Sedimentation of health technology assessment in hospitals: a scoping review

Galdino, Johnathan Portela da Silva; Camargo, Erika Barbosa; Elias, Flavia Tavares Silva

doi:10.1590/0102-311x00352520

Abstract

The aim of this study was to analyze the level of sedimentation of hospital-based health technology assessment (HTA) in diverse contexts. A scoping review was conducted according to the methodology of the Joanna Briggs Institute, whose data analysis model consisted of the combination of Donabedian’s structure, process, and outcome categories and the dimensions of the project Adopting Hospital Based Health Technology Assessment in European Union (AdHopHTA). We identified 270 studies, and after removing duplicates and reading full texts, 36 references met the eligibility criteria. Thirty-six hospitals were identified, of which there were 24 large-scale hospitals with extra bed capacity. Twenty-three hospitals were affiliated with universities. Canada stood out with five university hospitals, four of which with public funding. Half of the identified hospitals had hospital-based HTA units (18/36). Hospitals with sedimented levels of HTA corresponded to 75% of the sample (27/36), and the remainder had partially sedimented HTA, or 25% of the hospitals in the review (9/36). There were no hospitals with incipient sedimentation. Measuring the level of HTA sedimentation in the hospitals contributed to understanding how their participation has occurred in the field of hospital-based HTA. This study revealed the importance of identifying factors such as sustainability, growth, and evolution of hospital-based HTA in countries with and without a tradition in this field.

Keywords:
Biomedical Technology Assessment; Hospitals; Health Management; Decision Making; Governance

Introduction

Health technology assessment (HTA) has created different processes of incorporation of technologies in health services ¹1. Sampietro-Colom L, Martin J. Hospital-based health technology assessment: the next frontier. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 3-11.. Each of the various countries has tested HTA mechanisms in forms adapted to their contexts ²2. Sampietro-Colom LLK, Cicchetti AKK, Pasternack IFB, Rosenmöller MWC, Kahveci RWJ, Kiivet RA et al. The AdHopHTA handbook 2015. http://www.adhophta.eu/sites/files/adhophta/media/adhophta_handbook_website.pdf (acessado em 20/Dez/2020).
http://www.adhophta.eu/sites/files/adhop... ^,³3. Sampietro-Colom L, Lach K, Pasternack I, Wasserfallen J-B, Cicchetti A, Marchetti M, et al. Guiding principles for good practices in hospital-based health technology assessment units. Int J Technol Assess Health Care 2016; 31:457-65., considering the nutritional ⁴4. Souza NP, Lira PIC, Fontbonne A, Pinto FC de L, Cesse EAP. (Mal)nutrition and the new epidemiological trend in a context of development and inequalities. Ciênc Saúde Colet 2017; 22:2257-66., demographic, and epidemiological transition ⁵5. Nunes AA, Mello LM, Ana LW, Marques PMA, Dallora MEL, Martinez EZ, et al. Avaliação e incorporação de tecnologias em saúde: processo e metodologia adotados por um hospital universitário de alta complexidade assistencial. Cad Saúde Pública 2013; 29 Suppl 1:S179-86., economic and technological pressures ⁶6. Aguiar Pereira CC, Dos Santos Rabello R, Elias FTS. Hospital-based health technology assessment in Brazil: an overview of the initial experiences. Int J Technol Assess Health Care 2017; 33:227-31., expansion of the supply of technologies, and scarce financial investments ¹1. Sampietro-Colom L, Martin J. Hospital-based health technology assessment: the next frontier. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 3-11.^,⁷7. Francisco F, Malik AM. Aplicação de Avaliação de Tecnologias em Saúde (ATS) na tomada de decisão em hospitais. J Bras Econ Saúde 2019; 11:10-7.^,⁸8. Banta D, Jonsson E. History of HTA: introduction. Int J Technol Assess Health Care 2009; 25 Suppl 1:1-6..

The high demand for technologies in hospital settings ⁹9. Demirdjian G. A 10-year hospital-based health technology assessment program in a public hospital in Argentina. Int J Technol Assess Health Care 2015; 31:103-10. requires information to orient the decision-making process in the optimization of use of technological advancements ⁹9. Demirdjian G. A 10-year hospital-based health technology assessment program in a public hospital in Argentina. Int J Technol Assess Health Care 2015; 31:103-10.. Many factors influence this process, such as society’s expectations for new technologies and high demand for care, increasing costs related to the lack of technical rationality in the acquisition of technologies, and consequently, short- and long-term budget and organizational impacts on hospital finances and patient care ¹⁰10. Francisco FR, Malik AM. Aplicação de avaliação de tecnologias em saúde (ATS) na tomada de decisão em hospitais. J Bras Econ Saúde 2019; 11:10-7..

The use of HTA in hospitals contributes to decision-making, professional training, greater interaction with technical to scientific knowledge, resource-saving, and partnerships ¹¹11. McGregor M, Brophy JM. End-user involvement in health technology assessment (HTA) development: a way to increase impact. Int J Technol Assess Health Care 2005; 21:263-7.^,¹²12. McGregor M. The Health Technology Assessment Unit (TAU) of the McGill University Health Centre (MUHC) (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 167-71.^,¹³13. Almeida ND, Mines L, Nicolau I, Sinclair A, Forero DF, Brophy JM, et al. A framework for aiding the translation of scientific evidence into policy: the experience of a hospital-based technology assessment unit. Int J Technol Assess Health Care 2019; 35:204-11.^,¹⁴14. Catananti C, Cicchetti A, Marchetti M. Hospital-based health technology assessment: the experience of Agostino Gemelli University Hospital's HTA Unit. Ital J Public Health 2005; 2:23-8.^,¹⁵15. Marchetti M, Cicchetti A. The HTA and innovation unit at the A. Gemelli University Hospital (Italy). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 85-94.. Hospitals are strategic for the field of clinical management and quality of care ¹⁰10. Francisco FR, Malik AM. Aplicação de avaliação de tecnologias em saúde (ATS) na tomada de decisão em hospitais. J Bras Econ Saúde 2019; 11:10-7. and are open to partnerships with national and international agencies and groups ³3. Sampietro-Colom L, Lach K, Pasternack I, Wasserfallen J-B, Cicchetti A, Marchetti M, et al. Guiding principles for good practices in hospital-based health technology assessment units. Int J Technol Assess Health Care 2016; 31:457-65. such as the subgroup Hospital-based health technology assessment (HB-HTA), created in 2006 by Health Technology Assessment International ⁵5. Nunes AA, Mello LM, Ana LW, Marques PMA, Dallora MEL, Martinez EZ, et al. Avaliação e incorporação de tecnologias em saúde: processo e metodologia adotados por um hospital universitário de alta complexidade assistencial. Cad Saúde Pública 2013; 29 Suppl 1:S179-86.. Acknowledgement of hospitals in this strategic space has meant that HTA agencies have mobilized knowledge and tools to improve hospital management.

Hospital-based health technology assessment or HB-HTA is acknowledged throughout the world ¹1. Sampietro-Colom L, Martin J. Hospital-based health technology assessment: the next frontier. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 3-11., since it allows developing processes, leadership, tools, and good practices in HTA adapted to the hospital setting ²2. Sampietro-Colom LLK, Cicchetti AKK, Pasternack IFB, Rosenmöller MWC, Kahveci RWJ, Kiivet RA et al. The AdHopHTA handbook 2015. http://www.adhophta.eu/sites/files/adhophta/media/adhophta_handbook_website.pdf (acessado em 20/Dez/2020).
http://www.adhophta.eu/sites/files/adhop... ^,³3. Sampietro-Colom L, Lach K, Pasternack I, Wasserfallen J-B, Cicchetti A, Marchetti M, et al. Guiding principles for good practices in hospital-based health technology assessment units. Int J Technol Assess Health Care 2016; 31:457-65. to improve treatments, diagnoses, services, and optimization of hospital resources ²2. Sampietro-Colom LLK, Cicchetti AKK, Pasternack IFB, Rosenmöller MWC, Kahveci RWJ, Kiivet RA et al. The AdHopHTA handbook 2015. http://www.adhophta.eu/sites/files/adhophta/media/adhophta_handbook_website.pdf (acessado em 20/Dez/2020).
http://www.adhophta.eu/sites/files/adhop... .

Despite the HB-HTA movement, the incipient application of HTA to the hospital decision-making process is related to incipient planning ⁷7. Francisco F, Malik AM. Aplicação de Avaliação de Tecnologias em Saúde (ATS) na tomada de decisão em hospitais. J Bras Econ Saúde 2019; 11:10-7., and there is still much room for progress worldwide ¹1. Sampietro-Colom L, Martin J. Hospital-based health technology assessment: the next frontier. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 3-11.. Deficiencies in HB-HTA include scarcity of resources and/or a dedicated budget for HTA activities, lack of a qualified teams for managing useful evidence for decision-making processes, obstacles to the use of evidence, and resistance to change by administrators and healthcare professionals ¹1. Sampietro-Colom L, Martin J. Hospital-based health technology assessment: the next frontier. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 3-11.^,²2. Sampietro-Colom LLK, Cicchetti AKK, Pasternack IFB, Rosenmöller MWC, Kahveci RWJ, Kiivet RA et al. The AdHopHTA handbook 2015. http://www.adhophta.eu/sites/files/adhophta/media/adhophta_handbook_website.pdf (acessado em 20/Dez/2020).
http://www.adhophta.eu/sites/files/adhop... ^,⁹9. Demirdjian G. A 10-year hospital-based health technology assessment program in a public hospital in Argentina. Int J Technol Assess Health Care 2015; 31:103-10.^,¹⁰10. Francisco FR, Malik AM. Aplicação de avaliação de tecnologias em saúde (ATS) na tomada de decisão em hospitais. J Bras Econ Saúde 2019; 11:10-7.^,¹⁶16. Kosherbayeva L, Hailey D, Kurakbaev K, Tsoy A, Zhuzzhanov O, Donbay A, et al. Implementation of health technology assessment work in a hospital in Kazakhstan. Int J Technol Assess Health Care 2016; 32:78-80.. To minimize these barriers, the exploration of different organizational models ²2. Sampietro-Colom LLK, Cicchetti AKK, Pasternack IFB, Rosenmöller MWC, Kahveci RWJ, Kiivet RA et al. The AdHopHTA handbook 2015. http://www.adhophta.eu/sites/files/adhophta/media/adhophta_handbook_website.pdf (acessado em 20/Dez/2020).
http://www.adhophta.eu/sites/files/adhop... can be a strategy for reorganization of HB-HTA.

The combination of Donabedian’s structure, process, and outcome categories ¹⁷17. Donabedian A. Criteria and standards for quality assessment and monitoring. Qual Rev Bull 1986; 12:99-108.^,¹⁸18. Donabedian A. The seven pillars of quality. Arch Pathol Lab Med 1990; 114:1115-8. and the dimensions of the project Adopting Hospital Based Health Technology Assessment in European Union (AdHopHTA) ²2. Sampietro-Colom LLK, Cicchetti AKK, Pasternack IFB, Rosenmöller MWC, Kahveci RWJ, Kiivet RA et al. The AdHopHTA handbook 2015. http://www.adhophta.eu/sites/files/adhophta/media/adhophta_handbook_website.pdf (acessado em 20/Dez/2020).
http://www.adhophta.eu/sites/files/adhop... ^,³3. Sampietro-Colom L, Lach K, Pasternack I, Wasserfallen J-B, Cicchetti A, Marchetti M, et al. Guiding principles for good practices in hospital-based health technology assessment units. Int J Technol Assess Health Care 2016; 31:457-65. can support the definition of appropriate models for the context of countries such as Brazil, which also experience barriers in this area. The current study thus aims to analyze the level of sedimentation of hospital-based HTA in the Brazilian and international contexts.

Method

This scoping review aimed to discover the level of sedimentation of hospital-based HTA in Brazilian and international experiences. The analytical model consisted of the combination of Donabedian’s ¹⁷17. Donabedian A. Criteria and standards for quality assessment and monitoring. Qual Rev Bull 1986; 12:99-108.^,¹⁸18. Donabedian A. The seven pillars of quality. Arch Pathol Lab Med 1990; 114:1115-8. structure, process, and outcome categories and the dimensions of the AdHopHTA project ²2. Sampietro-Colom LLK, Cicchetti AKK, Pasternack IFB, Rosenmöller MWC, Kahveci RWJ, Kiivet RA et al. The AdHopHTA handbook 2015. http://www.adhophta.eu/sites/files/adhophta/media/adhophta_handbook_website.pdf (acessado em 20/Dez/2020).
http://www.adhophta.eu/sites/files/adhop... ^,³3. Sampietro-Colom L, Lach K, Pasternack I, Wasserfallen J-B, Cicchetti A, Marchetti M, et al. Guiding principles for good practices in hospital-based health technology assessment units. Int J Technol Assess Health Care 2016; 31:457-65..

