Demand outstrips HIQA’s capacity to deliver HTAs

HIQA has been unable to conduct a high number of health technology assessments (HTAs) in recent years as a result of limited resources, the Medical Independent (MI) can reveal.

Since 2015, there have been eight HTAs HIQA has been unable to include in its workplan or undertake within the relevant timeframe.

In 2015, HIQA implemented a HTA prioritisation process to select topics for inclusion in the HTA workplan for approval by its board. Prioritisation criteria include clinical and budget impact, and links to an imminent decision and national health policy.

Due to the fixed capacity to undertake HTAs, a limited number of topics can be included in each workplan, according to HIQA

Topics which were not included in the HTA workplan, or which could not be undertaken within the relevant timeframe, included domiciliary invasive ventilation in the management of motor neuron disease/amyotrophic lateral sclerosis; cancer genomics in all patients diagnosed with cancer; immunoablation followed by autologous haematopoetic stem cell transplant in relapsing-remitting multiple sclerosis; and monitored dosage systems in primary care.

“The demand for HTA outstrips our capacity to provide it,” Dr Máirín Ryan, HIQA’s Deputy Chief Executive and Director of HTA, told MI.

“So our capacity is to do three-to-four HTAs of national programmes or to inform national service decisions each year. And the last time we did a call for topics we got 26 proposals from the Department of Health and from the HSE. And then we had to prioritise those down.”

The HTA team in HIQA, which comprises six staff members, has not expanded since it began doing the assessments.

Since 2015 HIQA has published 11 HTAs, including on smoking cessation interventions and HPV testing as the primary screening method for the prevention of cervical cancer.

HTA is a multidisciplinary research process that collects and summarises information about a health technology. The information can cover a range of fields, including clinical effectiveness and safety, cost-effectiveness and budget impact, organisational and social aspects, and ethical and legal issues.

In 2018, the Department asked HIQA to grow capacity to develop evidence around supporting policy decisions. HIQA established a team funded through the Health Research Board, which has been asked to assist the national review of cardiac services and examine the economic costs around antimicrobial resistance.