Dr Máirín Ryan
Deputy CEO and Director of Health Technology Assessment at the Health Information and Quality Authority (HIQA)
Healthcare is evolving rapidly. To maximise public health, the health service and government need independent information on the most effective technologies to invest in. There is a focus on Hepatitis C.
In HIQA, we independently assess whether new drugs, vaccines, equipment or tests are safe and effective[1] – this work is called health technology assessment (or HTA). For example, during an HTA we also look at organisational, ethical, social or medico-legal issues around introducing a new technology. As well as this, assessing whether it would be cost-effective if introduced into the Irish healthcare system.
Thus, this process ensures that decision-makers, such as the government and health services, can make informed decisions based on unbiased and transparent evidence on how best the finite health budget is spent.
Our work to help the public
Our work has included advice on the introduction of new vaccination, cancer screening and smoking cessation programmes. Earlier this year we assessed the introduction of a PrEP programme to prevent HIV in Ireland and provided advice to the Minister for Health[2]. Our evaluation of PrEP found that providing the medication to those most at risk of acquiring blood-borne HIV would be safe, effective and cost-saving to the taxpayer.
Recently, we commenced a new assessment on offering hepatitis C testing to all people in Ireland born between 1965 and 1985.
Hepatitis C often found in Irish people born between 1965 and 1985
Hepatitis C is a blood-borne virus, which predominantly affects the liver. In Ireland, the birth-cohort of people born between 1965 and 1985 makes up the majority of all hepatitis C cases.[3]
Our next HTA will again be to establish the clinical benefit. Similarly looking at cost-effectiveness and budget impact of offering hepatitis C testing to this birth-cohort.
Effective treatment will be offered to those diagnosed with hepatitis C – recommended by National Clinical Guideline on Hepatitis C Screening.
Assessing a potential hepatitis C testing programme
With this in mind we aim to address a number of questions, in evaluating a health technology, including:
- Can the technology work?
- Does it offer benefits in practice?
- Does it represent a good use of resources?
- Is it affordable?
- Are there other important considerations, such as organisational, ethical or societal implications?
Following this, to help us, we established an expert advisory group with representation from clinicians with specialist expertise in hepatitis C screening and treatment, the National Screening Service, the National Centre for Pharmacoeconomics and patient advocates, the Irish Haemophilia Society and SAGE Advocacy.
A chance to speak about your views on hepatitis C
Following a systematic review of the evidence on clinical effectiveness and safety and development of an economic model to assess cost-effectiveness and budget impact, we will hold a public consultation. This is an opportunity for people affected, clinicians and the wider public to tell us their views about the assessment of birth-cohort testing for hepatitis C before we finalise the report.
Furthermore, once approved by the Board of HIQA, our independent, evidence-based advice will be submitted to the Minister for Health to allow him to make an informed decision on whether to implement a hepatitis C birth-cohort testing programme. In brief, the overall aim is to ensure best use of resources to maximise health benefits for the population.
1 https://www.hiqa.ie/reports-and-publications/health-technology-assessments/guide-health-technology-assessment-hiqa|
2 https://www.hiqa.ie/reports-and-publications/health-technology-assessment/hta-prep-programme
3 Garvey P, O’Grady B, Franzoni G, Bolger M, Irwin Crosby K, Connell J, et al. Hepatitis C virus seroprevalence and prevalence of chronic infection in the adult population in Ireland. A study of residual sera, April 2014 to February 2016.