NOKC, Norway
The Norwegian Knowledge Centre does not currently have a structured approach to assessing the applicability of external HTA reports or reviews, although issues tied to applicability and transferability are dealt with frequently. In practice, our approach when evaluating these documents resembles processes described by other institutions, including the New Zealand Guideline Group (NZGG) [1]. These issues are also described in a recent publication co-authored by two of the Norwegian Knowledge Centre’s staff members as background for advice from the WHO Advisory Committee on Health Research [2].
As an important first step we begin by appraising the quality of the document by checklists developed for assessing the quality of systematic reviews. If the document is evaluated as being of high enough quality, we then go on to evaluate its relevance or potential transferability to the Norwegian setting. This is particularly done for the following areas;
-the health setting or professional groups involved in intervention delivery,
-the patients or consumers the intervention targets, including their specific health condition, baseline risk, expected compliance, etc,
-the intervention, its current availability, cost, etc,
-the control intervention, and the degree in which the comparison is a relevant one in Norway,
-the outcomes, and the degree in which they reflect the values and goals of Norwegian health care users and policy makers.
The issue that most often hinders the applicability of an HTA-report from another agency, is uncertainties regarding the methods for how the review was undertaken. Thus developing a core model for HTA will facilitate the use of HTA-reports from other agencies.
When assessing applicability of another HTA-report or systematic review we consider whether there are special circumstances that may modulate the efficacy obtained in the research setting. For instance percutaneous coronary interventions (PCI) has proven to be better than thrombolysis in acute myocardial infarction (MI). PCI need to be given within a period of less than 3 hours, but if PCI is decentralised to hospitals with few annual procedures, patient outcomes are worse than in more experienced hospitals. Thus there are certainly other factors, that are unlikely to have been dealt with in the trial setting that may modulate the expected effectiveness of the technology when applied in another setting. These factors may relate to health care system, geography, population, need for education or special competence etc.
Another issue that might relate to the applicability of HTA-reports is the timeliness. If an issue is emerging with great importance, exchange of information may be extremely helpful. This may be not be a complete HTA report, but preliminary information. We have for example shared a preliminary version of our HPV-vaccination report so that other agencies may assess whether this report may be relevant to their question.