PUB HLTH 7147 - Health Technology Assessment

North Terrace Campus - Semester 2 - 2017

This course takes a broad view of the impact of health technologies on the health of the population & individual. Health technologies can include medical procedures, medical devices, diagnostic & investigative technologies, pharmaceuticals & public health interventions. In this course emphasis is placed on the methods used to assess these health technologies in order to inform government policy, clinical & public health practice. Methods include the systematic review of literature to assess the safety & effectiveness of a technology, meta-analysis,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; addressing particular challenges with the assessment of medical tests; to horizon scanning for new & emerging technologies; & to investment in, & disinvestment from, health technologies. The course has a strong practical focus & is taught by practitioners in the field.

  • General Course Information
    Course Details
    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 the health of the population & individual. Health technologies can include medical procedures, medical devices, diagnostic & investigative technologies, pharmaceuticals & public health interventions. In this course emphasis is placed on the methods used to assess these health technologies in order to inform government policy, clinical & public health practice. Methods include the systematic review of literature to assess the safety & effectiveness of a technology, meta-analysis,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; addressing particular challenges with the assessment of medical tests; to horizon scanning for new & emerging technologies; & to investment in, & disinvestment from, health technologies. The course has a strong practical focus & is taught by practitioners in the field.
    Course Staff

    Course Coordinator: Professor Tracy Merlin

    Telephone: +61 8313 3575
    Email: tracy.merlin@adelaide.edu.au
    Location: Level 7, 178 North Terrace
    Course Timetable

    The full timetable of all activities for this course can be accessed from Course Planner.

  • Learning Outcomes
    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)
    Deep discipline knowledge
    • informed and infused by cutting edge research, scaffolded throughout their program of studies
    • acquired from personal interaction with research active educators, from year 1
    • accredited or validated against national or international standards (for relevant programs)
    1-8
    Critical thinking and problem solving
    • steeped in research methods and rigor
    • based on empirical evidence and the scientific approach to knowledge development
    • demonstrated through appropriate and relevant assessment
    1, 3-8
    Teamwork and communication skills
    • developed from, with, and via the SGDE
    • honed through assessment and practice throughout the program of studies
    • encouraged and valued in all aspects of learning
    1, 4, 5, 6, 7
    Career and leadership readiness
    • technology savvy
    • professional and, where relevant, fully accredited
    • forward thinking and well informed
    • tested and validated by work based experiences
    3, 5, 7, 8
    Intercultural and ethical competency
    • adept at operating in other cultures
    • comfortable with different nationalities and social contexts
    • Able to determine and contribute to desirable social outcomes
    • demonstrated by study abroad or with an understanding of indigenous knowledges
    1, 2, 5, 6
    Self-awareness and emotional intelligence
    • a capacity for self-reflection and a willingness to engage in self-appraisal
    • open to objective and constructive feedback from supervisors and peers
    • able to negotiate difficult social situations, defuse conflict and engage positively in purposeful debate
    1-8
  • Learning Resources
    Required Resources
    All 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 Resources
    In addition to the Reading Brick provided to all course participants, the following resources are available:

    PRELIMINARY READING:

    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.

    FURTHER READING:

    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

    Electronic resources

    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 Learning
    Additional 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: 
    http://www.adelaide.edu.au /its/student_support/


  • Learning & Teaching Activities
    Learning & Teaching Modes
    Teaching 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.
    Workload

    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

    SUNDAY
    6.30-9pm
    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
    exercise [JK]

    Representing uncertainty [JK]
    Evaluating diagnostic tests – why is it different? Introduction to linked
    evidence approach [TM]
    Meta-analysis
    [TM]

    Practical - interpretation of meta-analyses [TM & LB]
    Australian policy framework for HTA

    Regulatory/TGA, horizon 
    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

    Investment/disinvestment [TM]
    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 &
    LB]
    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
    TEA
    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



    Independent
    group work by award and non-award students for Oral Presentation due Friday



    Independent
    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 Requirements
    None
    Small Group Discovery Experience
    N/A
  • Assessment

    The University's policy on Assessment for Coursework Programs is based on the following four principles:

    1. Assessment must encourage and reinforce learning.
    2. Assessment must enable robust and fair judgements about student performance.
    3. Assessment practices must be fair and equitable to students and give them the opportunity to demonstrate what they have learned.
    4. Assessment must maintain academic standards.

    Assessment Summary
    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 Requirements
    N/A
    Assessment Detail
    Quizzes

    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

     INTEGRATED HTA

    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
    Submission
    Submission

    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.

    Extensions

    ·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”.

    Lateness

    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/. 

    AUDIT STUDENTS

    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.
    Course Grading

    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.

  • Student Feedback

    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.

  • Student Support
  • Policies & Guidelines
  • Fraud Awareness

    Students are reminded that in order to maintain the academic integrity of all programs and courses, the university has a zero-tolerance approach to students offering money or significant value goods or services to any staff member who is involved in their teaching or assessment. Students offering lecturers or tutors or professional staff anything more than a small token of appreciation is totally unacceptable, in any circumstances. Staff members are obliged to report all such incidents to their supervisor/manager, who will refer them for action under the university's student’s disciplinary procedures.

The University of Adelaide is committed to regular reviews of the courses and programs it offers to students. The University of Adelaide therefore reserves the right to discontinue or vary programs and courses without notice. Please read the important information contained in the disclaimer.