The scoping review method was chosen to examine the extent and nature of publications that reported HTA experiences in the hospital setting, allowing to analyze the level of sedimentation in different contexts.

For the purposes of this study, “sedimentation” is defined as the provision of resources, processes, methods, and actions for the effective implementation of HTA in the hospital setting, considering the characteristics that define a hospital-based HTA unit, that is, sedimented in formalization, specialization, integration, authority, and professionalization ²2. Sampietro-Colom LLK, Cicchetti AKK, Pasternack IFB, Rosenmöller MWC, Kahveci RWJ, Kiivet RA et al. The AdHopHTA handbook 2015. http://www.adhophta.eu/sites/files/adhophta/media/adhophta_handbook_website.pdf (acessado em 20/Dez/2020).
http://www.adhophta.eu/sites/files/adhop... ^,¹⁹19. Nascimento GC, Rodrigues VJ, Megliorini E. Conceitos da teoria institucional: fonte propulsora de evolução para a gestão de desempenho. In: XVII Congresso Brasileiro de Custos. https://anaiscbc.emnuvens.com.br/anais/article/viewFile/761/761 (acessado em 20/Dez/2020).
https://anaiscbc.emnuvens.com.br/anais/a... .

This review follows the checklist Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) ²⁰20. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping reviews. In: Aromataris E, Munn Z, editors. Joanna Briggs Institute reviewer's manual. https://wiki.jbi.global/display/MANUAL/Chapter+11%3A+Scoping+reviews (acessado em 20/Dez/2020).
https://wiki.jbi.global/display/MANUAL/C... ^,²¹21. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018; 169:467-73.. The protocol was registered in the Open Science Framework (https://osf.io/jtmsc).

Information sources and search strategy

The data sources were the Virtual Health Library (VHL), MEDLINE/PubMed, Web of Science, SciVerse Scopus (Elsevier), and Embase, and the searches were performed with the term (MeSH) “hospital” together with the free term “Hospital-Based Health Technology Assessment”. The search was conducted on November 23, 2019 (Supplementary material: http://cadernos.ensp.fiocruz.br/static//arquivo/suppl-e-00352520-ingles_3487.pdf). Additional publications were found in the reference lists of the included articles.

Eligibility criteria and selection processes

The review considered complete articles on experiences related to the management, governance, structure, and organization of HTA in hospitals. The search was not limited by country, year of publication, or language. The sample did not include abstracts and articles that did not address specific contexts in hospitals and with emphasis on efficacy and safety results for specific technologies, except when they presented experiences with assessment criteria and models used by the respective hospitals. The Mendeley software (https://www.mendeley.com/?interaction_required=true) was used to remove duplicates. Two reviewers (J.P.S.G., F.T.S.E.) read the titles and abstracts with the software Rayyan Qatar Computing Research Institute (Rayyan QCRI. https://www.rayyan.ai/), and the full texts were read by one reviewer (J.P.S.G.). There was a third reviewer to resolve any doubts (E.B.C.).

Data extraction

Data extraction was done by one reviewer (J.P.S.G.), and the other two reviewers (F.T.S.E., E.B.C.) were consulted in case of doubts on the classification of the respective hospitals. Microsoft Excel (https://products.office.com/) was used to build the extraction table. The target variables were title, author, year, country, type of study, hospital identified, hospital’s size and profile of care, organizational model of hospital-based HTA, and other analytical dimensions. The hospital’s size and profile were analyzed in searches in the hospitals’ websites. The hospital’s size ²²22. Braga Neto FC, Barbosa PR, Santos IS, Oliveira CMF. Atenção hospitalar: evolução histórica e tendências. In: Giovanella L, Escorel S, Lobato LVC, Noronha JC, Carvalho AI, organizadores. Políticas e sistema de saúde no Brasil. Rio de Janeiro: Editora Fiocruz/Centro Brasileiro de Estudos de Saúde; 2008. p. 577-608. was measured as the number of beds, where up to 50 beds was defined as small, 51 to 150 beds as medium-sized, 151 to 500 beds as large, and more than 500 beds as large with extra hospital bed capacity. The establishments’ profile ²²22. Braga Neto FC, Barbosa PR, Santos IS, Oliveira CMF. Atenção hospitalar: evolução histórica e tendências. In: Giovanella L, Escorel S, Lobato LVC, Noronha JC, Carvalho AI, organizadores. Políticas e sistema de saúde no Brasil. Rio de Janeiro: Editora Fiocruz/Centro Brasileiro de Estudos de Saúde; 2008. p. 577-608. was defined as university hospital, specialized hospital, or teaching and research hospital, based on descriptions in the hospitals’ websites.

The variable organizational model of hospital-based HTA was based on the structure of The AdHopHTA Handbook²2. Sampietro-Colom LLK, Cicchetti AKK, Pasternack IFB, Rosenmöller MWC, Kahveci RWJ, Kiivet RA et al. The AdHopHTA handbook 2015. http://www.adhophta.eu/sites/files/adhophta/media/adhophta_handbook_website.pdf (acessado em 20/Dez/2020).
http://www.adhophta.eu/sites/files/adhop... ^,²³23. Samprietro-Colom L, Lach K, Escolar I, Sroka S, Soto M, Cicchetti A, et al. A handbook and a toolkit for hospital-based health technology assessment. Value Health 2015; 18:A556., corresponding to the following categories: “pioneer model or independent group”, opinion-makers that still act individually or informally; “stand-alone HTA or mini-HTA”, professionals with HTA experience that use relevant evidence (clinical, economic, epidemiological, and organizational) to inform decision-makers, involving internal and/or external collaborators; multidisciplinary “internal committee” with review of standardized internal evidence, perspectives, and recommendations; “hospital-based HTA unit”, formal structure dedicated to HTA with a full-time team, production of high-quality material on the incorporation of health technologies and external interface with other networks or institutions.

Twenty-one analytical dimensions were identified and distributed across the structure, process, and outcome categories. Structure included financial, legal, and normative aspects, information-sharing systems, prevailing models, governance, and partnerships for the development of hospital-based HTA. The process category included tools for research, development, and monitoring of HTA. The outcome category included financial indicators, trainings, changes in clinical and management organization, and challenges for the sustainability of HTA in the hospital services ¹⁷17. Donabedian A. Criteria and standards for quality assessment and monitoring. Qual Rev Bull 1986; 12:99-108.^,¹⁸18. Donabedian A. The seven pillars of quality. Arch Pathol Lab Med 1990; 114:1115-8..

The 21 analytical dimensions were classified according to the dimensions for good practices in hospital-based HTA in the AdHopHTA project ²2. Sampietro-Colom LLK, Cicchetti AKK, Pasternack IFB, Rosenmöller MWC, Kahveci RWJ, Kiivet RA et al. The AdHopHTA handbook 2015. http://www.adhophta.eu/sites/files/adhophta/media/adhophta_handbook_website.pdf (acessado em 20/Dez/2020).
http://www.adhophta.eu/sites/files/adhop... ^,³3. Sampietro-Colom L, Lach K, Pasternack I, Wasserfallen J-B, Cicchetti A, Marchetti M, et al. Guiding principles for good practices in hospital-based health technology assessment units. Int J Technol Assess Health Care 2016; 31:457-65.: evaluative process (D1); leadership, strategy, and partnerships (D2); resources (D3); and impact (D4), according to the theoretical model (Figure 1).

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Figure 1
Model for characterization of studies included in scoping review on hospital-based health technology assessment (HTA).

Data analysis

Hospitals identified in the reference lists received one point for each of the 21 dimensions (Figure 1) in case they presented the corresponding information. In cases where more than one hospital was identified, the point for the analytical dimension was divided by the number of hospitals identified. A focus group of three HTA experts harmonized (by consensus) the 21 points of the analytical dimensions across the structure, process, and outcome categories, resulting in up to seven points for each category. When the category resulted in 1 or 2, the HTA was classified as incipient (score 0.0); from 3 to 5, as partial (score 0.5); and 6 or 7 as sedimented (score 1.0). After analyzing the sum of the data, we found sedimentation of HTA activities in the hospitals in three levels ²2. Sampietro-Colom LLK, Cicchetti AKK, Pasternack IFB, Rosenmöller MWC, Kahveci RWJ, Kiivet RA et al. The AdHopHTA handbook 2015. http://www.adhophta.eu/sites/files/adhophta/media/adhophta_handbook_website.pdf (acessado em 20/Dez/2020).
http://www.adhophta.eu/sites/files/adhop... : “incipient sedimentation” (0.0 or 0.5 final points), corresponding to incipient or low backing of the HTA proposal in the hospitals; “partially sedimented” (1.0 or 1.5 final points), which did not present a completely mature hospital-based HTA structure or process but presented results; and “sedimented” (2.0, 2.5 or 3.0 final points), with definitive and formalized structure, process, and outcomes (Figure 1).

Results

Study searches and selection

The search identified 270 studies, 74 of which remained for reading the full text, 14 of which were eligible. A manual search of the eligible articles’ reference lists yielded another 22 studies, for a final total of 36 studies (Figure 2).

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Figure 2
PRISMA-ScR flowchart for the selection of studies.

Characteristics of the included studies

The 36 included studies were published from 2005 and 2019, with 58.3% published in 2016. The specialized reference for extraction of additional studies was the book Hospital-Based Health Technology Assessment: the next frontier for health technology assessment1, which resulted in the largest share of studies published in 2016. Nineteen countries were identified. Articles and book chapters were part of the studies included in the review, and five studies ²⁴24. Demirdjian G, Kurtzbart R, Hernandez R. Hospital-based HTA in Argentina: the Hospital Garrahan and Hospital El Cruce experiences. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 247-61.^,²⁵25. Saaid HB, Stewart D, England I, Parmar N. The impact of health technology assessment on decision-making orocesses in public versus not-for-profit private hospitals. Am Med J 2011; 2:72-8.^,²⁶26. Santos M, Magliano C, Kelles DB, Kelles SMB, Stein A. The role of hospitals in HTA in Brazil. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 239-46.^,²⁷27. Sampietro-Colom L, Soto M, García C, Benot S. Hospital-based HTA in three Spanish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 57-69.^,²⁸28. Wasserfallen J-B, Pinget C. Hospital-based HTA in Switzerland. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 77-83. addressed more than one hospital each.

Thirty-six hospitals were identified in the studies (Box 1). Five Canadian hospitals - Centre Hospitalier Universitaire de Sherbrooke (H11), McGill University Health Centre (H12), Centre Hospitalier de l’Université de Montréal (H13), Centre Hospitalier Universitaire de Québec-Université Laval (H14), and Hospital for Sick Children Peter Gilgan Centre for Research and Learning (H15) - formed the largest share of the identified hospitals, with 13.9% (5/36). Brazil had three hospitals (3/36): Clinical Hospital of the Faculty of Medicine of Ribeirão Preto, São Paulo University (H8), National Cardiology Institute (H9), and Nossa Senhora da Conceição Hospital (H10).

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Box 1
Characteristics of included studies and hospitals.

As for hospital size, large-scale hospitals with extra bed capacity were the majority, accounting for 66.7% (24/36), followed by large-scale hospitals with 25% (9/36) and medium-sized hospitals with with 8.3% (3/36). In Brazil, two hospitals were large-scale and one was large-scale with extra bed capacity. No small-scale hospitals were identified with hospital-based HTA.

As for the institutional profile, 23 hospitals were affiliated with universities, featuring large-scale hospitals with extra bed capacity, with 82.6% (19/23). Nine hospitals were specialized, the largest share of which were large hospitals, with 44.4% (4/9). Four teaching and research hospitals that did not have or did not report affiliation with universities were identified, three of which were large-scale hospitals with extra bed capacity, or 75% (3/4). Of all the hospitals identified, 19 were large-scale hospitals with extra bed capacity affiliated with universities, 89.5% of which (17/19) received government funding. In Canada, four university hospitals received public funding. In Brazil, three hospitals were university/teaching and research hospitals with public funding (3/36).

As for HTA organizational model, half of the hospitals had hospital-based HTA units, that is, 50% (18/36), followed by stand-alone HTA groups or mini-HTA, with 19.4% (7/36); hospital-based HTA units combined with the internal committee model, with 16.7% (6/36); internal committees with 11.1% (4/36); and the pioneer model or independent group with 2.8% (1/36). Two Brazilian hospitals had hospital-based HTA units, and one had a stand-alone HTA group or mini-HTA (3/36).

