
 Interest Sub-Group
Hospital Based HTA

Graph 15. Dissemination tools

Dissemination tools

Workshops

Website

Other

Training

Papers public on scientific journals

Intranet

Newsletter

0% 10% 20% 30% 40% 50% 60%

The analysis on professional training show how it plays a key role in the career path and has a
special relevance in HTA.
As results in Table 11, 38.9% of the overall staff is trained.

Table 11. Trained staff

Mean 38.90%
Median 25%
Minimum 0%
Maximum 100%

Furthermore, from the survey results that 78.8% of responders organized or participated or are
planning to organize or participate in HTA professional training. Of these 26 responders (Table
12), almost the 81% actively organized HTA training events.

Table 12. Role of HTA training

Does your organization organized or participate in HTA training activities? No % on 33

no 4 12.1
not yet. but they are included in the agenda 3 9.1
yes 26 78.8
of which: % on yes
as organizer 21 80.8
as attendant 15 57.7

30
 Interest Sub-Group
Hospital Based HTA

Graph 16 represents the type of HTA training events that ISG members organize. The most
preferred solutions are conferences and short courses, organized by respectively the 85% and 65%
of those members actively involved in HTA events.

Graph 16. Organized HTA training events

Organized HTA events

PhD programs;
BA courses; 15% 19%
Conferences; 85% Distance learning
courses; 27%

Msc/Ma Programs;
Short courses; 31%
65%

Finally, it is also possible to identify the other organizations with whom HB-HTA ISG members are
in contact. Table 13 provides a detailed vision on these links and connections. The item “other” was
specified only by one responder (on 3) as industry, consumer organizations. Performing HTA
activities determines contacts with university (30/33 members), national/regional HTA bodies
(27/33) and health policy institutions (25).
The links could have different nature; in particular they could be:

o Formal: links are based on written agreement.

o Informal: links are not based on written agreement.
o Permanent: continuing links, with sharing of competences, tasks and knowledge in the
assessment processes.
o Temporary: project based links.

Therefore the HCOs were also asked to describe the nature of their links with the different kind of
organizations listed.

Table 13. Links with other organizations

Yes
No. Formal Informal Both NA Permanent Temporary Both NA
National/regional HTA bodies 27 13 10 3 1 14 4 2 7
Research centres 23 7 12 2 2 8 8 7
University-faculties 30 11 17 1 1 10 8 12
Other HCOs 21 5 11 2 3 5 7 1 8
Health Policy Institutions 25 13 10 1 1 6 7 12
Other 3 1 1 1 2 1

31
 Interest Sub-Group
Hospital Based HTA

Not for all these connections data are available on the type of links actually running (Table 13, NA
column), but a clear distribution per institutions and type of relations is possible. Links with
national/regional HTA bodies and health policy institutions tend to be mainly formal, while with
research centers and other HCOs are mainly informal (Graph 17).
With national/regional HTA bodies permanent contacts are prevailing (Graph 18), while with other
HCOs and research centers there is an equilibrium between permanent and temporary connections.

Graph 17. Formal and informal links

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

National/regional HTA bodies

Research centres

University-faculties

Other HCOs

Health Policy Institutions

Other

Formal Informal Both

Graph 18. Temporary and permanent connections

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

National/regional HTA bodies

Research centres

University-faculties

Other HCOs

Health Policy Institutions

Other

Permanent Temporary Both

32
 Interest Sub-Group
Hospital Based HTA

7. Discussion and Conclusion

HTA activities are mainly performed in Teaching Hospital (43.3% of responders) with a double
perspective: to produce information and to inform clinical practice(76%).
The HTA unit is the most common organizational model adopted (63% of responders).
The key professional profiles are clinicians, managers and health economists, with different contract
arrangements for each profile.
Mainly medical device, biomedical equipments, combined and emerging technologies and clinical
procedures are evaluate by members, focusing the assessment on the safety, organizational impact
and efficacy. While to prioritize among activities and technologies the clinical relevance represents
the first concern.
Performed activities are summarized mainly in assessment reports, technical queries and quick
response services and disseminate through workshops and websites.
The main target users are internal users (52.6%), hospitals (11.1%) and national/regional HTA
bodies (10.8%). Different organization profiles have different target users.
About 40% of the personnel is trained and training is directly organized (79%) in form of
conferences (85%) and short courses (65%).
Finally, connections with external bodies are managed, both formal (health policy institutions and
national/regional HTA bodies) and informal (other HCOs). These links could be permanent
(national/regional HTA bodies) or temporary (other HCOs).

