HTA agency, Poland
Pre-assessment
In AHTAPol pre-assessment constitutes the initial stage in the procedure of developing HTA report (that has been recently implemented by the Order of the Director of the AHTAPol of the 27th of March 2007).
Pre-assessment of health technology is a summary of information, that is relevant for making a recommendation regarding terms of funding specific technology from public sources, for example:
• The description of a technology and alternative technologies, taking into consideration also availability and accessibility of those technologies for specific disease, health condition or indication the description of disease, health state or indication, in which the technology referred for analysis is to be applied to, mainly taking into consideration the significance for the health of the society, basic health priorities, prevalence, incidence or morbidity and significance of the consequences of the disease (e.g. partial or total incapacity for work, inability to exist unaided, reduced quality of live or even death).
• Scientific evidence (on clinical effectiveness and safety, the levels of cost-effectiveness or cost-utility for analyzed technologies, the budget impact) obtained from secondary sources - systematic reviews, HTA reports, meta-analyses or clinical practice guidelines, either submitted by the applicant together with the request for the analysis of specific health technology (in accordance with the Order of the Director of the AHTAPol of the 27th of March 2007) or found through search of available database for the purposes of the pre-assessment report. The material is verified and appraised by the AHTAPol with regard to their consistency with guidelines and reliability of the material and evidence.
Costs of analyzed technologies and their components
Decisions regarding terms of funding/financing the technology referred for analysis from public sources, made in other countries (with special regard to countries of comparable national income level)
A pre-assessment report is prepared by the AHTAPol, and consulted with clinical experts before submitting it to Consultative Council for discussion. It enables the Consultative Council to provide the Minister of Health with an informed recommendation for the terms of financing the analysed technology from public sources (either consider starting or ceasing financing referred technology or just changing the level of its financing). If the Consultative Council decides that there is not enough information to make recommendation, a scope of the HTA report that is to be undertaken (especially indications and technologies compared, perspective for the analysis, type of analysis: CEA, CUA, BIA, clinical safety). It is then discussed together with the representatives of appropriate department of the Ministry of Health and National Health Fund and clinical experts.
Rapid review
Generally, the term rapid review can concern any type of analysis which is done under time limitation (through an accelerated process) when urgent needs or the official procedure require very quick response to a given problem. The aim of this analysis is to help authorities to take good decision based on reasonable arguments and consistent with social and economic needs. Similarly, a rapid review of health technology assessment (or rapid HTA report) is done within shorter timeframe than a “regular” HTA report. It means that the process of producing this report is accelerated. There is no specific scheme for a rapid HTA report. It depends on aim of the analysis, needs and previous analyses available. For example, when government is going to protect people against an epidemic of a fatal disease, and the problem is very urgent, an economic analysis does not matter. Sometimes, when the evidence on effectiveness and safety of the therapy is established and commonly acknowledged (e.g. other HTA agencies has done full review) authorities dealing with political urgency need only economic analysis or budget impact analysis to make decision on the financing (and terms of such financing) of a specific medical technology.
Mini-HTA
Poland does not have any experience in producing mini-HTA.
As mini-HTA has analogous purpose, which is to serve as support in decision-making on introduction of a new technology and resulting from this introduction need for resource allocation. We would expect mini-HTA to be tool, that is based on reasoning involved in health technology assessments. The main difference between full HTA and mini-HTA is the target group and the time frame for this type of analysis. A mini-HTA is rather done for the purposes of local-scale (not national-scale) decision-making process. The tool for doing mini-HTA should be adapted, so its form would allow to make this type of assessment within a short timeframe, and to easily adapt its outcome to local or regional budget and planning processes (e.g. resembling the form of EUnetHTA’s “HTA adaptation toolkit”).
Taking into consideration the centralized healthcare system in Poland, where all of decisions on financing medical technologies are done at national-scale, we would rather expect that mini-HTA should prove useful for healthcare professionals at Polish hospitals, e.g. when considering investing in new technology for one of its wards, to prove justification for its acquisition expenditures.
Similar to a full HTA, a mini-HTAs would need a multidisciplinary team comprising personnel from different departments involved in providing the service (clinicians and nurses) under the leadership of the consultant in specific specialty and economists.