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Health Technology Assessment

Health Technology Assessment

From an extensive systematic literature review in the field of telerehabilitation conducted within the CLEAR project, two relevant points came out for HTA in telerehabilitation:

  1. usually HTA results related to Telerehabilitation Services are not enough deeply reported or discussed within peer-reviewed scientific publications. On the contrary they can only be found in dedicated databases which deals with Health Economic Evaluation;
  2. the above reports only cover very few issues/dimensions of HTA; among them, some are based on a qualitative approach; those which show a quantitative approach mainly deal with cost-related HTA. The analysis tools are basically cost-effectiveness analysis (CEA), cost-benefit analysis, cost-utility analysis.

An extensive HTA process is currently under implementation within the CLEAR Project with the double target of correctly assessing the CLEAR Telerehabilitation Service and of producing methodologies and indications which may be generalized and included in the Service guidelines. An ad-hoc method has been then developed and proposed, which is here briefly described; tools for the assessment are in the process of being completed and approved by the team of assessors of the Project. A complete HTA report will be delivered at the end of the clinical trials, i.e. at the end of the CLEAR project.

First relevant aspect within the CLEAR project is that HTA was not based on cost indicators only, which apply to specific sectors of telerehabilitation HTA, i.e. the assessment of organizational and economic aspects. These indicators may not be generalized to all other sectors CLEAR accounts for. For instance they do not furnish information about the clinical impact of the introduction of new rehabilitation concepts and methods.

The CLEAR assessment process, instead, deals with the evaluation of all 24 sectors that arise from considering 8 possible HTA dimensions (clinical impact, organizational impact, ethical and social issues, risk management, evidence based information, quality perception, security, privacy) and 3 possible HTA fields (protocols, technical assessment, service assessment). The sectors under evaluation are vastly heterogeneous and require the definition of widely applicable procedures and survey tools.

Identification of HTA staff.

Within the CLEAR project, one of the partners – the Italian National Institute of Health (ISS) – is in charge for the design and implementation of an independent HTA of the CLEAR Telerehabilitation service. Local Assessors have been identified within each of the four involved countries who act as reviewers for the validation and approval of the CLEAR HTA methodologies and tools, and who are in charge for the HTA data retrieval from the clinical centre of the same country.
Beside them, information will be collected from all professionals involved in the project, as well as from patients and caregivers. A special contribution is asked to SIGNOMOTUS both as Project leader and as the provider of the Telerehabilitation Service within the project.

Identification of HTA tools and procedures.

The instruments which have been identified as the most powerful to conduct the CLEAR HTA are:

  • the collection of structured background information;
  • the distribution of dedicated check lists as tools applicable to all sectors, easily interpreted and useful for the end-user.

Structured information, together with answers from the questionnaires, will be then treated with calculus algorithms and weighted-mean analyses. The user will then be able to act on those aspects that the evaluation has identified as the most critical that may hinder the smooth dissemination of the telerehabilitation tool under HTA.

With the HTA method proposed within the project - which requires the collection of all the parameters accounted for by the traditional cost analysis - it is also possible to calculate, for some specific sectors, the HTA cost indicators.

From an operative point of view, the following steps have been identified:

  • identification of HTA categories within each sector (i.e., a dimension with respect to a field);
  • definition of questionnaires and checklists for each sector;
  • review and approval of the above tools;
  • delivery of the tools together with guidelines for the compilation;
  • data collection and processing;
  • HTA reporting

The most recommended tools for data collection by the local Assessors are:

  • structured interviews to clinicians, stakeholders, healthcare providers, etc;
  • quality survey tools;
  • extraction of evidence from literature;
  • analysis of results from clinical trials;
  • collection of related regulations, standards and guidelines;
  • investigation of health organizational databases.

Currently, HTA categories have been established as well as the instruments to be used for HTA data retrieval. Questionnaires and check lists for HTA three sectors have already been prepared and currently under revision. Quality surveys have already been prepared for all actors – patient, caregiver, therapist and clinician – who will answer them at the end of the telerehabilitation treatment; they are currently under translation into local language.