The survey among the Hospital Based ISG members provides an overall picture on how HTA is
performed in the health care organization in terms of institutions profile, HTA organizational
model, involved competences and assessed technologies.
The double nature of HTA mission result widely accepted, given that 76% of members recognize it
as both production of information and information of clinical practice. The strong link with the
clinical dimension is further proved by its key role among prioritization criteria and in terms of
professional competences involved in HTA.
Hospital based HTA is not focused on a limited set of technologies. Then, it adopts a
multidimensional approach in the assessment process, mainly focusing on safety, organizational
impact and efficacy but not completely forgetting other aspects.
HTA bodies actively promoted training organizing events such conferences and short courses.
Finally, a deep network of contacts with external institutions is maintained.
Further studies could be useful in order to analyze and standardize HTA method applied in Health
Care Organization.
These final remarks could be biased by the selection criteria of institutions enrolled in the survey. In
fact the questionnaire has been submitted only to those organizations member of ISG – Hospital
Based HTA which couldn’t cover all the organization where Hospital based HTA is performed.
In order to overcome these limitations could be useful:

1. To enlarge the survey submitting the questionnaire to other hospitals not listed among ISG
HB-HTA group, that are experiencing hospital based HTA activities;
2. To update the survey in order to figure out how decision-making processes are developed
within the organizations – e.g who decides what to do and how to do it, which interactions
are established with other organizational committees.

The survey performed was the first experience that investigated the worldwide Hospital Based HTA
activities.
Despite limitations previously mentioned, this initiative was a very positive starting point in order
to establish collaboration among peers HTA institutions to better understand and harmonize hospital
based HTA practice.

33
 Interest Sub-Group
Hospital Based HTA

Acknowledgments
The authors would like to thank the Board of Directors and the President of Health Technology
Assessment International for their continuous support from the establishment of the Interest Sub-
Group Hospital Based HTA to the diffusion of the results of the first worldwide survey on Hospital
Based HTA. In particular, on behalf of HBHTA ISG’s members, the authors thank to HTAi for
financial support provided to print this booklet.
The authors would like to thank all ISG’s members for their support, in particular those who kindly
replied to this survey. .

34
 Interest Sub-Group
Hospital Based HTA

References
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Moutquin, J.-M. L’évaluation des technologies et des modes d’intervention en santé dans les
hôpitaux universitaires. Montréal: AETMIS; 2003.
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Gemelli” University Hospital. Ital J of Pub Health. 2005; 2(2) 23-29.
7. Cicchetti A. Strategic planning in healthcare organizations: the role of health technology
assessment. In Geisler E, Krabbendam K, Schuring R, eds., Technology, healthcare and
management in the hospital of the future, Westport, London; Praeger, 2003: 67-80.
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Oxford: Oxford University Press: 2005.
9. Ehlers L, Vestergaard M, Kidholm K, Bonnevie B, Pedersen PH, Jorgensen T, Jensen MF,
Kristensen FB, Kjolby M.. Doing mini-health technology assessments in hospitals : A new
concept of decision support in health care? Int J Technol Assess Health Care. 2006; 22(3):
295-301.
10. Jacob R, McGregor M. Assessing the impact of health technology assessment. Int J Technol
Assess Health Care. 1997; 13: 68-80.
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maintenance organizations, and third-party payers in the United States. Int J Technol Assess
Health Care, Winter; 11(1):79-92.
12. Maddern G. HTA in hospital setting: the Australian experience. Ital J Pub Health. 2005; 2:
(Suppl 1): 93
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14. Menon D, Marshall D. Technology assessment in teaching hospitals. Dimens Health Serv.
1990; 67: 123-132
15. Rehnqvist N. Bringing HTA into practice in Sweden. Ital J Pub Health. 2005; 2: (Suppl 1):
28
16. Rosen R, Gabbey J. Linking health technology assessment to practice, BMJ 1999; 319: 1-3.
17. Wasserfallen JB, Pinget C. HTA use in a Swiss hospital system. Ital J Pub Health. 2005; 2:
(Suppl 1): 54
18. Wild C. HTA in hospitals: a network of Austrian hospitals. Ital J Pub Health. 2005; 2:
(Suppl 1): 29
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Assessment (SNHTA). Ital J Pub Health. 2005; 2: (Suppl 1): 39