Level of sedimentation of health technology assessment activities in the hospitals

In the studies included in the review (Box 1), 75% (27/36) of the hospitals were characterized as having sedimented HTA and 25% (9/36) had partially sedimented HTA according to the respective criteria. The review did not identify any hospitals with incipient sedimentation of HTA (Table 1).

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Table 1
Level of health technology assessment sedimentation in the hospitals identified in the studies included in the review.

Sedimented hospitals

Among the 27 hospitals that presented sedimented level of HTA (Table 1), nine scored high in the final analysis (3.0 points) and presented hospital-based HTA units (H2 ⁹9. Demirdjian G. A 10-year hospital-based health technology assessment program in a public hospital in Argentina. Int J Technol Assess Health Care 2015; 31:103-10.^,²⁴24. Demirdjian G, Kurtzbart R, Hernandez R. Hospital-based HTA in Argentina: the Hospital Garrahan and Hospital El Cruce experiences. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 247-61., H18 ²⁹29. Kidholm K, Ølholm AM. Hospital-based HTA in Denmark. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 39-44., H19 ²⁷27. Sampietro-Colom L, Soto M, García C, Benot S. Hospital-based HTA in three Spanish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 57-69., H27 ¹⁴14. Catananti C, Cicchetti A, Marchetti M. Hospital-based health technology assessment: the experience of Agostino Gemelli University Hospital's HTA Unit. Ital J Public Health 2005; 2:23-8.^,¹⁵15. Marchetti M, Cicchetti A. The HTA and innovation unit at the A. Gemelli University Hospital (Italy). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 85-94., and H36 ³⁰30. Kahveci R, Tütüncü T, Yüksek YN, Küçük EÖ, Koç EM, Zengin N. Hospital-based HTA in Turkey. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 95-105.), internal committees (H3 ²⁴24. Demirdjian G, Kurtzbart R, Hernandez R. Hospital-based HTA in Argentina: the Hospital Garrahan and Hospital El Cruce experiences. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 247-61. and H21 ²⁷27. Sampietro-Colom L, Soto M, García C, Benot S. Hospital-based HTA in three Spanish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 57-69.), or both models (H13 ³⁴34. Poder TG, Bellemare CA, Bédard SK, Fisette J-F, Dagenais P. Impact of health technology assessment reports on hospital decision makers - 10-year insight from a hospital unit in Sherbrooke, Canada: impact of health technology assessment on hospital decisions. Int J Technol Assess Health Care 2018; 34:393-9. and H20 ²⁷27. Sampietro-Colom L, Soto M, García C, Benot S. Hospital-based HTA in three Spanish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 57-69.) supported by the administration to develop reports and issue accessible and translated recommendations for decision-makers. Only H36 lacked totally formalized support for staff training and production of multidisciplinary activities ³⁰30. Kahveci R, Tütüncü T, Yüksek YN, Küçük EÖ, Koç EM, Zengin N. Hospital-based HTA in Turkey. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 95-105.. All the methods used for the production of reports and recommendations, adapted to the respective hospitals’ contexts, were characterized as replicable to other hospitals, and with the implementation of HTA there was a reduction in costs and changes in the process of incorporation of technologies, with recognition and support by health professionals and administrators ⁹9. Demirdjian G. A 10-year hospital-based health technology assessment program in a public hospital in Argentina. Int J Technol Assess Health Care 2015; 31:103-10.^,¹⁴14. Catananti C, Cicchetti A, Marchetti M. Hospital-based health technology assessment: the experience of Agostino Gemelli University Hospital's HTA Unit. Ital J Public Health 2005; 2:23-8.^,¹⁵15. Marchetti M, Cicchetti A. The HTA and innovation unit at the A. Gemelli University Hospital (Italy). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 85-94.^,²⁴24. Demirdjian G, Kurtzbart R, Hernandez R. Hospital-based HTA in Argentina: the Hospital Garrahan and Hospital El Cruce experiences. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 247-61.^,²⁷27. Sampietro-Colom L, Soto M, García C, Benot S. Hospital-based HTA in three Spanish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 57-69.^,²⁹29. Kidholm K, Ølholm AM. Hospital-based HTA in Denmark. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 39-44.^,³⁰30. Kahveci R, Tütüncü T, Yüksek YN, Küçük EÖ, Koç EM, Zengin N. Hospital-based HTA in Turkey. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 95-105.^,³¹31. Lepanto L. Hospital-based HTA at the Centre Hospitalier de l'Université de Montréal (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 173-83.. Such hospitals presented at least six analytical dimensions in each of the structure, process, and outcome categories (Table 1).

The hospitals with sedimented HTA were from 14 different countries, namely Argentina ⁹9. Demirdjian G. A 10-year hospital-based health technology assessment program in a public hospital in Argentina. Int J Technol Assess Health Care 2015; 31:103-10.^,²⁴24. Demirdjian G, Kurtzbart R, Hernandez R. Hospital-based HTA in Argentina: the Hospital Garrahan and Hospital El Cruce experiences. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 247-61., Brazil ⁵5. Nunes AA, Mello LM, Ana LW, Marques PMA, Dallora MEL, Martinez EZ, et al. Avaliação e incorporação de tecnologias em saúde: processo e metodologia adotados por um hospital universitário de alta complexidade assistencial. Cad Saúde Pública 2013; 29 Suppl 1:S179-86.^,²⁶26. Santos M, Magliano C, Kelles DB, Kelles SMB, Stein A. The role of hospitals in HTA in Brazil. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 239-46., Canada ¹¹11. McGregor M, Brophy JM. End-user involvement in health technology assessment (HTA) development: a way to increase impact. Int J Technol Assess Health Care 2005; 21:263-7.^,¹²12. McGregor M. The Health Technology Assessment Unit (TAU) of the McGill University Health Centre (MUHC) (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 167-71.^,¹³13. Almeida ND, Mines L, Nicolau I, Sinclair A, Forero DF, Brophy JM, et al. A framework for aiding the translation of scientific evidence into policy: the experience of a hospital-based technology assessment unit. Int J Technol Assess Health Care 2019; 35:204-11.^,³⁰30. Kahveci R, Tütüncü T, Yüksek YN, Küçük EÖ, Koç EM, Zengin N. Hospital-based HTA in Turkey. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 95-105.^,³²32. Bellemare CA, Fisette J-F, Poder TG, Bédard SK, Dagenais P. The health technology assessment unit of the Centre hospitalier universitaire de Sherbrooke (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 185-200.^,³³33. Poder TG. Using the health technology assessment toolbox to facilitate procurement: the case of smart pumps in a Canadian hospital. Int J Technol Assess Health Care 2017; 33:54-62.^,³⁴34. Poder TG, Bellemare CA, Bédard SK, Fisette J-F, Dagenais P. Impact of health technology assessment reports on hospital decision makers - 10-year insight from a hospital unit in Sherbrooke, Canada: impact of health technology assessment on hospital decisions. Int J Technol Assess Health Care 2018; 34:393-9.^,³⁵35. Poder TG, Beffarat M, Benkhalti M, Ladouceur G, Dagenais P. A discrete choice experiment on preferences of patients with low back pain about non-surgical treatments: identification, refinement and selection of attributes and levels. Patient Prefer Adherence 2019; 13:933-40.^,³⁶36. Rhainds M, Asselin G, Coulombe M. CHU de Québec - Université Laval: 10-years' experience in hospital-based HTA (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 201-11.^,³⁷37. Ungar WJ. Technology Assessment at SickKids (TASK): a health technology assessment research unit devoted to child health in Canada. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 153-65., Kazakhstan ¹⁶16. Kosherbayeva L, Hailey D, Kurakbaev K, Tsoy A, Zhuzzhanov O, Donbay A, et al. Implementation of health technology assessment work in a hospital in Kazakhstan. Int J Technol Assess Health Care 2016; 32:78-80.^,³⁸38. Avdeyev A, Tabarov A, Akhetov A, Shanazarov N, Hailey D, Kaptagayeva A, et al. Hospital-based health technology assessment in Kazakhstan: 3 years' experience of one unit. Int J Technol Assess Health Care 2019; 35:436-40., Denmark ²⁹29. Kidholm K, Ølholm AM. Hospital-based HTA in Denmark. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 39-44., Spain ²⁷27. Sampietro-Colom L, Soto M, García C, Benot S. Hospital-based HTA in three Spanish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 57-69., United States ³⁹39. Mitchell MD, Williams K, Brennan PJ, Umscheid CA. Integrating local data into hospital-based healthcare technology assessment: two case studies. Int J Technol Assess Health Care 2010; 26:294-300., France ⁴⁰40. Barna A, Fahlgren B, Charpentier E, Taron-Brocard C, Guillevin L. The "Comité d'Evaluation et de Diffusion des Innovations Technologiques" (CEDIT) in France. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 71-6., Israel ⁴¹41. Tal O, Booch M, Bar-Yehuda S. Hospital staff perspectives towards health technology assessment: data from a multidisciplinary survey. Health Res Policy Syst 2019; 17:72., Italy ¹⁴14. Catananti C, Cicchetti A, Marchetti M. Hospital-based health technology assessment: the experience of Agostino Gemelli University Hospital's HTA Unit. Ital J Public Health 2005; 2:23-8.^,¹⁵15. Marchetti M, Cicchetti A. The HTA and innovation unit at the A. Gemelli University Hospital (Italy). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 85-94.^,⁴²42. Miniati R, Frosini F, Cecconi G, Dori F, Gentili GB. Development of sustainable models for technology evaluation in hospital. Technol Health Care 2014; 22:729-39., New Zealand ⁴³43. Munn SR. Hospital-based health technology assessment: insights from New Zealand. Pharmacoeconomics 2014; 32:815-7.^,⁴⁴44. Fitzgerald A, Streat S, McAleese C, Munn S. Hospital-based HTA in New Zealand. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 305-12., Sweden ⁴⁵45. Jivegård L, Bergh C, Kindblom J, Samuelsson O, Sjögren P, Sjövall H, et al. Activity-based HTA: hospital-based HTA performed by clinicians with support and quality control, the Sahlgrenska University Hospital HTA-Centrum Experience (Sweden). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 15-28., Switzerland ²⁸28. Wasserfallen J-B, Pinget C. Hospital-based HTA in Switzerland. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 77-83.^,⁴⁶46. Grenon X, Pinget C, Wasserfallen J-B. Hospital-based health technology assessment (HB-HTA): a 10-year survey at one unit. Int J Technol Assess Health Care 2016; 32:116-21., and Turkey ³⁰30. Kahveci R, Tütüncü T, Yüksek YN, Küçük EÖ, Koç EM, Zengin N. Hospital-based HTA in Turkey. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 95-105..

Canada had the most studies and hospitals with HTA. Ten studies from Canada reported on large-scale university hospitals with extra bed capacity (H11 ³²32. Bellemare CA, Fisette J-F, Poder TG, Bédard SK, Dagenais P. The health technology assessment unit of the Centre hospitalier universitaire de Sherbrooke (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 185-200.^,³³33. Poder TG. Using the health technology assessment toolbox to facilitate procurement: the case of smart pumps in a Canadian hospital. Int J Technol Assess Health Care 2017; 33:54-62.^,³⁴34. Poder TG, Bellemare CA, Bédard SK, Fisette J-F, Dagenais P. Impact of health technology assessment reports on hospital decision makers - 10-year insight from a hospital unit in Sherbrooke, Canada: impact of health technology assessment on hospital decisions. Int J Technol Assess Health Care 2018; 34:393-9.^,³⁵35. Poder TG, Beffarat M, Benkhalti M, Ladouceur G, Dagenais P. A discrete choice experiment on preferences of patients with low back pain about non-surgical treatments: identification, refinement and selection of attributes and levels. Patient Prefer Adherence 2019; 13:933-40., H12 ¹¹11. McGregor M, Brophy JM. End-user involvement in health technology assessment (HTA) development: a way to increase impact. Int J Technol Assess Health Care 2005; 21:263-7.^,¹²12. McGregor M. The Health Technology Assessment Unit (TAU) of the McGill University Health Centre (MUHC) (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 167-71.^,¹³13. Almeida ND, Mines L, Nicolau I, Sinclair A, Forero DF, Brophy JM, et al. A framework for aiding the translation of scientific evidence into policy: the experience of a hospital-based technology assessment unit. Int J Technol Assess Health Care 2019; 35:204-11., H13 ³¹31. Lepanto L. Hospital-based HTA at the Centre Hospitalier de l'Université de Montréal (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 173-83., and H14 ³⁶36. Rhainds M, Asselin G, Coulombe M. CHU de Québec - Université Laval: 10-years' experience in hospital-based HTA (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 201-11.) and one on a large university hospital (H15 ³⁷) with hospital-based HTA units. All these Canadian hospitals had sedimented HTA.

