HTA86 Health Technology Assessment in Hospitals: A Systematic Review on Methods and Practices

BACKGROUND: Hospitals are at the forefront of health technology innovation. Being hospitals characterized by constrained budgets, competencies, and time, they need a reference framework to select value-for-money technologies. Contrary to what happens for Health Technology Assessment (HTA) at national/regional level, there are not generally accepted guidelines for running Hospital-Based Health Technology Assessment (HBHTA). OBJECTIVES: This study aims at investigating how hospitals run HBHTA gathering evidence from what has been reported in the published literature so far about frameworks, criteria, methods, sources of evidence employed by hospitals to assess novel health technologies. The final purpose is developing a comprehensive and standardized synthesis of extant literature to advance both theory and practice of HBHTA. METHODS: A systematic Cochrane-compliant literature review was carried out on three electronic databases (Scopus, PubMed, Web of Science) from 2007 to 2022. Primary and secondary articles focusing on the assessment by hospitals of novel health technologies were included. We employed a data extraction form that categorized and included the following information: country and aim of the study, hospital features (e.g., type and size), intervention investigated, health technology or procedure analysed, innovativeness of the technology, disease area, stakeholders involved, the employment (or not) of an existing HTA model/practice, criteria used to run HBHTA, methodologies and sources of evidence for each criteria, the phases followed in the evaluation and the presence (or not) of monitoring indicators. RESULTS: Of the 703 papers extracted, 34 were included. In the selected studies, no standardised frameworks were employed, confirming that hospitals run HBHTA exercises without clear guidelines. We developed a novel framework for HBHTA by grouping the criteria used in the selected studies in multi-dimensional categories around the concepts of “value” and adoption “sustainability”. CONCLUSIONS: There is no consensus on how to run HBHTA exercises. This research provides a novel framework for HBHTA.