PUB HLTH 7147 - Health Technology Assessment
North Terrace Campus - Semester 2 - 2015
General Course Information
Course Code PUB HLTH 7147 Course Health Technology Assessment Coordinating Unit Public Health Term Semester 2 Level Postgraduate Coursework Location/s North Terrace Campus Units 3 Contact 1 week intensive Available for Study Abroad and Exchange N Assumed Knowledge PUB HLTH 7075 & PUB HLTH 7074 & PUB HLTH 7081 Course Description This course takes a broad view of the impact of health technologies on population & individual health. Health technologies can include medical procedures, medical devices, diagnostic and investigative technologies, pharmaceuticals & public health interventions. Emphasis is placed on the methods used to assess these health technologies in order to inform government policy, clinical and public health practice. Methods include the systematic review of literature to assess the safety & effectiveness of a technology, as well as economic evaluation to determine whether a technology is cost-effective. Attention is also given to the diffusion of technological innovations within their social, cultural & ethical context; to horizon scanning for new & emerging technologies; & to investment in, & disinvestment from, health technologies. The course has a strong practical focus and is taught by practitioners in the field..
Course Coordinator: Professor Tracy MerlinTelephone: +61 8313 3575
Location: Level 7, 178 North Terrace
The full timetable of all activities for this course can be accessed from Course Planner.
Course Learning Outcomes
1 Describe and critically appraise the conduct of health technology assessment (HTA), in particular the use of systematic literature
review and economic modelling, to inform the development of health policy
2 Understand the policy framework for HTA in Australia and internationally 3 Undertake basic systematic searching for evidence on a health technology 4 Critically appraise the quality of evidence supporting a health technology 5 Recognise the range of approaches used in HTA to conduct an economic evaluation 6 Recognise the role of ethical analysis and the use of deliberative methods for community and patient engagement in HTA 7 Understand the complex issues associated with evaluating diagnostic tests in an HTA 8 Interpret a meta-analysis and apply meta-analytic statistical techniques
University Graduate Attributes
This course will provide students with an opportunity to develop the Graduate Attribute(s) specified below:
University Graduate Attribute Course Learning Outcome(s) Knowledge and understanding of the content and techniques of a chosen discipline at advanced levels that are internationally recognised. 1-8 The ability to locate, analyse, evaluate and synthesise information from a wide variety of sources in a planned and timely manner. 1, 3, 4, 5, 6, 7, 8 An ability to apply effective, creative and innovative solutions, both independently and cooperatively, to current and future problems. 1, 5, 6, 7, 8 Skills of a high order in interpersonal understanding, teamwork and communication. 1, 4, 5, 6, 7 A proficiency in the appropriate use of contemporary technologies. 3, 5, 7, 8 A commitment to continuous learning and the capacity to maintain intellectual curiosity throughout life. 1-8 A commitment to the highest standards of professional endeavour and the ability to take a leadership role in the community. 1-8 An awareness of ethical, social and cultural issues within a global context and their importance in the exercise of professional skills and responsibilities. 1, 2, 5, 6
Required ResourcesAll enrolled students will be provided with a hard copy Reading Brick at the Sunday evening dinner, at registration or prior to commencement of the course.
An electronic copy of the Health Technology Assessment Short Course Handbook and all Readings from the Reading Brick will be made available on the University Intranet (MyUni http://www.adelaide.edu.au/myuni/) to which award, non-award and audit participants will have access.
Readings have been recommended because the authors have something interesting to say; recommendation does not necessarily imply endorsement by the teaching staff.
Recommended ResourcesIn addition to the Reading Brick provided to all course participants, the following resources are available:
Tailored preliminary reading may be provided to participants depending on their prior preparation for this course. Information provided by participants on the course registration form will help guide this determination.
Book available in the Barr Smith Library:
Gray, J. A. Muir. Evidence-based health care: how to make health policy and management decisions. Edinburgh: Churchill Livingstone, 2nd edition, 2001.
Webster, Andrew. Health, technology and society: a sociological critique. Basingstoke [England]; New York: Palgrave Macmillan, 2007
Lehoux, Pascale. The problem of health technology: policy implications for modern health care systems. New York: Routledge, 2006
Duckett SJ, Willcox S. The Australian Health Care System. South Melbourne, Vic: Oxford University Press, 4th edition, 2011.