Italy presented three studies ¹⁴14. Catananti C, Cicchetti A, Marchetti M. Hospital-based health technology assessment: the experience of Agostino Gemelli University Hospital's HTA Unit. Ital J Public Health 2005; 2:23-8.^,¹⁵15. Marchetti M, Cicchetti A. The HTA and innovation unit at the A. Gemelli University Hospital (Italy). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 85-94.^,⁴²42. Miniati R, Frosini F, Cecconi G, Dori F, Gentili GB. Development of sustainable models for technology evaluation in hospital. Technol Health Care 2014; 22:729-39., two on large-scale university hospitals with extra bed capacity and sedimented HTA (H27 ¹⁴14. Catananti C, Cicchetti A, Marchetti M. Hospital-based health technology assessment: the experience of Agostino Gemelli University Hospital's HTA Unit. Ital J Public Health 2005; 2:23-8.^,¹⁵15. Marchetti M, Cicchetti A. The HTA and innovation unit at the A. Gemelli University Hospital (Italy). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 85-94. and H28 ⁴⁴44. Fitzgerald A, Streat S, McAleese C, Munn S. Hospital-based HTA in New Zealand. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 305-12.) with hospital-based HTA units, and one (H27) with partially sedimented HTA ¹⁴14. Catananti C, Cicchetti A, Marchetti M. Hospital-based health technology assessment: the experience of Agostino Gemelli University Hospital's HTA Unit. Ital J Public Health 2005; 2:23-8. in 2000; by 2016, the latter hospital had reached the structure, process, and outcome categories, characterizing it as a context of sedimented HTA ¹⁵15. Marchetti M, Cicchetti A. The HTA and innovation unit at the A. Gemelli University Hospital (Italy). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 85-94..

In relation to Brazil, two studies reported experiences from three hospitals with public financing (H8, H9, and H10 ⁵5. Nunes AA, Mello LM, Ana LW, Marques PMA, Dallora MEL, Martinez EZ, et al. Avaliação e incorporação de tecnologias em saúde: processo e metodologia adotados por um hospital universitário de alta complexidade assistencial. Cad Saúde Pública 2013; 29 Suppl 1:S179-86.^,²⁶26. Santos M, Magliano C, Kelles DB, Kelles SMB, Stein A. The role of hospitals in HTA in Brazil. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 239-46.), one a large hospital and another large-scale hospital with extra bed capacity in teaching and research with hospital-based HTA units and a large-scale university hospital with a stand-alone HTA group or mini-HTA.

Of the six hospitals with more than one HTA organizational model, 83.3% (5/6) presented sedimented HTA (H13 ³¹31. Lepanto L. Hospital-based HTA at the Centre Hospitalier de l'Université de Montréal (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 173-83., H20 ²⁷27. Sampietro-Colom L, Soto M, García C, Benot S. Hospital-based HTA in three Spanish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 57-69., H22 ³⁹39. Mitchell MD, Williams K, Brennan PJ, Umscheid CA. Integrating local data into hospital-based healthcare technology assessment: two case studies. Int J Technol Assess Health Care 2010; 26:294-300., H26 ⁴¹41. Tal O, Booch M, Bar-Yehuda S. Hospital staff perspectives towards health technology assessment: data from a multidisciplinary survey. Health Res Policy Syst 2019; 17:72., and H30 ⁴³43. Munn SR. Hospital-based health technology assessment: insights from New Zealand. Pharmacoeconomics 2014; 32:815-7.^,⁴⁴44. Fitzgerald A, Streat S, McAleese C, Munn S. Hospital-based HTA in New Zealand. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 305-12.).

Partially sedimented hospitals

Nine hospitals from six countries presented partially sedimented HTA (Table 1). In relation to the structure category, hospitals H4, H5, H6, H7, and H23 had stand-alone HTA groups without specific funding to produce studies or conduct quick reviews called mini-HTA ²⁵25. Saaid HB, Stewart D, England I, Parmar N. The impact of health technology assessment on decision-making orocesses in public versus not-for-profit private hospitals. Am Med J 2011; 2:72-8.^,⁴⁷47. Pasternack RP, Iris R. HTA activities in finnish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 29-37.. Only H23 reported the presence of a standard reporting form with formal criteria for planning, priority-setting, and translation of knowledge applied to the decision-maker’s demands ⁴⁷47. Pasternack RP, Iris R. HTA activities in finnish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 29-37.. All the partially sedimented hospitals (H1 ⁴⁸48. Mueller DB, Govender M. HTA in a public hospital in South Africa. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 263-72., H4, H5, H6, H7 ²⁵25. Saaid HB, Stewart D, England I, Parmar N. The impact of health technology assessment on decision-making orocesses in public versus not-for-profit private hospitals. Am Med J 2011; 2:72-8., H23 ⁴⁷47. Pasternack RP, Iris R. HTA activities in finnish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 29-37., H25 ⁴⁹49. van der Wilt GJ, Rovers M, Oortwijn W, Grutters J. Hospital-based HTA at Radboud University Medical Centre in the Netherlands: welcome to reality. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 45-55., H29 ⁵⁰50. Manzi P, Barberini P, Dori F, Cecchini A. Hospital based health technology assessment: an example from Siena. Farmeconomia. Health Economics and Therapeutic Pathways 2015; 16:7-13., and H31 ⁵¹51. Pwee KH, Chow WL. Hospital-based HTA in a public-sector tertiary hospital in Singapore. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 273-82.) reported having incomplete teams and stakeholders and/or mostly with the presence of physicians. In relation to the process category, no in-depth discussions were reported on the adaptability of the method used in the internal context of its external replicability ²⁵25. Saaid HB, Stewart D, England I, Parmar N. The impact of health technology assessment on decision-making orocesses in public versus not-for-profit private hospitals. Am Med J 2011; 2:72-8.^,⁴⁷47. Pasternack RP, Iris R. HTA activities in finnish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 29-37.^,⁵¹51. Pwee KH, Chow WL. Hospital-based HTA in a public-sector tertiary hospital in Singapore. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 273-82.. In relation to the outcome category, the partially sedimented hospitals presented partial results on the process of incorporation of health technologies ²⁵25. Saaid HB, Stewart D, England I, Parmar N. The impact of health technology assessment on decision-making orocesses in public versus not-for-profit private hospitals. Am Med J 2011; 2:72-8.^,⁴⁷47. Pasternack RP, Iris R. HTA activities in finnish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 29-37.^,⁴⁸48. Mueller DB, Govender M. HTA in a public hospital in South Africa. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 263-72.^,⁴⁹49. van der Wilt GJ, Rovers M, Oortwijn W, Grutters J. Hospital-based HTA at Radboud University Medical Centre in the Netherlands: welcome to reality. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 45-55.^,⁵⁰50. Manzi P, Barberini P, Dori F, Cecchini A. Hospital based health technology assessment: an example from Siena. Farmeconomia. Health Economics and Therapeutic Pathways 2015; 16:7-13.^,⁵¹51. Pwee KH, Chow WL. Hospital-based HTA in a public-sector tertiary hospital in Singapore. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 273-82..

Hospitals H1 ⁴⁸48. Mueller DB, Govender M. HTA in a public hospital in South Africa. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 263-72. and H25 ⁴⁹49. van der Wilt GJ, Rovers M, Oortwijn W, Grutters J. Hospital-based HTA at Radboud University Medical Centre in the Netherlands: welcome to reality. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 45-55. had HTA units, but H1 did not report a fixed budget, trained teams, or administrative support in its unit ⁴⁸48. Mueller DB, Govender M. HTA in a public hospital in South Africa. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 263-72.. In the process category, both hospitals had a formal process with criteria for planning and setting priorities adapted to the local configurations of the clinical departments and hospital administration ⁴⁸48. Mueller DB, Govender M. HTA in a public hospital in South Africa. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 263-72.^,⁴⁹49. van der Wilt GJ, Rovers M, Oortwijn W, Grutters J. Hospital-based HTA at Radboud University Medical Centre in the Netherlands: welcome to reality. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 45-55.. Only H25 presented cost reductions and process improvements that resulted from the quality of the implemented technologies ⁴⁹49. van der Wilt GJ, Rovers M, Oortwijn W, Grutters J. Hospital-based HTA at Radboud University Medical Centre in the Netherlands: welcome to reality. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 45-55..

Hospital H29 had a hospital-based HTA unit that worked with an internal committee, but it did not report whether the organizational structure was formalized by the institution or whether there was a fixed budget for the unit ⁵⁰50. Manzi P, Barberini P, Dori F, Cecchini A. Hospital based health technology assessment: an example from Siena. Farmeconomia. Health Economics and Therapeutic Pathways 2015; 16:7-13.. H29 had a multidisciplinary commission with collaborative working groups with other institutions to compare the territory’s needs and assess the acquisition, rental, or disposal of health technologies. H29 has a formal HTA process and the production of studies for procedural support. The study reported a reduction in the costs and assessment of the mean prices for technology purchases ⁵⁰50. Manzi P, Barberini P, Dori F, Cecchini A. Hospital based health technology assessment: an example from Siena. Farmeconomia. Health Economics and Therapeutic Pathways 2015; 16:7-13..

Hospital H31 had internal committees with financing, but without integrated processes to support governance for the inclusion of new services and technologies ⁵¹51. Pwee KH, Chow WL. Hospital-based HTA in a public-sector tertiary hospital in Singapore. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 273-82.. They highlighted the presence of multidisciplinary teams qualified to conduct trainings and rapid reviews and to support other hospital committees and departments. They reported that they aimed to conduct efficient allocation of hospital budget resources and conduct analysis of evidence to formulate public policies on hospital technologies ⁵¹51. Pwee KH, Chow WL. Hospital-based HTA in a public-sector tertiary hospital in Singapore. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 273-82..

All the hospitals with partially sedimented HTA in South Africa ⁴⁸48. Mueller DB, Govender M. HTA in a public hospital in South Africa. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 263-72., Australia ²⁵25. Saaid HB, Stewart D, England I, Parmar N. The impact of health technology assessment on decision-making orocesses in public versus not-for-profit private hospitals. Am Med J 2011; 2:72-8., Finland ⁴⁷47. Pasternack RP, Iris R. HTA activities in finnish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 29-37., Netherlands ⁴⁹49. van der Wilt GJ, Rovers M, Oortwijn W, Grutters J. Hospital-based HTA at Radboud University Medical Centre in the Netherlands: welcome to reality. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 45-55., Singapore ⁵¹51. Pwee KH, Chow WL. Hospital-based HTA in a public-sector tertiary hospital in Singapore. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 273-82., and Italy ⁵⁰50. Manzi P, Barberini P, Dori F, Cecchini A. Hospital based health technology assessment: an example from Siena. Farmeconomia. Health Economics and Therapeutic Pathways 2015; 16:7-13. presented perspectives for the sustainability of HTA. In South Africa, there were provisions for coordinated efforts at the national, regional, and local levels ⁴⁸48. Mueller DB, Govender M. HTA in a public hospital in South Africa. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 263-72.. In the Australian hospitals, the authorities, organizations, and companies that supervised the private sector reported actively promoting the introduction of mini-HTA in public and private hospitals ²⁵25. Saaid HB, Stewart D, England I, Parmar N. The impact of health technology assessment on decision-making orocesses in public versus not-for-profit private hospitals. Am Med J 2011; 2:72-8.. In Finland, they reported national and local strategies for effectiveness in hospital decision-making, but also the need for more action in hospital practice ⁴⁷47. Pasternack RP, Iris R. HTA activities in finnish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 29-37.. In the Netherlands, there is a large demand for hospital-based HTA in the production of important information to support the hospitals’ clinical departments and boards ⁴⁹49. van der Wilt GJ, Rovers M, Oortwijn W, Grutters J. Hospital-based HTA at Radboud University Medical Centre in the Netherlands: welcome to reality. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 45-55.. In the hospital in Singapore, HTA is in the initial phase, but the staff professionals are involved in the national and international HTA scientific community ⁵¹51. Pwee KH, Chow WL. Hospital-based HTA in a public-sector tertiary hospital in Singapore. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 273-82.. In Italy, there is an organization of hospital commissions, but it has still not been institutionalized ⁵⁰50. Manzi P, Barberini P, Dori F, Cecchini A. Hospital based health technology assessment: an example from Siena. Farmeconomia. Health Economics and Therapeutic Pathways 2015; 16:7-13..

