A model for best practice HTA

The aims of this paper are: to review and describe different approaches to HTA used in Australia and in other countries and to identify the features of best practice in HTA, particularly those likely to be most relevant to HTA at a local (ie state/regional) level. There are a number of well-developed models of HTA at the national and local levels. Most information about the operation of these models, particularly about the type and number of evaluations conducted, the recommendations/decisions made and the reasons for these is available for national processes, but there is much less readily available documentation about local level HTA. Most HTA processes that operate nationally and internationally can be categorised in one of three ways: guidance (provides structured information about appropriate technologies), mandatory (provides mandatory information about technologies to be implemented) and funding and implementation (provides structured evidence-based advice about which technologies should be implemented, the level of funding required to implement them and the source of these funds). The main factors which distinguish a high quality HTA process are that i) it is efficient in terms of setting priorities, the scope of the technologies to be assessed, avoidance of duplication and overall cost of the process, ii) the overall impact on utilisation and health budget is calculated as part of the HTA and iii) procedural justice occurs and is seen to occur; iv) it includes a comprehensive assessment of the impact on issues such as workforce, credentialing of providers and the ethical dimension of the technology; v) it influences decision making by being communicated appropriately and using trusted methods; vi) it influences adoption and diffusion of technology by ensuring that there is no diffusion prior to HTA, the results are incorporated into guidelines or recommendations, funding is linked to the decision, and remuneration arrangements and other characteristics of the HS facilitate the appropriate adoption and diffusion and vii) it influences health outcomes/efficiency/equity by ensuring that the methods and/or results are available and able to be used at a local level. Firm recommendations for an ideal system for HTA at the local level are not possible as much of the necessary information and evidence is not available about the strengths and weaknesses of HTA practices and processes currently in use. However, it is likely that the operation of a successful model of HTA at a local level would require the development of a central organizational unit, a process for implementing the results of HTA and, crucially, the building of capacity to support both types of activities. Additional expertise and skills will be required for both providers of HTA evaluations and for the commissioners and users of HTA.