Table 2.

Reported effects and impact—HTA units

References and country	Methods	Type of impact
Bodeau-Livinec et al. 2006 France [21]	Semi-directive interviews and survey	On decision-making (or management)
		• 10 of 13 recommendations had an impact on theintroduction of the technology in health organizations.
		• One recommendation appears not to have had an impact. The impact of two technologies was impossible to assess.
		Financial
		• The main criterion upon which to base a new technology introduction decision on HTA is the cost. Some medical specialties were more concerned by CEDIT’s work than others—cardiology and medical imaging, for instance.
		On clinicians’ or other stakeholders’ perceptions
		• Interviewees viewed the CEDIT as very scientifically reputable. HTA recommendations were used as decision-making tools by administrative staff and as negotiating instruments by physicians in dealing with management.
Lee et al. 2003 Canada [22]	Case study (review of document and structured consultation)	Financial
		• Example of one evaluation to address the issue of arthroplasty operations. Savings were estimated at CAN $1 million annually through orthopedic supply standardization and a new contract with vendors.
		On clinicians’ or other stakeholders’ perceptions
		• High level of interest for a locally focused HTA and implementation unit.
McGregor 2012 Canada [19]	Impact study using mixed methods (interviews and financial analysis)	On decision-making (or management)
		• Impact of 55 HTA reports produced (2004–2011): Of 63 recommendations, 45 (71%) have been accepted and incorporated into hospital policy.
Update of McGregor and Brophy 2005 Canada [20]		• Most frequent reasons for recommendations not being accepted: failure to identify administrative responsibility to carry this out, lack of funds, complex administrative changes, technology already implanted, technology which would potentially render the hospital vulnerable to legal action.
		Financial
		• 19 accepted reports have resulted in conservation of hospital resources.
		• The extent of these savings could be estimated in the case of 15 reports: estimated overall savings of CAN$ 9,840,270.
		• Over the 8 years of full functioning of the HTA unit: average annual quantifiable savings have been CAN$ 1,140,958.
Mitchell 2010 USA [15]	Case studies	On decision-making (or management)
		• Two examples of local data integrated into hospital-based HTA. In both case studies, important differences were found among the hospitals. These differences affected the prioritization of different attributes of a technology and could result in different conclusions being drawn about how the technology should be used at each hospital, even within the same health-care network.
Veluchamy and Alder 1989 USA [16]	Case study	On decision-making (or management)
		• The HTA units helped decision makers integrate patient needs and medical staff interests and capabilities with the hospital’s resources (i.e., staff, facilities, financing).
		• It speeded up the delivery of newly developed treatment technologies (9–12 months as compared to 24–36 months before HTA implementation). It identified the most promising technologies and coordinated their acquisition and implementation.
		• It provided better access to these technologies for patients and reduced length of stay (42% reduction for laser angioplasty).
		On clinicians’ or other stakeholders’ perceptions
		• Physicians derived personal and professional satisfaction from participation in the HTA units. These units have improved relations between medical staff and hospital management (better communication and physicians’ needs better fulfilled).
Schumacher and Zechmeister 2013 Austria [23]	Impact study using mixed methods (interviews, questionnaire, download analysis, etc.)	On decision-making (or management)
		• Hospital associations used HTA for investment/reimbursement decisions, treatment guidelines, and budget allocation, as well as for the preparation of negotiations.
		• Various pressure groups, such as the pharmaceutical industry and the professionals’ association, could explain the inability to implement some HTA recommendations.
		• With the exception of the rapid technology assessment program for single hospital procedures, selective use of HTA reports was identified, rather than standardized inclusion of HTA into the processes.
		Financial
		• Several technologies, identified as showing patterns of over-usage, were used more restrictively after the HTA report was published, leading to a decrease in expenditure. Expenditure decrease accounted for at least several million euros for single hospital associations.
		On clinicians’ or other stakeholders’ perceptions
		• Clearest evidence was available for the “awareness” impact category, while references regarding “acceptance” were rarely mentioned. The LBI-HTA was usually seen as a vehicle for simple cost containment and rationing, rather than a tool supporting redistribution of resources into evidence-based technologies.
Zechmeister and Schumacher 2012 Austria [24]	Impact study using mixed methods (administrative data analysis and interviews)	On decision-making (or management)
		• 5 full HTA reports and 56 rapid technology assessments were used for reimbursement decisions, while 4 full HTA reports and 2 rapid assessments were used for disinvestment decisions and resulted in reduced volumes and expenditure. There were 2 full HTA reports showing no impact on decision-making. Impact was most evident for hospital technologies.
		• In 48% of reports produced for reimbursement/investment decisions, the recommendation and decision were totally consistent. In 40% of reports, technologies that were not recommended were included on certain conditions, while the decision was more restrictive than the recommendation for 12% of reports.
		Financial
		• Several millions of euros were saved due to HTA recommendations. For disinvestment decisions, cost savings were about 3 million euros per report, with huge variation (0–12 million). Savings were frequently for more than one hospital (regional hospital associations).