Characteristics of the hospitals’ action

All the hospitals drafted specific criteria that resulted in tools, sedimented and partially sedimented, derived from HTA reports, recommendations, and/or studies, considering feasibility, local knowledge, and the criteria set by the unit. Hospitals H4, H5, H6, H7 ²⁵25. Saaid HB, Stewart D, England I, Parmar N. The impact of health technology assessment on decision-making orocesses in public versus not-for-profit private hospitals. Am Med J 2011; 2:72-8., and H27, in their initial phase ¹⁴14. Catananti C, Cicchetti A, Marchetti M. Hospital-based health technology assessment: the experience of Agostino Gemelli University Hospital's HTA Unit. Ital J Public Health 2005; 2:23-8., had specific criteria but with a process still in development and without standardization.

The principal method used by most of the hospitals was the HTA report. This tool can be based on technical aspects or evidence from reviews of the scientific literature for assessment of relevance and local applicability ³²32. Bellemare CA, Fisette J-F, Poder TG, Bédard SK, Dagenais P. The health technology assessment unit of the Centre hospitalier universitaire de Sherbrooke (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 185-200.. Recommendations are issued with simple, transparent, and accessible backing ⁵5. Nunes AA, Mello LM, Ana LW, Marques PMA, Dallora MEL, Martinez EZ, et al. Avaliação e incorporação de tecnologias em saúde: processo e metodologia adotados por um hospital universitário de alta complexidade assistencial. Cad Saúde Pública 2013; 29 Suppl 1:S179-86.^,⁹9. Demirdjian G. A 10-year hospital-based health technology assessment program in a public hospital in Argentina. Int J Technol Assess Health Care 2015; 31:103-10.^,⁴²42. Miniati R, Frosini F, Cecconi G, Dori F, Gentili GB. Development of sustainable models for technology evaluation in hospital. Technol Health Care 2014; 22:729-39. to sustain clinical practice and decision-making in hospitals. The tool’s short version, called mini-HTA, features a brief assessment of the advantages and disadvantages according to a local report ³²32. Bellemare CA, Fisette J-F, Poder TG, Bédard SK, Dagenais P. The health technology assessment unit of the Centre hospitalier universitaire de Sherbrooke (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 185-200.. The reports can be submitted to national and international meetings, besides scientific reviews and abstracts published in information bulletin format ²⁴24. Demirdjian G, Kurtzbart R, Hernandez R. Hospital-based HTA in Argentina: the Hospital Garrahan and Hospital El Cruce experiences. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 247-61.^,³⁶36. Rhainds M, Asselin G, Coulombe M. CHU de Québec - Université Laval: 10-years' experience in hospital-based HTA (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 201-11.^,⁴⁰40. Barna A, Fahlgren B, Charpentier E, Taron-Brocard C, Guillevin L. The "Comité d'Evaluation et de Diffusion des Innovations Technologiques" (CEDIT) in France. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 71-6..

In general, HTA processes should play an advisory role ²⁹29. Kidholm K, Ølholm AM. Hospital-based HTA in Denmark. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 39-44. to offer recommendations to the hospital administration in the process of acquisition or disposal of health technologies. In addition, more specific knowledge, adapted to the local context, may not offer replicability of the method to other institutions, as emphasized by the Centre Hospitalier Universitaire de Sherbrooke in Canada ³²32. Bellemare CA, Fisette J-F, Poder TG, Bédard SK, Dagenais P. The health technology assessment unit of the Centre hospitalier universitaire de Sherbrooke (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 185-200.^,³³33. Poder TG. Using the health technology assessment toolbox to facilitate procurement: the case of smart pumps in a Canadian hospital. Int J Technol Assess Health Care 2017; 33:54-62.^,³⁴34. Poder TG, Bellemare CA, Bédard SK, Fisette J-F, Dagenais P. Impact of health technology assessment reports on hospital decision makers - 10-year insight from a hospital unit in Sherbrooke, Canada: impact of health technology assessment on hospital decisions. Int J Technol Assess Health Care 2018; 34:393-9.^,³⁵35. Poder TG, Beffarat M, Benkhalti M, Ladouceur G, Dagenais P. A discrete choice experiment on preferences of patients with low back pain about non-surgical treatments: identification, refinement and selection of attributes and levels. Patient Prefer Adherence 2019; 13:933-40.. In this hospital, the use of HTA created a specific organizational coherence with the local process, which resulted in partnerships between administrators, professionals, and patients’ representatives to produce recommendations and develop policies, but which is not replicable to other contexts since it requires specific resources and skills to conduct the studies ³⁵35. Poder TG, Beffarat M, Benkhalti M, Ladouceur G, Dagenais P. A discrete choice experiment on preferences of patients with low back pain about non-surgical treatments: identification, refinement and selection of attributes and levels. Patient Prefer Adherence 2019; 13:933-40..

Barriers to the sedimentation of hospital-based HTA

Thirty-two hospitals, even those classified as sedimented, reported as the principal barrier the capacity to elaborate and maintain compliance with guidelines and local formalities for the implementation of hospital-based HTA ⁵5. Nunes AA, Mello LM, Ana LW, Marques PMA, Dallora MEL, Martinez EZ, et al. Avaliação e incorporação de tecnologias em saúde: processo e metodologia adotados por um hospital universitário de alta complexidade assistencial. Cad Saúde Pública 2013; 29 Suppl 1:S179-86.^,⁹9. Demirdjian G. A 10-year hospital-based health technology assessment program in a public hospital in Argentina. Int J Technol Assess Health Care 2015; 31:103-10.^,¹¹11. McGregor M, Brophy JM. End-user involvement in health technology assessment (HTA) development: a way to increase impact. Int J Technol Assess Health Care 2005; 21:263-7.^,¹²12. McGregor M. The Health Technology Assessment Unit (TAU) of the McGill University Health Centre (MUHC) (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 167-71.^,¹³13. Almeida ND, Mines L, Nicolau I, Sinclair A, Forero DF, Brophy JM, et al. A framework for aiding the translation of scientific evidence into policy: the experience of a hospital-based technology assessment unit. Int J Technol Assess Health Care 2019; 35:204-11.^,¹⁴14. Catananti C, Cicchetti A, Marchetti M. Hospital-based health technology assessment: the experience of Agostino Gemelli University Hospital's HTA Unit. Ital J Public Health 2005; 2:23-8.^,¹⁵15. Marchetti M, Cicchetti A. The HTA and innovation unit at the A. Gemelli University Hospital (Italy). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 85-94.^,¹⁶16. Kosherbayeva L, Hailey D, Kurakbaev K, Tsoy A, Zhuzzhanov O, Donbay A, et al. Implementation of health technology assessment work in a hospital in Kazakhstan. Int J Technol Assess Health Care 2016; 32:78-80.^,²⁴24. Demirdjian G, Kurtzbart R, Hernandez R. Hospital-based HTA in Argentina: the Hospital Garrahan and Hospital El Cruce experiences. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 247-61.^,²⁵25. Saaid HB, Stewart D, England I, Parmar N. The impact of health technology assessment on decision-making orocesses in public versus not-for-profit private hospitals. Am Med J 2011; 2:72-8.^,²⁶26. Santos M, Magliano C, Kelles DB, Kelles SMB, Stein A. The role of hospitals in HTA in Brazil. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 239-46.^,²⁷27. Sampietro-Colom L, Soto M, García C, Benot S. Hospital-based HTA in three Spanish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 57-69.^,²⁸28. Wasserfallen J-B, Pinget C. Hospital-based HTA in Switzerland. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 77-83.^,²⁹29. Kidholm K, Ølholm AM. Hospital-based HTA in Denmark. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 39-44.^,³⁰30. Kahveci R, Tütüncü T, Yüksek YN, Küçük EÖ, Koç EM, Zengin N. Hospital-based HTA in Turkey. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 95-105.^,³¹31. Lepanto L. Hospital-based HTA at the Centre Hospitalier de l'Université de Montréal (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 173-83.^,³²32. Bellemare CA, Fisette J-F, Poder TG, Bédard SK, Dagenais P. The health technology assessment unit of the Centre hospitalier universitaire de Sherbrooke (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 185-200.^,³³33. Poder TG. Using the health technology assessment toolbox to facilitate procurement: the case of smart pumps in a Canadian hospital. Int J Technol Assess Health Care 2017; 33:54-62.^,³⁴34. Poder TG, Bellemare CA, Bédard SK, Fisette J-F, Dagenais P. Impact of health technology assessment reports on hospital decision makers - 10-year insight from a hospital unit in Sherbrooke, Canada: impact of health technology assessment on hospital decisions. Int J Technol Assess Health Care 2018; 34:393-9.^,³⁵35. Poder TG, Beffarat M, Benkhalti M, Ladouceur G, Dagenais P. A discrete choice experiment on preferences of patients with low back pain about non-surgical treatments: identification, refinement and selection of attributes and levels. Patient Prefer Adherence 2019; 13:933-40.^,³⁶36. Rhainds M, Asselin G, Coulombe M. CHU de Québec - Université Laval: 10-years' experience in hospital-based HTA (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 201-11.^,³⁷37. Ungar WJ. Technology Assessment at SickKids (TASK): a health technology assessment research unit devoted to child health in Canada. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 153-65.^,³⁸38. Avdeyev A, Tabarov A, Akhetov A, Shanazarov N, Hailey D, Kaptagayeva A, et al. Hospital-based health technology assessment in Kazakhstan: 3 years' experience of one unit. Int J Technol Assess Health Care 2019; 35:436-40.^,³⁹39. Mitchell MD, Williams K, Brennan PJ, Umscheid CA. Integrating local data into hospital-based healthcare technology assessment: two case studies. Int J Technol Assess Health Care 2010; 26:294-300.^,⁴¹41. Tal O, Booch M, Bar-Yehuda S. Hospital staff perspectives towards health technology assessment: data from a multidisciplinary survey. Health Res Policy Syst 2019; 17:72.^,⁴²42. Miniati R, Frosini F, Cecconi G, Dori F, Gentili GB. Development of sustainable models for technology evaluation in hospital. Technol Health Care 2014; 22:729-39.^,⁴³43. Munn SR. Hospital-based health technology assessment: insights from New Zealand. Pharmacoeconomics 2014; 32:815-7.^,⁴⁴44. Fitzgerald A, Streat S, McAleese C, Munn S. Hospital-based HTA in New Zealand. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 305-12.^,⁴⁵45. Jivegård L, Bergh C, Kindblom J, Samuelsson O, Sjögren P, Sjövall H, et al. Activity-based HTA: hospital-based HTA performed by clinicians with support and quality control, the Sahlgrenska University Hospital HTA-Centrum Experience (Sweden). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 15-28.^,⁴⁶46. Grenon X, Pinget C, Wasserfallen J-B. Hospital-based health technology assessment (HB-HTA): a 10-year survey at one unit. Int J Technol Assess Health Care 2016; 32:116-21.^,⁴⁷47. Pasternack RP, Iris R. HTA activities in finnish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 29-37.^,⁵⁰50. Manzi P, Barberini P, Dori F, Cecchini A. Hospital based health technology assessment: an example from Siena. Farmeconomia. Health Economics and Therapeutic Pathways 2015; 16:7-13.^,⁵¹51. Pwee KH, Chow WL. Hospital-based HTA in a public-sector tertiary hospital in Singapore. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 273-82.. H1, H10, H24, and H25 were the only hospitals not to report installed capacity as a barrier ²⁶26. Santos M, Magliano C, Kelles DB, Kelles SMB, Stein A. The role of hospitals in HTA in Brazil. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 239-46.^,⁴⁰40. Barna A, Fahlgren B, Charpentier E, Taron-Brocard C, Guillevin L. The "Comité d'Evaluation et de Diffusion des Innovations Technologiques" (CEDIT) in France. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 71-6.^,⁴⁸48. Mueller DB, Govender M. HTA in a public hospital in South Africa. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 263-72.^,⁴⁹49. van der Wilt GJ, Rovers M, Oortwijn W, Grutters J. Hospital-based HTA at Radboud University Medical Centre in the Netherlands: welcome to reality. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 45-55..

