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:
- 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;
- 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.
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.
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.
- 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.