Drummond M, Sculpher MJ, Torrance GW et al. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press, 3rd edition, 2005
Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration, 2009. Available from www.cochrane-handbook.org
Health Technology Assessment International (HTAi) Vortal http://www.htai.org/index.php?id=579
International Network of Agencies for Health Technology Assessment (INAHTA). HTA Resources http://www.inahta.org/HTA/
International Journal of Technology Assessment in Health Care. [electronic journal available through Barr Smith Library Catalogue]
Jefferson T, Demicheli V, Mugford M. Elementary economic evaluation in health care. 2nd edition. London: BMJ Publishing, 2000. [electronic book available through Barr Smith Library catalogue -http://site.ebrary.com.proxy.library.adelaide.edu.au/lib/adelaide /docDetail.action?docID=10033004 ]
Health Technology Assessment database http://www.crd.york.ac.uk/CRDWeb/ [also available in the Cochrane Library]
Health Technology Assessment journal series http://www.hta.ac.uk/research/HTAjournal.shtml NIHR Health Technology Assessment programme
EuroScan international network http://www.euroscan.bham.ac.uk/
Online LearningAdditional course-related material is available through MyUni.
This includes the course timetable, tutorials, and more information on learning support services available for students. Pdfs of lecture notes will be made available through MyUni to award, non-award and audit participants after the lectures have been given. Hard copies of lecture notes will be available at each lecture. Electronic copies of the readings included in the Reading Brick will also be available.
COMPUTER LABORATORIES AND OTHER COMPUTING SERVICES
University information on computer laboratories and other computing services is available at:
Learning & Teaching Activities
Learning & Teaching ModesTeaching in Health Technology Assessment begins from the assumption that the participants have extensive professional and personal ideas and experience and that our role as teachers is to harness your knowledge and skills and build on them. We assume that you are willing and able to prepare fully for classes, to participate in discussions and to carry your share of the workload.
The course is built around examples of health technology assessment. People learn best when they are able to put developing knowledge and skills into practice. We believe that this is the most effective way of learning and the course has a range of lectures, workshops discussions and a major group project to facilitate this process. In addition, we have key concepts and theoretical issues threaded throughout the course.
This course is taught as an intensive, over 5 straight days with a preliminary evening get-together on the Sunday night. This form of teaching has been chosen instead of a weekly teaching session as it provides immersion in the subject area and facilitates the participation of audit students from policy areas and industry. The course introduces a range of new concepts that are all related to health technology assessment, and teaching in a concentrated format will make it easier to recognise the links and reinforce the concepts as the course progresses. Given the intense form of teaching it would help students if they read the pre-readings prior to the course.
The teaching comprises a broad mix of lectures, practicals, and small group discussions. This course gives a high priority to interaction between the participant and the academic staff, and amongst participants. It is understood that students may have different learning styles and may come from different cultural backgrounds, but all students are encouraged to participate actively.
The information below is provided as a guide to assist students in engaging appropriately with the course requirements.The information below is provided as a guide to assist students in engaging appropriately with the course requirements.
As a general rule in any university course, you will need to allow a minimum of three independent study hours for every hour undertaken in formal class work contact. This time is needed for such activities as reading for the topic, preparation for activities in class and work on assignments. As this course is taught in an intensive mode, there will be a need for revision in the evening.
Award and non-award students will need to complete a group presentation and answer two quizzes during the course. Time is provided for groups to work on their presentation on Tuesday, Wednesday and Thursday afternoons.
A major assessment task will need to be completed by award and non-award students and submitted electronically by 5pm on a Date TBA.
Learning Activities Summary
Welcome Dinner - Goodlife Pizza
(in the courtyard),
170 Hutt St, Adelaide
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 8.45am Welcome, introductions, overview of week, registrations Day registration Day registration 9.00am What is health technology assessment? [TM] Appraising the level and quality of intervention studies [TM] Modelling
Representing uncertainty [JK]
Evaluating diagnostic tests – why is it different? Introduction to linked
evidence approach [TM]
Practical - interpretation of meta-analyses [TM & LB]
Australian policy framework for HTA
scanning, state-based HTA [TV]
Quiz - interpreting diagnostic test accuracy Heterogeneity and publication bias [TM] 10.20-10.40am MORNING TEA MORNING TEA MORNING TEA MORNING TEA MORNING TEA Australian policy framework for HTA
Synthesis in an HTA: communicating to the policy maker [TM] Critical appraisal of the health economics component of an HTA [HH/JK] Appraising the level and quality of diagnostic studies [TM]
Practical - understanding heterogeneity [TM & LB]
Role play - relevance of HTA in decision-making Critical appraisal of SRs and HTAs [TM] Feedback on critical appraisal exercise [JK/HH] Practical – assigning level of evidence and critical appraisal of diagnostic accuracy studies (QUADAS-2) [TM & LB] Computer exercise on meta-analysis in Stata [TM and LB]
Rm S118, Medical School South Computing Suite
HTA methodology - why systematic reviews? [TM] Practical - critical appraisal of secondary research (PRISMA) [TM &
Research translation [HH] 12.45-1.15 LUNCH LUNCH LUNCH LUNCH LUNCH How to conduct an HTA? Place of economics in HTA decisions [HH] Ethical/ social aspects of HTA [ABM] Incorporating
community values into HTA [JS]
Quiz on pre-readings.
