Health Technology Assessment International 2015: A delegate’s report

By Eoin Moloney

The Health Technology Assessment International (HTAi) conference was held last month between the 15th and 17th of June in the Norwegian city of Oslo. I was fortunate enough to have the opportunity to attend the conference as a delegate and, I have to say, I was hugely impressed by the scale, organisation and content of the event. For anyone unfamiliar, HTAi is the global society for individuals involved in the production and use of HTA. The annual delegates meeting, held in alternating host cities, serves as a forum to share research and hold discussions which have the potential to advance methods and policy. In addition, it is a fantastic opportunity to carry out a little bit of ‘global networking’ which, I have no doubt, forms the basis for many future international collaborations.

For me, the conference began a little earlier than the majority as I attended an all-day pre-conference workshop on the ‘Critical appraisal of network meta-analysis for health technology assessment’. Delivered by Dr. Kristian Thorlund, experienced in conducting 100 + network meta-analyses, and targeted at an intermediate to advanced audience, I had anticipated that the content might be challenging to follow. To date, I have worked on the economics for health technology assessments which have required both meta-analyses and network meta-analyses (NMA); however, I had never really got ‘up close and personal’ with the methods involved or the theory underlying the various statistical models that can be used. I was pleasantly surprised to find that Dr. Thorlund began with basics and delivered an excellent, interactive workshop that took us through the key concepts and assumptions of NMA, whilst facilitating discussion regarding some of the more advanced techniques.

The official three-day conference, beginning on the Monday morning, was held in the extravagant Radisson Blu plaza hotel, which dominates the skyline of Oslo city centre. The conference was opened with a display of traditional Norwegian folk dancing, held in the impressively-named, and equally-impressive looking, Sonja Henie Ballroom. Following this, we heard the keynote addresses delivered by Bent Höie, Norwegian minister for health; Carole Longson, director of the centre for health technology evaluation at NICE; and Richard Horton, editor-in-chief at The Lancet. I believe the entire room was struck by the impassioned speech delivered by Richard Horton, which emphasised the need to focus not only on the assessment of health care devices but the system as a whole, whilst highlighting some of the less encouraging statistics regarding global health today (namely the global failure with regard to the Ebola outbreak). The opening of the conference ended with a presentation of cheese cutters (invented by a Norwegian!) to all speakers, where the minister for health was reminded to use it to cut cheese and not the health budget.

Radisson blu

I must say that I found the conference to be extremely well organised, with plenary addresses and panel sessions on a range of issues taking place each morning before two separate oral presentation sessions in the afternoon. Each one of these was split with tea/coffee breaks, and this time was utilised to display the many e-posters that had been accepted at poster stations throughout the conference venue. This had the added benefit of maximising footfall, and poster presenters could be safe in the knowledge that simultaneous sessions were not being held while their work was being displayed. My one slight criticism was that the number of screens was not sufficient to display all poster presentations simultaneously, leaving presenters to ‘jockey for position’ to put their work on display for a period of time. However, this was somewhat redeemed by the fact that all presentations were readily available, and downloadable, in PDF format on the conference app; which brings me to the next point.

To me, this felt like the dawn of a new era of e-conference. Technology and social media were utilised to great effect in order to make the conference as interactive as possible. A HTAi 2015 app was created which allowed delegates to plan their conference schedule and receive notifications as reminders of events of interest, navigate the conference venue using the handy interactive map, preview all oral and poster presentations to see whether it would be a topic of interest and even interact with, and message, other attendees. It also allowed one to participate actively in the plenary sessions as live debate votes and poll votes could be registered through the app. The conference organisers also actively encouraged delegates to make use of social media and tweet whenever possible. This was clearly done so as to spread word to a global audience, but also to reinforce the interactive culture of the conference among delegates – tweets were used to pose questions to panel members at some of the larger discussions. Additionally, the previously-mentioned e-posters allowed significantly more content to be displayed than your traditional poster, and in an arguably more viewer-friendly manner.

eoin poster

One of the more interesting aspects of the conference were the discussions held at the daily plenary sessions. Two of the key messages which appeared to recur across the three days, and which stood out to me, were: (1) HTA should be linked to an imminent decision. This point was first made by Máirín Ryan, Director of Health Technology Assessment and Deputy Chief Exec. Officer at the Health Information and Quality Authority (HIQA) in Ireland, on day 1 of the conference, but was repeated by many speakers afterwards. It is a simple but crucial point – our research needs to be timely and relevant at the time that the decision-maker needs us, (2) HTA needs to be co-produced with the patient. Sophie Staniszewska, Visiting Professor at London Southbank University, asked “What is the point in the research if the patients don’t want it?” The following equation was used to illustrate the point: K (knowledge) = {Cl (clinical) + Ec (economic) + PBE (patient-based evidence)}.

The conference concluded with a lively, and at times heated, debate entitled ‘International collaboration in knowledge synthesis and transfer: is it worth the effort?’ Kalipso Chalikidou, founding director of NICE’s international programme, argued in favour on the basis that economies of scale matter when generating and synthesising evidence, and that collaboration is necessary when negotiating (globally) with lobbies  and vested interest parties. Leslie Levin, chief scientific officer and professor of medicine at MaRS EXCITE and the University of Toronto, argued against on the basis that with global evidence synthesis, there is too much heterogeneity to allow it to be carried across countries and, for this reason, evidence needs to be considered in the context of local realities. It was a fascinating debate to watch as it took place in front of an audience who, on the whole (one would assume), were almost inherently in favour of international collaboration, and at a conference being held under the banner of ‘global efforts in knowledge transfer’. Although the live debate poll revealed that Leslie was comprehensively defeated, I found myself agreeing with many of the points he raised. However, in truth, the best approach probably lies somewhere in between, i.e. utilising a combination of both perspectives whereby we take advantage of global evidence and opportunities, but individualise and localise evidence where possible.

It was great that HTAi 2015 could be my first experience of an international conference, and I would encourage anyone with an interest or involvement in health technology assessment to consider attending in the future.