35
 Interest Sub-Group
Hospital Based HTA

APPENDIX 1 – List of HB-HTA ISG’s organizations members

Organization City Country
Argentina
Head-Medicine Program Southern Health
Victoria Australia Melbourne Australia
ASERNIP-S, Australia Melbourne Australia
Institute of Technology Assessment,
Austrian Academy of Sciences Wien Austria
Farmacêutica- Gerente de Risco
Instituto da Criança HCFMUSP Sao Paulo Brasil
Brazilian Health Suveillance agency -
ANVISA Brasilia Brasil
University of Montreal Montreal (Quebec) Canada
McGill & University of Montreal - CHUM /
MUHC Technology Assessment Unit Montreal (Quebec) Canada
AETMIS - Agence d'évaluation des
technologies et des modes d'intervention en
santé (AETMIS) Montréal (Quebec) Canada
Hospital St-francois d'Assise, CHUQ Quebec Canada
High Impact Technology Evaluation Centre
(HiTEC) London Health Sciences Centre London (Ontario) Canada
Hayes Inc. Mississauga (Ontario) Canada
master ulysses's student Montreal (Quebec) Canada
CHUQ Québec (Quebec) Canada
3rd Edition Master Ulysses's student Montreal (Quebec) Canada

Levitra Andean Region - Bayer- HeathCare Bogotá Colombia

3rd Edition Master Ulysses's student Colombia
DACEHTA - Danish Centre for Evaluation
and HTA Copenhagen Denmark
Odense University Hospital, Department of
Research and HTA Odense Denmark
HTA-unit, Århus University Hospital
Department of Public Health Århus Denmark

Fédération Hospitalière de France - FHF Paris France

CEDIT - Comité d’Evaluation et de
Diffusion des Innovations Technologiques Paris France
Ethicon Endo Surgery - European
Headquarter Norderstedt Germany
Policlinico Niguarda Milan Italy
Celgene Italia Milan Italy

IRCCS Ospedale Pediatrico Bambino Gesù Rome Italy

A.O.U. Ospedali Riuniti di Ancona Ancona Italy
Ospedale Universitario di Padova Padova Italy
Agenzia Nazionale per i Servizi Sanitari
Regionali Rome Italy
ASL Roma E Rome Italy

Azienda Provinciale per i Servizi Sanitari Trento Italy

36
 Interest Sub-Group
Hospital Based HTA

Ospedale San Matteo Pavia Pavia Italy

HTA Unit - University Hospital "A.
Gemelli" - Universitò Cattolica del Sacro
Cuore Rome Italy
Università di Pavia Pavia Italy
ISS Rome Italy
Azienda Sanitaria di Bressanone Bressanone Italy
Università di Trento Trento Italy
Ethicom Endosurgery Rome Italy

Azienda Ospedaliera San Filipppo Neri Rome Italy

ASL Firenze Firenze Italy
Centro Nacional de Excelencia Tecnológica
en Salud - CENETEC Colonia Juárez Mexico

Auckland District Health Board Auckland New Zealand

University medical center Groningen Groningen The Netherlands

Agency for Health Technology Assessment
in Poland AHTAPol Poland
AETSA - Andalusian Agency for Health
Technology Assessment Seville Spain
University Hospital in Göteborg Göteborg Sweden
SBU - Swedish Council on Technology
Assessment in Health Care Stockholm Sweden
Swiss Network for Health Technology
Assessment Berne Switzerland
University Hospital of Lausanne
in French: Centre Universitaire Hospitalier
Vaudois / CHUV Lausanne Switzerland
Massachusetts General Hospital Boston USA

37
 Interest Sub-Group
Hospital Based HTA

APPENDIX 2 – List of responders (in alphabetical order)

ASERNIP-S - Australian Safety and Efficacy Register of New Interventional
ANVISA - National Health Surveillance Agency
Procedures - Surgical
City Brasilia City Stepney
Country Brazil Country Australia
Respondent Manager Respondent Manager
Web-site www.anvisa.gov.br Web-site www.surgeons.org/asernip-s

ASL Firenze Auckland District Health Board

City Florence City Auckland
Country Italy Country New Zeeland
Respondent Medical Director Respondent Clinical Practice Committee Manager
Web-site http://www.asf.toscana.it/ Web-site www. adhb.govt.nz

Azienda Ospedaliera Università di Padova Azienda Provinciale per i Servizi Sanitari di Trento
City Padua City Trento
Country Italy Country Italy
Respondent Medical Director Respondent Director of Quality improvement Unit
Web-site www.sanita.padova.it Web-site www.apss.tn.it

