gov·ern·ment / HTA
Health technology assessments (HTAs) are typically reserved for innovative health products that are considered to be “disruptive”. Non-disruptive health products often do not require these assessments. It is important to determine a product’s innovation type before proceeding with an HTA. A product that requires public funding from the Ontario government often must undergo the HQO HTA process.
Under the Ontario government, an innovative health product may undergo an HTA by Health Quality Ontario (HQO) with a funding recommendation to follow from the Ontario Health Technology Advisory Committee (OHTAC). HQO is the provincial advisor on quality in health care for Ontarians. HQO uses established scientific methods and criteria to evaluate new and existing health care services and medical devices. Following an HTA, OHTAC, a group of evidence-based experts from across the province, reviews the results of the HTA and provides their final recommendation back to HQO. As part of their legislated mandate, HQO then makes their final recommendation to the Ministry of Health and Long-Term Care (MOHLTC) on whether such services and/or devices should be publicly funded. A positive recommendation for funding by HQO to the MOHLTC, while not a guarantee, increases the likelihood that a product will be publicly funded. Once the MOHLTC receives the recommendation from HQO, a product or service may receive a positive or negative recommendation, or a government endorsement. However, a positive recommendation by the MOHLTC does not guarantee that a product will be adopted in the Ontario healthcare system; economic factors affecting the price, demand, and availability of the product (i.e., market forces) still apply. Ultimately, adoption occurs when patients and clinicians decide together that the product is useful.
As part of the HTA submission process, HQO screens incoming requests to help determine which topics are reviewed first. Topics are prioritized using 10 explicit criteria to evaluate domains of clinical benefit and harm, burden of illness, need, and equity and economic considerations. Prioritization occurs at least twice a year, depending on the volume of applications received. During each round of prioritization, consideration is given to both new topics and deferred topics from previous rounds of prioritization. Once a topic is selected for an HTA, the process can take up to one year to complete.
HTAs do not produce new evidence but rather, are evaluations of clinical effectiveness and/or cost-effectiveness, and may include the ethical, legal, and social implications of health products on patient health and the healthcare system in Ontario. HQO only conducts a limited amount of HTAs per year. They have a comprehensive set of prioritization criteria, outlined below, in order to determine the innovations with the greatest need for an HTA.
HTA Prioritization criteria used by HQO:
Potential to improve health outcomes relative to existing alternatives
Number of patients likely to use the health service/ intervention
Potential to reduce harm relative to existing alternatives
Patients accessing health services or interventions outside the province or country
Implementation feasibility/system readiness
Potential unmet need
Potential savings to the health care system
Determine whether the product is a disruptive or non-disruptive innovation before seeking an HTA by HQO.
Determine whether the product requires public funding or if a change in funding policy is required. If yes, then government HTA process is the best pathway.
Review HQO’s prioritization criteria against the product prior to submission in order to determine whether the product meets requirements for ranking.
Consider that an HTA may be a lengthy process.
Last update: 2018-Nov-26
© Copyright 2018 HIIO