Course Evaluation Developing policy relevant questions (PICO) [TM] QALYs [HH] Facilitated discussion about community engagement in Australian HTA [JS] Group oral presentation and evaluation Searching for evidence [MB] Frameworks for economic evaluation (focus on modelling) [JK] Selection of evidence [TM] Practical - applying PICO criteria to the evidence [TM & SN] 3.00-4.00pm AFTERNOON
AFTERNOON TEA AFTERNOON TEA AFTERNOON TEA AFTERNOON TEA 4.00-5.00pm Online exercise on searching for SRs and HTAs [TM & SN]
Rm S118, Medical School South Computing Suite
Independent group work by award and non-award students for Oral Presentation due Friday
group work by award and non-award students for Oral Presentation due Friday
group work by award and non-award students for Oral Presentation due Friday
4:30pm Searching exercise answers 5.00-5.30pm Award and non award students meet to discuss assessment
Specific Course RequirementsNone
Small Group Discovery ExperienceN/A
The University's policy on Assessment for Coursework Programs is based on the following four principles:
- Assessment must encourage and reinforce learning.
- Assessment must enable robust and fair judgements about student performance.
- Assessment practices must be fair and equitable to students and give them the opportunity to demonstrate what they have learned.
- Assessment must maintain academic standards.
Assessment Task Task Type Weighting Learning Outcome Quiz on interpreting diagnostic test accuracy Summative 10% 12 Quiz on pre-readings supporting Community Engagement topic Summative 10% 11 Oral presentation of critical appraisal (in small groups) Summative 20% 7 Integrated HTA Summative 60% 1, 4
Assessment Related RequirementsN/A
Each student is to complete two short quizzes on Thursday. One quiz will assess individual students’ understanding and interpretation of diagnostic test accuracy measures. The answers to the quiz will be provided following quiz completion so that you receive immediate feedback on your learning. The other quiz will be open-book and test students’ understanding of the Community Engagement pre-readings distributed in the Reading Brick prior to course commencement.
ORAL PRESENTATION OF CRITICAL APPRAISAL
Working in pre-allocated groups of 3 or 4, you are to prepare a 12 minute power point presentation with up to 8 slides, of a critical appraisal of a published paper (to be allotted to each group on the Monday). The presentation will be made on Friday afternoon. A hard copy of the presentation will need to be submitted at that time.
The presentation should contain the following elements:
· An introductory slide listing the paper to be discussed and the names of members of the presentation team.
· A summary of the paper and the question it addresses
· The level of evidence of the study
· Which tools were used to assist with the critical appraisal
· The critical appraisal itself
· Conclusions regarding the validity of the study’s results
Each student is to submit an evaluation of a health technology from the selected topics listed below. You need to assume that the technology is new and has not yet been publicly funded in Australia. The evaluation should contain the following elements.
· Assessment of the clinical need for this technology in Australia in terms of the mortality and/or morbidity associated with the underlying disease/condition that the technology aims to address. [10%]
· PICO criteria for conducting a systematic review to assess the effectiveness and harm/safety of the health technology. [10%]
· Conduct a PubMed search for randomised controlled trials and systematic reviews based on the PICO criteria developed above. The PubMed search strategy should be submitted, including the number of citations yielded at each line of the search. The results of the search (a snapshot of the first page of citations is sufficient) should also be submitted. The search strategy should have enough detail that it can be replicated. [10%]
· Identify one recent systematic review on the topic from your search and critically appraise it using the PRISMA checklist. You should aim to come to a conclusion regarding the quality of the systematic review. [15%]
· Search for an HTA report on your topic that includes an economic evaluation. Searches should be conducted using Google, the HTA database (accessible through http://www.crd.york.ac.uk or the Cochrane Library), and/or the UK Health Technology Assessment journal. Using a structured approach critically appraise the health economic evaluation presented in the HTA report. [15%]
· Identify and evaluate the likely applicability, extrapolation and transformation issues associated with applying the evidence identified in the systematic review and/or HTA to the current Australian situation (1/2 page). [10%]
· Apply the ethics framework from Hofman to your topic. [15%]
· Prepare a 3 page policy brief including a conclusion for your policy maker as to whether the health technology should be publicly
funded. This should be included as the first section of your submission. [15%]
Topics for integrated HTA
1. Computer-assisted (navigated) total knee arthroplasty
2. Mandatory influenza vaccination of health care workers.
3. Pressurised metered-dose hand-held inhalers to deliver medication for the routine management of chronic asthma
4. Positron emission tomography (PET) for the diagnosis of breast cancer recurrence
In this course, assessment tasks 1, 2 and 3 will be done in class. Assessment task 4 will need to be submitted electronically by clicking on the relevant ‘Assessment’ link in the Course Information tab on the MyUni Control Panel. Your assignment must be formatted as a Microsoft Word file; no other file type will be accepted.