Azienda Sanitaria Locale Roma E CEDIT - Comité d’Evaluation et de Diffusion des Innovations Technologiques
City Rome City Paris
Country Italy Country France
Respondent Risk Manager Respondent Biomedical engineer -Direction de la Politique Médicale
Web-site www.asl-rme.it Web-site http://cedit.aphp.fr/

CENETEC - Centro Nacional de Excelencia Tecnologica en Salud Centre Hospitalier Universitaire de Québec - Hôpital Saint-François d'Assise
City Mexico, DF City Québec (Quebec)
Country Mexico Country Canada
Respondent Subdirectora de Evaluación Tecnológica Respondent Researcher
Web-site www.cenetec.gob.mx Web-site www.crsfa.ulaval.ca

38
 Interest Sub-Group
Hospital Based HTA

CHUQ - Centre Hospitalier Universitaire de Québec CHUV - Centre Hospitalier Universitaire Vaudois Lausanne
City Québec (Québec) City Lausanne
Country Canada Country Switzerland
Respondent Coordinator of HTA unit Respondent Associate Medical Director
Web-site www.chuq.qc.ca Web-site www.chuv.ch

DACEHTA - Danish Centre for Health Technology Assessment Department of Health Administration, Universitè de Montréal
City Copenhagen City Montreal (Quebec)
Country Denmark Country Canada
Respondent HTA adviser Respondent Director
Web-site www.dacehta.dk Web-site http://www.mdas.umontreal.ca/

Ethicon Endo Surgery - European Headquarter Fondazione IRCCS Policlinico San Matteo
City Hamburg City Pavia
Country Germany Country Italy
Respondent Senior Health Outcome Manager Respondent Director of HTA unit - consultant
Web-site http://www.ethiconendo.com/ Web-site www.sanmatteo.org

HTA Unit Aarhus Instituto de Bioética - Pontificia Universidad Javeriana

City Aarhus City Bogotá, D.C.
Country Denmark Country Colombia
Respondent Health Economist Respondent Researcher
Web-site Web-site

IRCCS Ospedale Pediatrico Bambino Gesù ISS - Istituto Superiore di Sanità

City Rome City Rome
Country Italy Country Italy
Respondent Director of Clinical Engineering Unit Respondent Researcher
Web-site www.ospedalebambinogesu.it Web-site www.iss.it

39
 Interest Sub-Group
Hospital Based HTA

LBI-HTA - Ludwig Boltzmann Institute of Health Technology Assessment Massachusetts General Hospital
City Wien City Boston
Country Austria Country USA
Respondent Director Respondent Sr. Project Specialist/ Assistant in Internal Medicine for Clinical
Technology Assessment & Innovation
Web-site http://hta.lbg.ac.at/de/index.php Web-site www.massgeneral.org/

McGill University Health Center Monash Medical Centre, Southern Health

City Montreal (Quebec) City Melbourne
Country Canada Country Australia
Respondent Director Respondent Head, Medicine Program
Web-site www.mcgill.ca/tau Web-site www.southernhealth.org.au/mmc.htm

Odense University Hospital Regional HTA-centre in the West Swedish health care region
City Odense City Goteborg
Country Denmark Country Sweden
Respondent Head of department for research and HTA Respondent MD, PhD, Ass Prof, Head of HTA project
Web-site www.ouh.dk Web-site

San Filippo Neri SBU - Swedish Council on Technology Assessment in Health

City Rome City Stockholm
Country Italy Country Sweden
Respondent Medical Director Respondent Deputy director
Web-site www.sanfilipponeri.roma.it Web-site www.sbu.se

SFPOH - Swiss Federal Office of Public Health University Medical Center Groningen
City Berne City Groningen
Country Switzerland Country The Netherlands
Respondent Scientific collaborator Respondent Senior HTA researcher
Web-site www.bag.admin.ch Web-site www.umcg.nl

40
 Interest Sub-Group
Hospital Based HTA

University of Trento, Department of Physics UVT - Unità di Valutazione delle Tecnologie, Policlinico A. Gemelli
City Trento City Rome
Country Italy Country Italy
Respondent Professor Respondent Director, HTA Unit
Web-site www.science.unitn.it/biophysicslab/ Web-site www.policlinicogemelli.it/area/?s=206

Valme University Hospital. Andalusian Health Service

City Seville
Country Spain
Respondent Head of Quality and Clinical Records Department
Web-site

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