Health Technology Assessment Process
The Canadian Coordinating
Office for Health Technology Assessment
This section gives an overview of the basic steps in the technology assessment
process based on a health needs perspective as described with this toolkit.
It also incorporates the method of technology assessment as developed
at the Canadian Coordinating Office for Health Technology Assessment (CCOHTA).
Technology Assessment Process
Needs Assessment and Priority Setting
- Perform a health needs assessment of the population group.
- What type of needs will be addressed? (e.g. health vs healthcare, absolute
vs relative, perceived vs expressed or measured)
- How will the needs be measured (e.g. morbidity, mortality, risk factors,
- Prioritize the health needs, and decide which need(s) you will concentrate
- What criteria, process and participants will be used to prioritize
- Identify the technologies that could be used or are in use to treat,
prevent or manage the priority health need(s).
- Prioritize these technologies to decide which ones will be assessed.
- A preliminary literature review and/or a consultation with experts
on this technology will help to identify the issues.
- Determine the criteria to be used to prioritize which technology will
Examples of criteria:
- Is there sufficient quality information available to conduct
- Is this technology likely to have a significant impact on the
quality of patient care, or on the health care system?
- Is there a variation in practice patterns?
- Is there a question regarding over- or under-utilization?
- Does this technology call into question the existing "gold standard"
of therapy or practice?
- Has this technology been replaced by another technology?
- Is there no existing therapy or treatment?
Technology Assessment CCOHTA's Method
- Identify external specialists with expertise in the area who are willing
to participate in the assessment as advisors and reviewers.
- Define the assessment objectives and define the target audience in
consultation with the advisory group and with those who have requested
- What does your audience need to know?
- How will the results of the assessment be used?
- What format will the results take? Eg. full written report, summaries,
- Identify primary HTA issues of interest including safety and adverse
effects, efficacy / effectiveness, cost and cost-effectiveness, budget
impact of health system, appropriate utilization, significant social
implications, and ethical / distributional / equity issues, etc.
- Narrow the scope as much as possible. (Use SMART criteria: specific,
measurable, action-oriented, realistic and time-bound).
- Define specific questions to be asked. Consider clinical, social and
economic impacts and identify relevant populations (e.g. Is the intervention
effective in high risk groups? Are there frequent adverse effects? Is
it cost-effective for healthy adults?).
- Identify and collect relevant evidence, including:
- a literature search with a defined strategy - information from
key contacts, sources, other HTA agencies in this area and the owners
or holders of the technology - studies, reports suggested by the
- Analyze and synthesize the evidence:
- Clinical review - this may include a systematic review
of studies with or without a statistical analysis or meta-analysis.
If a systematic review is undertaken, then define the criteria for
study inclusion and exclusion, quality assessment and data extraction
(reference can be made to specific criteria e.g. Cochrane). Specify
the main health outcomes to be reported.
- Economic evaluation - design an economic evaluation. Plan and
develop an economic model, if required. Consider items 1-25 of CCOHTA's "Guidelines for Economic Evaluation of Pharmaceuticals: Canada", and indicate any deviations.
- Initiate review of the drafts of the assessment to verify content
and methods. This step is important to ensure scientific rigor. (A consistent
review process should be developed that includes internal and external
- Write the final report, edit, format and print for distribution.
CCOHTA Standardized Report Format
- Reviewers - a list of external reviewers
- Table of Contents
- Executive Summary
- clinical background
- main issues surrounding the technology
- product description
- Objectives of the assessment
- Clinical Review
- Meta-analysis results
- Cost-effectiveness analysis/ economic evaluation Method:
- type of analyses
- decision model
- target audience
- treatment comparator(s)
- time horizon
- outcome measurement
- cost measurement and valuation
- sub-group analyses
Results - analysis and results