Other aspects that limited and/or hindered the sedimentation of hospital-based HTA were reported by the hospitals, such as lack of transparency, planning, and speed in the acquisition of technologies (27/36); professional inertia and resistance to change (26/36); lack of adherence to HTA tools or other related procedures to support local decisions (21/36); insufficient training, orientation, and technical skills (21/36); lack of internal and external recognition (20/36); lack of administrative, financial, or government support (16/36); guarantee of decisions based on evidence, without untoward influences (13/36); administration discredited on collective decisions (13/36); scarcity of qualified evidence (11/36); and finally the lack of full-time work in HTA, related to staff time and turnover (8/36).

The hospitals’ organizational models require constant resources for hospital-based HTA to contribute to quality and safety in the adoption of technologies. One study ³⁴34. Poder TG, Bellemare CA, Bédard SK, Fisette J-F, Dagenais P. Impact of health technology assessment reports on hospital decision makers - 10-year insight from a hospital unit in Sherbrooke, Canada: impact of health technology assessment on hospital decisions. Int J Technol Assess Health Care 2018; 34:393-9. cited the abandonment of innovative practices due to lack of financing, recognition, and/or follow-up of HTA processes.

According to the selected studies, the administrators that lack internal financing can opt, according to the context, for other sources of financing such as reimbursement for procedures ²⁶26. Santos M, Magliano C, Kelles DB, Kelles SMB, Stein A. The role of hospitals in HTA in Brazil. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 239-46.; search for financing and hospital budget funds ¹⁵15. Marchetti M, Cicchetti A. The HTA and innovation unit at the A. Gemelli University Hospital (Italy). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 85-94.; external financing ³²32. Bellemare CA, Fisette J-F, Poder TG, Bédard SK, Dagenais P. The health technology assessment unit of the Centre hospitalier universitaire de Sherbrooke (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 185-200.; cross-subsidies ²⁷27. Sampietro-Colom L, Soto M, García C, Benot S. Hospital-based HTA in three Spanish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 57-69.^,³⁷37. Ungar WJ. Technology Assessment at SickKids (TASK): a health technology assessment research unit devoted to child health in Canada. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 153-65.; search for resources in health departments or regional boards ¹⁶16. Kosherbayeva L, Hailey D, Kurakbaev K, Tsoy A, Zhuzzhanov O, Donbay A, et al. Implementation of health technology assessment work in a hospital in Kazakhstan. Int J Technol Assess Health Care 2016; 32:78-80.^,⁴⁴44. Fitzgerald A, Streat S, McAleese C, Munn S. Hospital-based HTA in New Zealand. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 305-12.; and financing from national organizations for HTA ²⁹29. Kidholm K, Ølholm AM. Hospital-based HTA in Denmark. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 39-44.^,⁴⁹49. van der Wilt GJ, Rovers M, Oortwijn W, Grutters J. Hospital-based HTA at Radboud University Medical Centre in the Netherlands: welcome to reality. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 45-55..

Discussion

This scoping review identified levels of HTA sedimentation in 36 hospitals, 75% (27/36) of which were classified as sedimented because they met criteria for structuring organizational HTA models, besides displaying stages in the HTA process and demonstrating implementation of practical results for the hospital level.

Practical results for hospital administration were related to the hospital staff’s own capacity to demonstrate the value of the HTA in the sphere of hospital administration, and such teams also contributed to the overall coverage policies adopted in their countries. Hailey et al. ⁵²52. Hailey D, Werkö S, Rosén M, MacPherson K, Myles S, Gallegos Rivero V, et al. Influence of health technology assessment and its measurement. Int J Technol Assess Health Care 2016; 32:376-84. and Favaretti et al. ⁵³53. Favaretti C, Cicchetti A, Guarrera G, Marchetti M, Ricciardi W. Health technology assessment in Italy. Int J Technol Assess Health Care 2009; 25 Suppl 1:127-33. corroborate these findings with studies on the impacts of HTA at the local and national levels. Novaes et al. ⁵⁴54. Novaes HMD, De Soárez PC. A Avaliação das Tecnologias em Saúde: origem, desenvolvimento e desafios atuais. Panorama internacional e Brasil. Cad Saúde Pública 2020; 36:e00006820. report that the adoption of decision-making processes, when included in value assessment structures, can lend more legitimacy to both the decisions and the prioritization of technologies.

The allocation of fixed resources for the organizational models was specified in 17 hospitals with sedimented HTA. This finding was corroborated by Attieh et al. ⁵⁵55. Attieh R, Gagnon M-P. Implementation of local/hospital-based health technology assessment initiatives in low- and middle-income countries. Int J Technol Assess Health Care 2012; 28:445-51. in a systematic review that reported effects and repercussions of the adoption of HTA by hospitals, showing that by producing savings for the hospitals, HTA demonstrated the importance of continuing the work by dedicated professionals with appropriate organizational models.

The sustainability of support and administrative commitment to hospital-based HTA structures were key factors for internal and external growth according to some studies ⁹9. Demirdjian G. A 10-year hospital-based health technology assessment program in a public hospital in Argentina. Int J Technol Assess Health Care 2015; 31:103-10.^,²⁴24. Demirdjian G, Kurtzbart R, Hernandez R. Hospital-based HTA in Argentina: the Hospital Garrahan and Hospital El Cruce experiences. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 247-61. on experiences with hospital-based HTA. These factors were also confirmed by Francisco & Malik ⁷7. Francisco F, Malik AM. Aplicação de Avaliação de Tecnologias em Saúde (ATS) na tomada de decisão em hospitais. J Bras Econ Saúde 2019; 11:10-7., who analyzed the experience of HTA groups in Brazil, reporting that the sustainability of hospital-based HTA over time is related to reinforcement of the hospital’s strategic management.

According to the experience of other HTA initiatives in Brazil, sustainability requires continuous investments to increase production, continuing education, and adherence, legitimizing the administrative acts, which should be directed to relevant HTA policies for the respective context ⁵5. Nunes AA, Mello LM, Ana LW, Marques PMA, Dallora MEL, Martinez EZ, et al. Avaliação e incorporação de tecnologias em saúde: processo e metodologia adotados por um hospital universitário de alta complexidade assistencial. Cad Saúde Pública 2013; 29 Suppl 1:S179-86.^,⁶6. Aguiar Pereira CC, Dos Santos Rabello R, Elias FTS. Hospital-based health technology assessment in Brazil: an overview of the initial experiences. Int J Technol Assess Health Care 2017; 33:227-31..

The process of defining criteria for ordering HTA reports and issuing recommendations was present in 14 of the hospitals. The problems included lack of formalization, which opened the way for conflicts of interest and mistrust ⁴⁷47. Pasternack RP, Iris R. HTA activities in finnish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 29-37., and outside influences in issuing recommendations ²⁸28. Wasserfallen J-B, Pinget C. Hospital-based HTA in Switzerland. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 77-83.. Grenon et al. ²⁸28. Wasserfallen J-B, Pinget C. Hospital-based HTA in Switzerland. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 77-83. reported that these problems occur when there are no standardized procedures for developing HTA reports, and that these processes need to be developed formally in the local context.

Study limitations

The scoping review identified experiences in articles published in Brazilian and international journals, but no technical visits or interviews were conducted with key informants in the respective hospitals. It was thus an exploratory study. Although the strategy included enhanced search, manual search, and searches in the proceedings of specialized conferences in the HTA field, many of the abstracts published in the proceedings of these scientific events could not be used because they lacked complete information on the respective hospitals. The scoping review only selected studies that addressed HTA specifically in a hospital context and excluded studies that dealt with the topic at the national or general levels, but without citing each hospital’s unique experiences. The articles’ data extraction was performed by a single author, but it was reviewed in meetings with the other authors to clarify doubts on classification of the sedimentation dimensions. Some hospitals may have been misjudged in the assessment due to lack of specific information on the structure, process, and outcome of HTA in the hospitals, although the authors had searched for information on the hospitals’ own websites.

Practical implications

The study contributed to structuring HTA activities in hospitals in the Brazilian Unified National Health System (SUS). Knowing the experiences and level of sedimentation of hospital-based HTA in the domestic and international contexts contributed to a better understanding of the field, since the studies in the scoping review pointed to sustainability, growth, and evolution of hospital-based HTA in countries with and without a tradition in the field. Thus, the study presented dimensions that will serve as the basis for mapping installed capacities in hospitals and new studies on HTA in hospitals.

Conclusions

This scoping review showed dimensions and levels of sedimentation in 36 hospitals that adopted HTA in their management processes, identified via an extensive search of Brazilian and international experiences. Most were classified as having sedimented HTA because they met criteria for structuring HTA organizational models, displayed stages in the HTA process, and demonstrated practical results at the hospital level. The review also revealed challenges throughout the entire process of sedimentation of hospital-based HTA, ranging from the implementation of new clinical and management practices to sustainability of the structures and processes over time.

In hospitals with partially sedimented HTA, the initial barriers pertaining to structural aspects were related to the available financial, physical, and human resources and adherence to HTA tools applied to the context of strategic management. In hospitals with sedimented HTA, the main barrier was to give impact to the results, explained by the scarcity of evidence for the target topics, the lack of continuing training, and noncompliance with the established guidelines in the assessment and decision process, influencing the internal and external recognition of the results obtained with HTA. We hope that the target dimensions and the findings will serve as the basis for creating strategies for HTA implementation in hospitals.

Acknowledgments

The authors wish to thank the experts who participated in the focus group to create the classification score for level of sedimentation and for their support in the literature searches. The study was supported by the cooperative project between the Oswaldo Cruz Foundation (Fiocruz) and the National Health Surveillance Agency (Anvisa) entitled “Actions to Support Regulatory Governance of Products Subject to Health Surveillance”.

