EC8001 Assignment 2 Group 3 Marie Sinnott Deirdre Mahony

1. EC8001 Assignment 2 Group 3 Marie Sinnott Deirdre Mahony Health technology assessment of a population-based colorectal cancel screening programme in Ireland(2009)

2. HiQA – Health Technology Assessment (HTA) • HiQA has statutory responsibility for Health Technology Assessment; • Ensuring the best outcome for the service user by evaluating the clinical and economic effectiveness of drugs, equipment, diagnostic techniques and health promotion activities; • Required to make recommendation to the Minister on the preferred option • HTA directorate manages the research project but “buys in” expertise based on the requirements identified by the Expert Advisory Group

3. The Problem • Colorectal cancer is the second most frequently diagnosed cancer in both men and women; • Slow progression – 10-15 years to occur – patient prognosis is much better with early diagnosis; • On average 2,040 cases identified each year with 925 deaths each year; • Older people are most at risk; • Presents major challenges for an ageing population; • OECD critical of Irish performance in cancer care services.

4. Conduct population-based screening to save lives: Preventing disease; Earlier detection and treatment for better outcomes; Invite a defined population who are at average risk to attend screening; Many different interventions available with different age targets; Population screening programmes widely used internationally Found to be cost-effective and occasionally cost-saving WHO guidance – must be effective, safe and acceptable to the population. Must be cost-effective and feasible for the health care system The Possible Solution?

5. Purpose of HTA • Does the intervention (technology) work? • For whom does it work? • What is the benefit to the individual? • At what cost? • How does it compare to the alternative options available?

6. Specific Evaluation Questions • Evaluate the cost-effectiveness of three selected screening options, relative to each other and against no-screening; • To estimate the resource requirements and health outcomes over 10 years; • To examine the ethical considerations arising from these findings; • The HTA did not estimate the budgetary impact of establishing such a screening programme – this had previously been done by the NCSS and formed part of the rationale for the HTA.

7. HTA Process • Project Management Methodology & Approach • Expert Group • Multi-disciplinary team with experience of economic modelling, HTA, and Health Services Research; • Literature Review – published and unpublished • Economic Evaluation to determine the most cost-effective interventions; • Report on Ethical considerations; • Longitudinal resource implications. • Review planned for 2012

8. Economic Analysis in HTA • Particularly useful for assessing cost-effectiveness of screening programmes • Three possible analytic approaches • Cost-effectiveness analysis (CEA) – uses LYG • Cost-Utility analysis (CUA) – uses - QALYs • Cost-Benefit – monetises benefits • Similar approaches to measuring costs – direct rather than indirect • Differences in measuring benefits • Cost-Utility analysis most widely used • Current evaluation uses both CEA and CUA • Incremental Cost Effectiveness Ratios

9. Economic model useful: Dealing with uncertainty To predict the Future ScHARR Model – modified to the Irish setting; Assumptions documented Whole of population approach; Cost estimates were compiled from hospital/pharmacies data and other studies; Extensive sensitivity analysis was conducted Economic Model

10. Data • Population data • Rates of diagnosis • Rates of mortality • Costs of screening/diagnostics/treatment • Lifetimes costs of colorectal cancer • Assumptions/sensitivity analyses

11. HTA Output

12. HTA Conclusions & Recommendations • HTA found that any of the proposed screening options was more cost-effective than the “do nothing” option; • The optimal strategy among the “do something” options was found to be a biennial immunochemical faecal testing for individuals aged 55-74 years; • This was based on considerations of health gain and cost-effectiveness, including 10-year resources

13. Critical Appraisal • Benefit of a HTA directorate within HiQA with particular evaluative (oversight) expertise. Lack of robust Irish data; • Possible disconnect between budgetary process and HTA; • Cost estimates were not derived from any particular estimation exercise but rather an amalgam of available information; • Extensive sensitivity analysis including one way and multi-way analyses; • Criticality of Assumptions e.g. immediate roll out assumed, discount rate used

14. Conclusion • Good example of a thorough Evaluation Process • In line with stated Health Policy objectives • “evidence and strategic objectives underpin all planning/decision making” • Approach has the benefit of international comparison • Will the Programme survive the budget cuts? • Cancer services ringfenced