If for some reason you are unable to upload the assignment to MyUni, please email it to the Course Coordinator. In case we mislay it, you should retain a copy of the assignment submitted.
In the unlikely event that resubmission of any paper is accepted, the maximum marks available for that resubmitted paper will be 50% of the total for that aspect of the assessment.
·Must be requested, at the latest, by the last working day before the due date of submission.
·Will generally be granted only on medical or genuine compassionate grounds.
All requests must go to the Course Coordinator or a person authorised by him or her.
Documentary supporting evidence such as a medical certificate or a police report (in the case of lost computers, car & household theft etc.) may be required when requesting an extension.
Students submitting examinable written work who request (and receive) an extension that takes them beyond the examination period are advised that there is no guarantee that their grades will be finalised “in time for graduation” or “in time to meet usual University deadlines”.
Marks will be deducted when assignments for which no extension has been granted are handed in late.
The procedure is as follows:
All assignments, including those handed in late, will be assessed on their merits.
In the case of late assignments, marks will then be deducted from the mark awarded, at the rate of 5 percentage points of the total possible per day.
e.g. If an assignment which is 2 days late is awarded 65% on its merits, the mark will then be reduced by 10 (5 marks per day for 2 days) to 55%. If that same assignment is 4 days late its mark will be reduced by 20 (5 marks per day for 4 days) to 45% etc.
The Discipline reserves the right to refuse to accept an assignment that is more than 7 days late.
Resubmission of Work
Resubmission of any assignment is subject to the agreement of the Course Coordinator and will only be allowed for the most compelling of reasons.
Complaints about Assessment
Students who are not satisfied with a particular assessment can raise their concerns with the Course Coordinator. This must be done within 10 business days of the notification of the mark or return of the assignment. Raising a concern in this way does not constitute a formal complaint, and the majority of issues are resolved at this stage. In order to qualify for a re-mark, you will need to provide a substantive reason as to why your original mark is incorrect. This should relate to the academic quality of the work.
Re-marking of any piece of work will be performed on a clean copy of the original by a person who has not been informed of either the original grade or of the first marker’s comments. The result of the re-mark will be recorded as the final mark even if it is lower than the original.
If you are still dissatisfied, you may request a formal review in accordance with the Student Grievance Resolution Process described at http://www.adelaide.edu.au/student/grievance/.
Health Technology Assessment is open to audit students. Audit enrolment is a type of enrolment where a student can attend a single course but is not enrolled in any program. The student will attend the course for information only and will not be assessed for the course. Audit enrolment cannot be used to gain credit towards future enrolment in an award program, unlike a non-award enrolment.
All course attendees will receive a Certificate of Attendance.
Grades for your performance in this course will be awarded in accordance with the following scheme:
M10 (Coursework Mark Scheme) Grade Mark Description FNS Fail No Submission F 1-49 Fail P 50-64 Pass C 65-74 Credit D 75-84 Distinction HD 85-100 High Distinction CN Continuing NFE No Formal Examination RP Result Pending
Further details of the grades/results can be obtained from Examinations.
Grade Descriptors are available which provide a general guide to the standard of work that is expected at each grade level. More information at Assessment for Coursework Programs.
Final results for this course will be made available through Access Adelaide.
The University places a high priority on approaches to learning and teaching that enhance the student experience. Feedback is sought from students in a variety of ways including on-going engagement with staff, the use of online discussion boards and the use of Student Experience of Learning and Teaching (SELT) surveys as well as GOS surveys and Program reviews.
SELTs are an important source of information to inform individual teaching practice, decisions about teaching duties, and course and program curriculum design. They enable the University to assess how effectively its learning environments and teaching practices facilitate student engagement and learning outcomes. Under the current SELT Policy (http://www.adelaide.edu.au/policies/101/) course SELTs are mandated and must be conducted at the conclusion of each term/semester/trimester for every course offering. Feedback on issues raised through course SELT surveys is made available to enrolled students through various resources (e.g. MyUni). In addition aggregated course SELT data is available.
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