References

¹
Sampietro-Colom L, Martin J. Hospital-based health technology assessment: the next frontier. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 3-11.
²
Sampietro-Colom LLK, Cicchetti AKK, Pasternack IFB, Rosenmöller MWC, Kahveci RWJ, Kiivet RA et al. The AdHopHTA handbook 2015. http://www.adhophta.eu/sites/files/adhophta/media/adhophta_handbook_website.pdf (acessado em 20/Dez/2020).
» http://www.adhophta.eu/sites/files/adhophta/media/adhophta_handbook_website.pdf
³
Sampietro-Colom L, Lach K, Pasternack I, Wasserfallen J-B, Cicchetti A, Marchetti M, et al. Guiding principles for good practices in hospital-based health technology assessment units. Int J Technol Assess Health Care 2016; 31:457-65.
⁴
Souza NP, Lira PIC, Fontbonne A, Pinto FC de L, Cesse EAP. (Mal)nutrition and the new epidemiological trend in a context of development and inequalities. Ciênc Saúde Colet 2017; 22:2257-66.
⁵
Nunes AA, Mello LM, Ana LW, Marques PMA, Dallora MEL, Martinez EZ, et al. Avaliação e incorporação de tecnologias em saúde: processo e metodologia adotados por um hospital universitário de alta complexidade assistencial. Cad Saúde Pública 2013; 29 Suppl 1:S179-86.
⁶
Aguiar Pereira CC, Dos Santos Rabello R, Elias FTS. Hospital-based health technology assessment in Brazil: an overview of the initial experiences. Int J Technol Assess Health Care 2017; 33:227-31.
⁷
Francisco F, Malik AM. Aplicação de Avaliação de Tecnologias em Saúde (ATS) na tomada de decisão em hospitais. J Bras Econ Saúde 2019; 11:10-7.
⁸
Banta D, Jonsson E. History of HTA: introduction. Int J Technol Assess Health Care 2009; 25 Suppl 1:1-6.
⁹
Demirdjian G. A 10-year hospital-based health technology assessment program in a public hospital in Argentina. Int J Technol Assess Health Care 2015; 31:103-10.
¹⁰
Francisco FR, Malik AM. Aplicação de avaliação de tecnologias em saúde (ATS) na tomada de decisão em hospitais. J Bras Econ Saúde 2019; 11:10-7.
¹¹
McGregor M, Brophy JM. End-user involvement in health technology assessment (HTA) development: a way to increase impact. Int J Technol Assess Health Care 2005; 21:263-7.
¹²
McGregor M. The Health Technology Assessment Unit (TAU) of the McGill University Health Centre (MUHC) (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 167-71.
¹³
Almeida ND, Mines L, Nicolau I, Sinclair A, Forero DF, Brophy JM, et al. A framework for aiding the translation of scientific evidence into policy: the experience of a hospital-based technology assessment unit. Int J Technol Assess Health Care 2019; 35:204-11.
¹⁴
Catananti C, Cicchetti A, Marchetti M. Hospital-based health technology assessment: the experience of Agostino Gemelli University Hospital's HTA Unit. Ital J Public Health 2005; 2:23-8.
¹⁵
Marchetti M, Cicchetti A. The HTA and innovation unit at the A. Gemelli University Hospital (Italy). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 85-94.
¹⁶
Kosherbayeva L, Hailey D, Kurakbaev K, Tsoy A, Zhuzzhanov O, Donbay A, et al. Implementation of health technology assessment work in a hospital in Kazakhstan. Int J Technol Assess Health Care 2016; 32:78-80.
¹⁷
Donabedian A. Criteria and standards for quality assessment and monitoring. Qual Rev Bull 1986; 12:99-108.
¹⁸
Donabedian A. The seven pillars of quality. Arch Pathol Lab Med 1990; 114:1115-8.
¹⁹
Nascimento GC, Rodrigues VJ, Megliorini E. Conceitos da teoria institucional: fonte propulsora de evolução para a gestão de desempenho. In: XVII Congresso Brasileiro de Custos. https://anaiscbc.emnuvens.com.br/anais/article/viewFile/761/761 (acessado em 20/Dez/2020).
» https://anaiscbc.emnuvens.com.br/anais/article/viewFile/761/761
²⁰
Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping reviews. In: Aromataris E, Munn Z, editors. Joanna Briggs Institute reviewer's manual. https://wiki.jbi.global/display/MANUAL/Chapter+11%3A+Scoping+reviews (acessado em 20/Dez/2020).
» https://wiki.jbi.global/display/MANUAL/Chapter+11%3A+Scoping+reviews
²¹
Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018; 169:467-73.
²²
Braga Neto FC, Barbosa PR, Santos IS, Oliveira CMF. Atenção hospitalar: evolução histórica e tendências. In: Giovanella L, Escorel S, Lobato LVC, Noronha JC, Carvalho AI, organizadores. Políticas e sistema de saúde no Brasil. Rio de Janeiro: Editora Fiocruz/Centro Brasileiro de Estudos de Saúde; 2008. p. 577-608.
²³
Samprietro-Colom L, Lach K, Escolar I, Sroka S, Soto M, Cicchetti A, et al. A handbook and a toolkit for hospital-based health technology assessment. Value Health 2015; 18:A556.
²⁴
Demirdjian G, Kurtzbart R, Hernandez R. Hospital-based HTA in Argentina: the Hospital Garrahan and Hospital El Cruce experiences. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 247-61.
²⁵
Saaid HB, Stewart D, England I, Parmar N. The impact of health technology assessment on decision-making orocesses in public versus not-for-profit private hospitals. Am Med J 2011; 2:72-8.
²⁶
Santos M, Magliano C, Kelles DB, Kelles SMB, Stein A. The role of hospitals in HTA in Brazil. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 239-46.
²⁷
Sampietro-Colom L, Soto M, García C, Benot S. Hospital-based HTA in three Spanish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 57-69.
²⁸
Wasserfallen J-B, Pinget C. Hospital-based HTA in Switzerland. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 77-83.
²⁹
Kidholm K, Ølholm AM. Hospital-based HTA in Denmark. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 39-44.
³⁰
Kahveci R, Tütüncü T, Yüksek YN, Küçük EÖ, Koç EM, Zengin N. Hospital-based HTA in Turkey. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 95-105.
³¹
Lepanto L. Hospital-based HTA at the Centre Hospitalier de l'Université de Montréal (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 173-83.
³²
Bellemare CA, Fisette J-F, Poder TG, Bédard SK, Dagenais P. The health technology assessment unit of the Centre hospitalier universitaire de Sherbrooke (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 185-200.
³³
Poder TG. Using the health technology assessment toolbox to facilitate procurement: the case of smart pumps in a Canadian hospital. Int J Technol Assess Health Care 2017; 33:54-62.
³⁴
Poder TG, Bellemare CA, Bédard SK, Fisette J-F, Dagenais P. Impact of health technology assessment reports on hospital decision makers - 10-year insight from a hospital unit in Sherbrooke, Canada: impact of health technology assessment on hospital decisions. Int J Technol Assess Health Care 2018; 34:393-9.
³⁵
Poder TG, Beffarat M, Benkhalti M, Ladouceur G, Dagenais P. A discrete choice experiment on preferences of patients with low back pain about non-surgical treatments: identification, refinement and selection of attributes and levels. Patient Prefer Adherence 2019; 13:933-40.
³⁶
Rhainds M, Asselin G, Coulombe M. CHU de Québec - Université Laval: 10-years' experience in hospital-based HTA (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 201-11.
³⁷
Ungar WJ. Technology Assessment at SickKids (TASK): a health technology assessment research unit devoted to child health in Canada. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 153-65.
³⁸
Avdeyev A, Tabarov A, Akhetov A, Shanazarov N, Hailey D, Kaptagayeva A, et al. Hospital-based health technology assessment in Kazakhstan: 3 years' experience of one unit. Int J Technol Assess Health Care 2019; 35:436-40.
³⁹
Mitchell MD, Williams K, Brennan PJ, Umscheid CA. Integrating local data into hospital-based healthcare technology assessment: two case studies. Int J Technol Assess Health Care 2010; 26:294-300.
⁴⁰
Barna A, Fahlgren B, Charpentier E, Taron-Brocard C, Guillevin L. The "Comité d'Evaluation et de Diffusion des Innovations Technologiques" (CEDIT) in France. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 71-6.
⁴¹
Tal O, Booch M, Bar-Yehuda S. Hospital staff perspectives towards health technology assessment: data from a multidisciplinary survey. Health Res Policy Syst 2019; 17:72.
⁴²
Miniati R, Frosini F, Cecconi G, Dori F, Gentili GB. Development of sustainable models for technology evaluation in hospital. Technol Health Care 2014; 22:729-39.
⁴³
Munn SR. Hospital-based health technology assessment: insights from New Zealand. Pharmacoeconomics 2014; 32:815-7.
⁴⁴
Fitzgerald A, Streat S, McAleese C, Munn S. Hospital-based HTA in New Zealand. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 305-12.
⁴⁵
Jivegård L, Bergh C, Kindblom J, Samuelsson O, Sjögren P, Sjövall H, et al. Activity-based HTA: hospital-based HTA performed by clinicians with support and quality control, the Sahlgrenska University Hospital HTA-Centrum Experience (Sweden). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 15-28.
⁴⁶
Grenon X, Pinget C, Wasserfallen J-B. Hospital-based health technology assessment (HB-HTA): a 10-year survey at one unit. Int J Technol Assess Health Care 2016; 32:116-21.
⁴⁷
Pasternack RP, Iris R. HTA activities in finnish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 29-37.
⁴⁸
Mueller DB, Govender M. HTA in a public hospital in South Africa. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 263-72.
⁴⁹
van der Wilt GJ, Rovers M, Oortwijn W, Grutters J. Hospital-based HTA at Radboud University Medical Centre in the Netherlands: welcome to reality. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 45-55.
⁵⁰
Manzi P, Barberini P, Dori F, Cecchini A. Hospital based health technology assessment: an example from Siena. Farmeconomia. Health Economics and Therapeutic Pathways 2015; 16:7-13.
⁵¹
Pwee KH, Chow WL. Hospital-based HTA in a public-sector tertiary hospital in Singapore. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 273-82.
⁵²
Hailey D, Werkö S, Rosén M, MacPherson K, Myles S, Gallegos Rivero V, et al. Influence of health technology assessment and its measurement. Int J Technol Assess Health Care 2016; 32:376-84.
⁵³
Favaretti C, Cicchetti A, Guarrera G, Marchetti M, Ricciardi W. Health technology assessment in Italy. Int J Technol Assess Health Care 2009; 25 Suppl 1:127-33.
⁵⁴
Novaes HMD, De Soárez PC. A Avaliação das Tecnologias em Saúde: origem, desenvolvimento e desafios atuais. Panorama internacional e Brasil. Cad Saúde Pública 2020; 36:e00006820.
⁵⁵
Attieh R, Gagnon M-P. Implementation of local/hospital-based health technology assessment initiatives in low- and middle-income countries. Int J Technol Assess Health Care 2012; 28:445-51.

Publication Dates

Publication in this collection
22 Sept 2021
Date of issue
2021

History

Received
25 Dec 2020
Reviewed
18 May 2021
Accepted
28 May 2021

Este é um artigo publicado em acesso aberto sob uma licença Creative Commons

[1] ¹
Sampietro-Colom L, Martin J. Hospital-based health technology assessment: the next frontier. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 3-11.

[2] ²
Sampietro-Colom LLK, Cicchetti AKK, Pasternack IFB, Rosenmöller MWC, Kahveci RWJ, Kiivet RA et al. The AdHopHTA handbook 2015. http://www.adhophta.eu/sites/files/adhophta/media/adhophta_handbook_website.pdf (acessado em 20/Dez/2020).
» http://www.adhophta.eu/sites/files/adhophta/media/adhophta_handbook_website.pdf

[3] ³
Sampietro-Colom L, Lach K, Pasternack I, Wasserfallen J-B, Cicchetti A, Marchetti M, et al. Guiding principles for good practices in hospital-based health technology assessment units. Int J Technol Assess Health Care 2016; 31:457-65.

[4] ⁴
Souza NP, Lira PIC, Fontbonne A, Pinto FC de L, Cesse EAP. (Mal)nutrition and the new epidemiological trend in a context of development and inequalities. Ciênc Saúde Colet 2017; 22:2257-66.

[5] ⁵
Nunes AA, Mello LM, Ana LW, Marques PMA, Dallora MEL, Martinez EZ, et al. Avaliação e incorporação de tecnologias em saúde: processo e metodologia adotados por um hospital universitário de alta complexidade assistencial. Cad Saúde Pública 2013; 29 Suppl 1:S179-86.

[6] ⁶
Aguiar Pereira CC, Dos Santos Rabello R, Elias FTS. Hospital-based health technology assessment in Brazil: an overview of the initial experiences. Int J Technol Assess Health Care 2017; 33:227-31.

[7] ⁷
Francisco F, Malik AM. Aplicação de Avaliação de Tecnologias em Saúde (ATS) na tomada de decisão em hospitais. J Bras Econ Saúde 2019; 11:10-7.

[8] ⁸
Banta D, Jonsson E. History of HTA: introduction. Int J Technol Assess Health Care 2009; 25 Suppl 1:1-6.

[9] ⁹
Demirdjian G. A 10-year hospital-based health technology assessment program in a public hospital in Argentina. Int J Technol Assess Health Care 2015; 31:103-10.

[10] ¹⁰
Francisco FR, Malik AM. Aplicação de avaliação de tecnologias em saúde (ATS) na tomada de decisão em hospitais. J Bras Econ Saúde 2019; 11:10-7.

[11] ¹¹
McGregor M, Brophy JM. End-user involvement in health technology assessment (HTA) development: a way to increase impact. Int J Technol Assess Health Care 2005; 21:263-7.

[12] ¹²
McGregor M. The Health Technology Assessment Unit (TAU) of the McGill University Health Centre (MUHC) (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 167-71.

[13] ¹³
Almeida ND, Mines L, Nicolau I, Sinclair A, Forero DF, Brophy JM, et al. A framework for aiding the translation of scientific evidence into policy: the experience of a hospital-based technology assessment unit. Int J Technol Assess Health Care 2019; 35:204-11.

[14] ¹⁴
Catananti C, Cicchetti A, Marchetti M. Hospital-based health technology assessment: the experience of Agostino Gemelli University Hospital's HTA Unit. Ital J Public Health 2005; 2:23-8.

[15] ¹⁵
Marchetti M, Cicchetti A. The HTA and innovation unit at the A. Gemelli University Hospital (Italy). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 85-94.

[16] ¹⁶
Kosherbayeva L, Hailey D, Kurakbaev K, Tsoy A, Zhuzzhanov O, Donbay A, et al. Implementation of health technology assessment work in a hospital in Kazakhstan. Int J Technol Assess Health Care 2016; 32:78-80.

[17] ¹⁷
Donabedian A. Criteria and standards for quality assessment and monitoring. Qual Rev Bull 1986; 12:99-108.

[18] ¹⁸
Donabedian A. The seven pillars of quality. Arch Pathol Lab Med 1990; 114:1115-8.

[19] ¹⁹
Nascimento GC, Rodrigues VJ, Megliorini E. Conceitos da teoria institucional: fonte propulsora de evolução para a gestão de desempenho. In: XVII Congresso Brasileiro de Custos. https://anaiscbc.emnuvens.com.br/anais/article/viewFile/761/761 (acessado em 20/Dez/2020).
» https://anaiscbc.emnuvens.com.br/anais/article/viewFile/761/761

[20] ²⁰
Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping reviews. In: Aromataris E, Munn Z, editors. Joanna Briggs Institute reviewer's manual. https://wiki.jbi.global/display/MANUAL/Chapter+11%3A+Scoping+reviews (acessado em 20/Dez/2020).
» https://wiki.jbi.global/display/MANUAL/Chapter+11%3A+Scoping+reviews

[21] ²¹
Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018; 169:467-73.

