With the increasing demand for health technology decision making in hospitals, the activities of hospital-based health technology assessment are increasing globally. Several developed countries, such as France, Finland, Denmark, Italy, Canada, The United State and Australia have carried out hospital-based health technology assessment activities. In order to further promote the development of health technology assessment in China and establish evidence-based management and decision-making concept of hospitals, the National Center for Medical Service Administration has carried out theoretical and practical research on hospital technology assessment by fully drawing on foreign advanced experience. This paper introduces the background, object, method and content of the research, the achievements of the pilot project and the prospect of the future, so as to provide a reference for readers to understand the overall situation of the project and related work.
ObjectiveCapsule endoscopy (CE) has been widely used in the diagnosis of small bowel disease (SBD) in the world. To bring CE into the national health insurance directory, and intensify its popularization in primary hospitals, the government needs high quality health technology assessment (HTA) evidence for decision making. This study was aimed to comprehensively evaluate the effectiveness, safety, applicability and economics of CE in the diagnosis of SBD based on global review, to providing the best currently-available evidence for decision making. MethodsWe electronically searched The Cochrane Library (Issue 8, September 2013), PubMed, EMbase, INAHTA, VIP, CBM, CNKI and WanFang Data. We screened studies, extracted data, and evaluated quality independently, according to inclusion and exclusion criteria; and then we made final conclusion after comprehensive analysis. ResultsWe finally included 4 HTAs, 11 systematic reviews (SRs)/ Meta-analyses, 2 randomized controlled trials (RCTs), 5 guidelines, and 10 economics studies for assessment. The results of HTAs, SRs/ meta-analyses and RCTs all showed that, the disease detection rate of CE was higher than that of many other traditional technologies, and that the main adverse event for CE was retention (0.7% to 3.0%), which were consistent with those of the guidelines' recommendations. Besides, the comprehensive results of economics studies showed the superiority of CE compared with other technologies. As the first choice, CE could significantly decrease potential costs, especially when used in outpatients. Conclusiona) Compared with similar technologies, CE indeed has advantages in diagnostic yield, safety and potential costs in the diagnosis of SBD. However, its application has certain limitations, which still needs to be verified by more high quality evidence about CE diagnosis accuracy. b) It is sug gested that, when the government approves the introduction of CE to hospitals, many factors must be considered, such as local disease burden, clinical demands, ability to pay, and staff configuration. At the same time, it is necessary to standardize training for medical technicians, to reduce economic loss caused by poor technical abilities of medicaltechnicians.
The reporting checklist of health technology assessment (HTA) was a tool developed by the International Network of Agencies for Health Technology Assessment (INAHTA) to be used to guide the reporting of HTA. Experiential evidence showed that the tool was effective to improve the reporting quality of HTA and also could be used as a reference in performing HTA and translating the research evidence into decision-making. This paper introduced the background, developing process and main contents of the checklist, so as to improve the reporting quality of HTA in China.
ObjectivesTo provide a reference for the evaluation procedures of genetic testing technology applicable to China by combining the existing evaluation frameworks and procedures for genetic testing techniques globally, and also put forward design suggestions for the construction of evaluation procedures in China.MethodsThe literature research method was primarily used to summarize different evaluation progress, as well as put forward design suggestions.ResultsAt present, numerous developed countries have organized genetic testing technology evaluation projects. The various evaluation frameworks developed were based on the ACCE or HTA framework. The evaluation and decision-making procedures were similar in general, including topic selection, evaluation implementation, results reporting and making recommendations. However, there still remained difficulties such as limited evidence and uncertainty in decision-making.ConclusionsTo establish the procedures of genetic testing technology applicable in China, the following specific procedures are recommended: selecting target genetic testing technology topics; analyzing necessity and feasibility of target testing technology evaluation; evaluating and reviewing the evidence; applying results and decision-making transformation; developing regular review and revision mechanisms.
ObjectiveTo investigate the construction strategy of a knowledge base for health technology assessment (HTA) indicators based on a multi-granularity knowledge representation model, in order to meet the users' diverse demands for HTA knowledge services. MethodsFirstly, we constructed a multi-granularity HTA indicator knowledge representation model based on systematically analyzing the content and structure of the HTA indicator system in literature. Secondly, we extracted multi-granularity HTA indicator knowledge from literatures and conduct subject indexing in a human-computer collaborative way. Finally, based on the HTA knowledge service requirements, a prototype of the HTA indicator knowledge base-HTA Indicators was designed and developed. ResultsA multi-granularity HTA indicator knowledge representation model was constructed, covering 5 core knowledge units(indicator systems, indicator items, formulas, measurement variables, and subjects), 20 types of attributes, and 12 types of relationships. This model represents the intrinsic characteristics and connections between multi-granularity indicator knowledge units. Knowledge extraction and subject indexing of multi-grain HTA indicators were conducted based on 227 HTA indicator documents, forming instance data. Finally, a prototype of the HTA indicator knowledge base, named HTA Indicators, was developed.HTA Indicators provides services such as multi-granularity HTA indicator knowledge retrieval, navigation, and linking. ConclusionThe construction strategy of the HTA indicator knowledge base based on the multi-granularity knowledge representation model is feasible. The indicator knowledge base can achieve multi-dimensional semantic organization of indicator knowledge, provide multi-level and multi-dimensional indicator knowledge retrieval and discovery services, and meet the users' demand for precise HTA knowledge. In the future, we will explore the use of cutting-edge technologies such as large language models to achieve the automated construction of large-scale HTA knowledge, thereby enhancing the efficiency and intelligence level of knowledge base construction.