Americo Cicchetti1, Valentina Iacopino2, Silvia Coretti1, Alessandra Fiore3, Marco Marchetti4, Laura Sampietro-Colom5, Kristian Kidholm6, Jean-Blaise Wasserfallen7, Rabia Kahveci8, Esa Halmesmäki9, Magdalene Rosenmöller10, Claudia Wild11, Raul-Allan Kivet12. 1. Università Cattolica del Sacro Cuore,Faculty of Economics and Graduate School of Health Economics and Management. 2. Università Cattolica del Sacro Cuore,Faculty of Economics and Graduate School of Health Economics and Managementvalentina.iacopino@unicatt.it. 3. Graduate School of Health Economics and Management,Università Cattolica del Sacro Cuore. 4. National Center for Health Technology Assessment,National Institute of Health. 5. Hospital-Based HTA Unit,Innovation and Research Directorate,Hospital Clinic Barcelona. 6. Department of Quality and Research/HTA,Odense University Hospital. 7. Lausanne University Hospital. 8. Ankara Numune Training and Research Hospital. 9. Hospital District of Helsinki and Uusima. 10. IESE Business School. 11. Ludwig-Boltzman Institute for HTA. 12. Tartu University Clinics.
Abstract
OBJECTIVES: Hospital-based health technology assessment (HB-HTA) is becoming increasingly relevant because of its role in managing the introduction and withdrawal of health technologies. The organizational arrangement in which HB-HTA activities are conducted depends on several contextual factors, although the dominant models have several similarities. The aims of this study were to explore, describe, interpret, and explain seven cases of the application of HB-HTA logic and to propose a classification for HB-HTA organizational models which may be beneficial for policy makers and HTA professionals. METHODS: The study was part of the AdHopHTA Project, granted under the European 7th Framework Research Programme. A case study methodology was applied to analyze seven HB-HTA initiatives in seven countries, with collection of qualitative and quantitative data. Cross-case analysis was performed within the framework of contingent organizational theory. RESULTS: Evidence showed that some organizational or "structural" variables, namely the level of procedure formalization/structuration and the level of integration with other HTA bodies at the national, regional, and provincial levels, predominantly shape the HB-HTA approach, determining a contingency model of HB-HTA. Crossing the two variables, four options have emerged: integrated specialized HTA unit, stand-alone HTA unit, integrated-essential HTA, independent group unit. CONCLUSIONS: No one-best-way approach can be used for HTA at the hospital level. Rather, the characteristics of HTA models depend on many contextual factors. Such conceptualization may aid the diffusion of HB-HTA to inform managerial decision making and clinical practice.
OBJECTIVES: Hospital-based health technology assessment (HB-HTA) is becoming increasingly relevant because of its role in managing the introduction and withdrawal of health technologies. The organizational arrangement in which HB-HTA activities are conducted depends on several contextual factors, although the dominant models have several similarities. The aims of this study were to explore, describe, interpret, and explain seven cases of the application of HB-HTA logic and to propose a classification for HB-HTA organizational models which may be beneficial for policy makers and HTA professionals. METHODS: The study was part of the AdHopHTA Project, granted under the European 7th Framework Research Programme. A case study methodology was applied to analyze seven HB-HTA initiatives in seven countries, with collection of qualitative and quantitative data. Cross-case analysis was performed within the framework of contingent organizational theory. RESULTS: Evidence showed that some organizational or "structural" variables, namely the level of procedure formalization/structuration and the level of integration with other HTA bodies at the national, regional, and provincial levels, predominantly shape the HB-HTA approach, determining a contingency model of HB-HTA. Crossing the two variables, four options have emerged: integrated specialized HTA unit, stand-alone HTA unit, integrated-essential HTA, independent group unit. CONCLUSIONS: No one-best-way approach can be used for HTA at the hospital level. Rather, the characteristics of HTA models depend on many contextual factors. Such conceptualization may aid the diffusion of HB-HTA to inform managerial decision making and clinical practice.
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