[22] ²²
Braga Neto FC, Barbosa PR, Santos IS, Oliveira CMF. Atenção hospitalar: evolução histórica e tendências. In: Giovanella L, Escorel S, Lobato LVC, Noronha JC, Carvalho AI, organizadores. Políticas e sistema de saúde no Brasil. Rio de Janeiro: Editora Fiocruz/Centro Brasileiro de Estudos de Saúde; 2008. p. 577-608.

[23] ²³
Samprietro-Colom L, Lach K, Escolar I, Sroka S, Soto M, Cicchetti A, et al. A handbook and a toolkit for hospital-based health technology assessment. Value Health 2015; 18:A556.

[24] ²⁴
Demirdjian G, Kurtzbart R, Hernandez R. Hospital-based HTA in Argentina: the Hospital Garrahan and Hospital El Cruce experiences. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 247-61.

[25] ²⁵
Saaid HB, Stewart D, England I, Parmar N. The impact of health technology assessment on decision-making orocesses in public versus not-for-profit private hospitals. Am Med J 2011; 2:72-8.

[26] ²⁶
Santos M, Magliano C, Kelles DB, Kelles SMB, Stein A. The role of hospitals in HTA in Brazil. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 239-46.

[27] ²⁷
Sampietro-Colom L, Soto M, García C, Benot S. Hospital-based HTA in three Spanish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 57-69.

[28] ²⁸
Wasserfallen J-B, Pinget C. Hospital-based HTA in Switzerland. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 77-83.

[29] ²⁹
Kidholm K, Ølholm AM. Hospital-based HTA in Denmark. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 39-44.

[30] ³⁰
Kahveci R, Tütüncü T, Yüksek YN, Küçük EÖ, Koç EM, Zengin N. Hospital-based HTA in Turkey. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 95-105.

[31] ³¹
Lepanto L. Hospital-based HTA at the Centre Hospitalier de l'Université de Montréal (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 173-83.

[32] ³²
Bellemare CA, Fisette J-F, Poder TG, Bédard SK, Dagenais P. The health technology assessment unit of the Centre hospitalier universitaire de Sherbrooke (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 185-200.

[33] ³³
Poder TG. Using the health technology assessment toolbox to facilitate procurement: the case of smart pumps in a Canadian hospital. Int J Technol Assess Health Care 2017; 33:54-62.

[34] ³⁴
Poder TG, Bellemare CA, Bédard SK, Fisette J-F, Dagenais P. Impact of health technology assessment reports on hospital decision makers - 10-year insight from a hospital unit in Sherbrooke, Canada: impact of health technology assessment on hospital decisions. Int J Technol Assess Health Care 2018; 34:393-9.

[35] ³⁵
Poder TG, Beffarat M, Benkhalti M, Ladouceur G, Dagenais P. A discrete choice experiment on preferences of patients with low back pain about non-surgical treatments: identification, refinement and selection of attributes and levels. Patient Prefer Adherence 2019; 13:933-40.

[36] ³⁶
Rhainds M, Asselin G, Coulombe M. CHU de Québec - Université Laval: 10-years' experience in hospital-based HTA (Canada). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 201-11.

[37] ³⁷
Ungar WJ. Technology Assessment at SickKids (TASK): a health technology assessment research unit devoted to child health in Canada. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 153-65.

[38] ³⁸
Avdeyev A, Tabarov A, Akhetov A, Shanazarov N, Hailey D, Kaptagayeva A, et al. Hospital-based health technology assessment in Kazakhstan: 3 years' experience of one unit. Int J Technol Assess Health Care 2019; 35:436-40.

[39] ³⁹
Mitchell MD, Williams K, Brennan PJ, Umscheid CA. Integrating local data into hospital-based healthcare technology assessment: two case studies. Int J Technol Assess Health Care 2010; 26:294-300.

[40] ⁴⁰
Barna A, Fahlgren B, Charpentier E, Taron-Brocard C, Guillevin L. The "Comité d'Evaluation et de Diffusion des Innovations Technologiques" (CEDIT) in France. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 71-6.

[41] ⁴¹
Tal O, Booch M, Bar-Yehuda S. Hospital staff perspectives towards health technology assessment: data from a multidisciplinary survey. Health Res Policy Syst 2019; 17:72.

[42] ⁴²
Miniati R, Frosini F, Cecconi G, Dori F, Gentili GB. Development of sustainable models for technology evaluation in hospital. Technol Health Care 2014; 22:729-39.

[43] ⁴³
Munn SR. Hospital-based health technology assessment: insights from New Zealand. Pharmacoeconomics 2014; 32:815-7.

[44] ⁴⁴
Fitzgerald A, Streat S, McAleese C, Munn S. Hospital-based HTA in New Zealand. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 305-12.

[45] ⁴⁵
Jivegård L, Bergh C, Kindblom J, Samuelsson O, Sjögren P, Sjövall H, et al. Activity-based HTA: hospital-based HTA performed by clinicians with support and quality control, the Sahlgrenska University Hospital HTA-Centrum Experience (Sweden). In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 15-28.

[46] ⁴⁶
Grenon X, Pinget C, Wasserfallen J-B. Hospital-based health technology assessment (HB-HTA): a 10-year survey at one unit. Int J Technol Assess Health Care 2016; 32:116-21.

[47] ⁴⁷
Pasternack RP, Iris R. HTA activities in finnish hospitals. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 29-37.

[48] ⁴⁸
Mueller DB, Govender M. HTA in a public hospital in South Africa. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 263-72.

[49] ⁴⁹
van der Wilt GJ, Rovers M, Oortwijn W, Grutters J. Hospital-based HTA at Radboud University Medical Centre in the Netherlands: welcome to reality. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 45-55.

[50] ⁵⁰
Manzi P, Barberini P, Dori F, Cecchini A. Hospital based health technology assessment: an example from Siena. Farmeconomia. Health Economics and Therapeutic Pathways 2015; 16:7-13.

[51] ⁵¹
Pwee KH, Chow WL. Hospital-based HTA in a public-sector tertiary hospital in Singapore. In: Sampietro-Colom L, Martin J, editors. Hospital-based health technology assessment: the next frontier for health technology assessment. Cham: Springer; 2017. p. 273-82.

[52] ⁵²
Hailey D, Werkö S, Rosén M, MacPherson K, Myles S, Gallegos Rivero V, et al. Influence of health technology assessment and its measurement. Int J Technol Assess Health Care 2016; 32:376-84.

[53] ⁵³
Favaretti C, Cicchetti A, Guarrera G, Marchetti M, Ricciardi W. Health technology assessment in Italy. Int J Technol Assess Health Care 2009; 25 Suppl 1:127-33.

[54] ⁵⁴
Novaes HMD, De Soárez PC. A Avaliação das Tecnologias em Saúde: origem, desenvolvimento e desafios atuais. Panorama internacional e Brasil. Cad Saúde Pública 2020; 36:e00006820.

[55] ⁵⁵
Attieh R, Gagnon M-P. Implementation of local/hospital-based health technology assessment initiatives in low- and middle-income countries. Int J Technol Assess Health Care 2012; 28:445-51.

Hospitals	Structures	Process	Results	Level of sedmentation
H1	0.5	0.5	0.5	1.5
H2	1.0	1.0	1.0	3.0
H3	1.0	1.0	1.0	3.0
H4	0.0	0.5	0.5	1.0
H5	0.0	0.5	0.5	1.0
H6	0.0	0.5	0.5	1.0
H7	0.0	0.5	0.5	2.0
H8	0.5	1.0	0.5	2.0
H9	1.0	0.5	1.0	2.5
H10	1.0	0.5	1.0	2.5
H11	1.0	0.5	0.5	2.0
H12	0.5	1.0	1.0	2.5
H13	1.0	1.0	1.0	3.0
H14	1.0	0.5	1.0	2.5
H15	0.5	1.0	1.0	2.5
H16	1.0	0.5	1.0	2.5
H17	1.0	1.0	0.5	2.5
H18	1.0	1.0	1.0	3.0
H19	1.0	1.0	1.0	3.0
H20	1.0	1.0	1.0	3.0
H21	1.0	1.0	1.0	3.0
H22	0.5	0.5	1.0	2.0
H23	0.5	0.5	0.5	1.5
H24	1.0	0.5	0.5	2.0
H25	0.5	0.5	0.5	1.5
H26	1.0	0.5	0.5	2.0
H27	1.0	1.0	1.0	3.0
H28	0.5	1.0	1.0	2.5
H29	0.5	0.5	0.5	1.5
H30	1.0	0.5	0.5	2.0
H31	0.5	0.5	0.5	1.5
H32	0.5	1.0	1.0	2.5
H33	0.5	0.5	1.0	2.0
H34	1.0	0.5	0.5	2.0
H35	1.0	0.5	0.5	2.0
H36	1.0	1.0	1.0	3.0

Hospitals	Structures	Process	Results	Level of sedmentation
H1	0.5	0.5	0.5	1.5
H2	1.0	1.0	1.0	3.0
H3	1.0	1.0	1.0	3.0
H4	0.0	0.5	0.5	1.0
H5	0.0	0.5	0.5	1.0
H6	0.0	0.5	0.5	1.0
H7	0.0	0.5	0.5	2.0
H8	0.5	1.0	0.5	2.0
H9	1.0	0.5	1.0	2.5
H10	1.0	0.5	1.0	2.5
H11	1.0	0.5	0.5	2.0
H12	0.5	1.0	1.0	2.5
H13	1.0	1.0	1.0	3.0
H14	1.0	0.5	1.0	2.5
H15	0.5	1.0	1.0	2.5
H16	1.0	0.5	1.0	2.5
H17	1.0	1.0	0.5	2.5
H18	1.0	1.0	1.0	3.0
H19	1.0	1.0	1.0	3.0
H20	1.0	1.0	1.0	3.0
H21	1.0	1.0	1.0	3.0
H22	0.5	0.5	1.0	2.0
H23	0.5	0.5	0.5	1.5
H24	1.0	0.5	0.5	2.0
H25	0.5	0.5	0.5	1.5
H26	1.0	0.5	0.5	2.0
H27	1.0	1.0	1.0	3.0
H28	0.5	1.0	1.0	2.5
H29	0.5	0.5	0.5	1.5
H30	1.0	0.5	0.5	2.0
H31	0.5	0.5	0.5	1.5
H32	0.5	1.0	1.0	2.5
H33	0.5	0.5	1.0	2.0
H34	1.0	0.5	0.5	2.0
H35	1.0	0.5	0.5	2.0
H36	1.0	1.0	1.0	3.0

Hospitals	Structures	Process	Results	Level of sedmentation
H1	0.5	0.5	0.5	1.5
H2	1.0	1.0	1.0	3.0
H3	1.0	1.0	1.0	3.0
H4	0.0	0.5	0.5	1.0
H5	0.0	0.5	0.5	1.0
H6	0.0	0.5	0.5	1.0
H7	0.0	0.5	0.5	2.0
H8	0.5	1.0	0.5	2.0
H9	1.0	0.5	1.0	2.5
H10	1.0	0.5	1.0	2.5
H11	1.0	0.5	0.5	2.0
H12	0.5	1.0	1.0	2.5
H13	1.0	1.0	1.0	3.0
H14	1.0	0.5	1.0	2.5
H15	0.5	1.0	1.0	2.5
H16	1.0	0.5	1.0	2.5
H17	1.0	1.0	0.5	2.5
H18	1.0	1.0	1.0	3.0
H19	1.0	1.0	1.0	3.0
H20	1.0	1.0	1.0	3.0
H21	1.0	1.0	1.0	3.0
H22	0.5	0.5	1.0	2.0
H23	0.5	0.5	0.5	1.5
H24	1.0	0.5	0.5	2.0
H25	0.5	0.5	0.5	1.5
H26	1.0	0.5	0.5	2.0
H27	1.0	1.0	1.0	3.0
H28	0.5	1.0	1.0	2.5
H29	0.5	0.5	0.5	1.5
H30	1.0	0.5	0.5	2.0
H31	0.5	0.5	0.5	1.5
H32	0.5	1.0	1.0	2.5
H33	0.5	0.5	1.0	2.0
H34	1.0	0.5	0.5	2.0
H35	1.0	0.5	0.5	2.0
H36	1.0	1.0	1.0	3.0