Hospital based HTA in Switzerland : development of an innovative prioritization process for competing health technology investments requests

Healthcare systems have developed at different speeds, and levels of complexity, reflecting different political and social conditions but are nowadays facing with a big common issue: resource scarcity. Growing health technology innovations contributed to rising healthcare costs leading health systems to the limits of their financial possibilities. In this context, systematic approaches like HTA proved to be good solutions to allocate resources at best especially at the macro level. At the hospital (micro) level, instead, there is still a lack of a systematic and shared approach to the health technology assessment and prioritization of investments. This work has been developed in collaboration with a healthcare Company in Switzerland which, like others hospitals world wide, was asking for a new comprehensive systematic tool, applicable at the hospital level, able to assign priorities among requests of investments for new health technologies. A deep systematic literature analysis has been carried out in order to understand the state of the art of models currently proposed. Following, a comprehensive study of the Swiss healthcare context has been performed. Rigorously applying action research methods, the preparation phase was completed by a series of interviews with professionals acting within the health company in order to achieve a deep understanding of the current investment management process functioning. After this, we run the second designing phase, adopting business process modelling methodologies and taking into account findings from literature and issue addressed by responders of our survey. We simulated and tested the new designed model on 17 requests of investment for various health technologies previously received and on 3 current requests coming from different health departments. This process provided positive indications for a potential functioning at the hospital level and might facilitate hospital decision-makers deliberation on the prioritization among competing investments under fixed budget. The model seems also to have some advantages compared with the current hospital based HTA models.