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Introducing new technologies in Victoria: VPACT

Country: 
Australia
Partner Institute: 
Centre for Health, Economics Research and Evaluation (CHERE), University of Technology, Sydney
Survey no: 
(7)2006
Author(s): 
Health Policy Issues: 
New Technology, Political Context, Benefit Basket
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no

Abstract

The Department of Human Services in Victoria (Australia) has established the Victorian Policy Advisory Committee on Clinical Practice and Technology (VPACT) to consider and make recommendations regarding the application of new and existing technologies and clinical practices in health services such as public hospitals. This includes identifying, prioritising, introducing, evaluating and ongoing monitoring of new and existing technologies and clinical practices.

Purpose of health policy or idea

VPACT was established to enable a systematic approach to the introduction and use of new and existing technologies and clinical practices in public health services in Victoria. In doing so it will develop:

  • Mechanisms for early identification of new technologies and clinical practices.
  • Assessment of clinical and cost effectiveness of new and existing technologies and clinical practices
  • Priorities for the introduction and use of new technologies and clinical practices.
  • Policies and procedures for best practice for introduction and use of new and existing technologies and clinical practices.
  • Policies about new or modified health service delivery as required by introduction of new or changed technology.
  • Requirements for evaluating and monitoring the introduction and use of new technologies and clinical practices.
  • Dissemination of information on the introduction and use of new and existing technologies and clinical practices.

Main points

Main objectives

The principles underpinning the deliberations and recommendations of VPACT are:

  • Health and safety for patients, clinicians and the community is paramount
  • Broad-based stakeholder consultation
  • Ethics procedures are in place to protect patients, clinicians and the community
  • Appropriate institutional committees approve technology for use
  • Evidence-based practice informs conditions and logistics for introduction
  • Patient information and informed consent procedures are established
  • Appropriate, credentialed and trained staff in place to assist with new technology introduction
  • Risk management procedures are in place to reduce adverse events
  • There is no conflict of interest between a provider and technology supplier.

Type of incentives

VPACT will: consider submissions from Public Health Services seeking to introduce a new technology/clinical practice through the New technology/Clinical Practice Program.

In 2006-07, funding is available for existing and new technology/clinical practice initiatives.  Approximately $4 million is available for new initiatives.

Groups affected

Victorian health care service providers such as public hospitals

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Characteristics of this policy

Degree of Innovation traditional rather innovative innovative
Degree of Controversy consensual consensual highly controversial
Structural or Systemic Impact marginal rather fundamental fundamental
Public Visibility very low low very high
Transferability strongly system-dependent neutral system-neutral

In the Australia setting, VPACT can be considered to be a rather innovative and is certainly the first systematic attempt to bring technology assessment to public health care facilities.

Thus far the initiative has not received widespread public attention and, to the best of our knowledge, no major organisation has made any public statements for or against VPACT.

Whilst the precise form and shape of VPACT is particular to the Australian Health Care System, the notion of creating a process for the introduction of effective and cost-effective health technologies entering hospital and other health care services has universal application.

Political and economic background

A significant challenge for Australia's health care system is to manage the process through which new technologies are assessed and then introduced when these have been shown to be effective and cost effective.

Whilst Australia has a very strong history of systematically reviewing new technologies for its effectiveness and cost-effectiveness as part of its decision-making processes, these activities have largely been confined to the national stage. The Victorian Department of Human Services critised this approach as being reactive; HTA is undertaken when someone wants funding. The gap in the Australian system is lack of a systematic process/agency to translate information from technology assessment into practice guidance.

VPACT is a new initiative that supplements existing national initiatives and seeks to introduce evidence based decisions when introducing new technologies into public hospitals and local health services in Victoria.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no

Origins of health policy idea

The history and origin of this idea have not been established.

What is clear is that the Victorian Government has carefully examined processes in the UK under the auspices of NICE and in Canada with CCOHTA.  The Government has also stated that functions performed by such organisations as Euroscan are yet to be realised in Australia.

Initiators of idea/main actors

  • Government

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

As far as we can tell there has been no policy paper on VPACT and internet searches have not revealed any public statements by any of the major stakeholders such as industry, provider groups, patient groups or local area health services.

The VPACT includes membership from a wide range of expertise, including:

  • Health technology assessment
  • Health service delivery
  • Health policy
  • Quality and safety
  • Evidence-based practice
  • Population health
  • Clinical pharmacology
  • Health economics
  • Cardiology
  • Medical oncology
  • Surgery.

Actors and positions

Description of actors and their positions
Government
State governmentvery supportivevery supportive strongly opposed

Influences in policy making and legislation

N/A

Actors and influence

Description of actors and their influence

Government
State governmentvery strongvery strong none
State government

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

Whilst VPACT still is in the early stages of implementation, it has already set up a number of processes to guide applications. These include:

  • VPACT will meet up to 4 times per annum depending on the number and scope of issues and initiatives being addressed.
  • Clinical experts may be invited to attend VPACT meetings and contribute to its activities.
  • It has established rules to prevent applicants lobbying VPACT members and will not routinely be invited to present to VPACT.
  • Panels may be formed to oversee particular projects or assemble advice on a specific issue. Such panels will be chaired by a VPACT member, but may also appoint independent members and may seek other expert opinion.
  • External consultants may be contracted by the Department to undertake a review of new technology/clinical practice to inform VPACT consideration.

In addition, VPACT has developed a proforma for potential applicants to assist them in applying for funding.

Monitoring and evaluation

VPACT will play a strong role in monitoring, including:

  • Monitor the establishment of new technology/clinical practice committees in Public Health Services.
  • Establish mechanisms to identify, monitor and assess information about new and emerging technology/clinical practice.
  • Establish mechanisms to identify and monitor new technology/clinical practice in Public Health Services.
  • Establish mechanisms to review the use and clinical and cost effectiveness of existing technology/clinical practice. It is not clear whether VPACT's role will include an evaluation of its impact on the difussion of effective and cost-effective technologies in Victorian public health facilities.

Results of evaluation

N/A

Expected outcome

Whilst Australian processes on technology assessment and decision-making have been model for other countries, several problems have been identified.  In general there is no formal linkage to decision making on technology assessment at a state/territory level - in particular for technological developments impacting on public hospitals. 

Sometimes states/territories use national evaluation processes and at other times they institute their own processes. However, at best these arrangements could be argued to ad hoc. Furthermore, the evaluation processes and decisions are often taken in isolation, and therefore could result in outcomes that are far from optimal.For example there are clinical conditions in which there are alternatives to pharmaceutical interventions, but the PBS process can only consider and compare pharmaceuticals to pharmaceuticals.

Gaps in the assessment process for certain types of "technology" result in a system that is skewed towards relatively rapid introduction of some technologies and relative slow uptake of others.

VPACT addresses these problems in a systematic and considered way and is therefore considered to be an important step in closing one of the most important gaps in evidence based decision-making in

Impact of this policy

Quality of Health Care Services marginal rather marginal fundamental
Level of Equity system less equitable neutral system more equitable
Cost Efficiency very low high very high

Whilst VPACT sounds like a worthwhile initiative, it is still very much in its early days. The success of the VPACT initiative is likely to depend on a number of key factors:

  • the acceptance of its decisions by key stakeholders, especially providers and regional health administrators.
  • the authority it has over implementing its decisions. This authority may be direct in terms of the policy levers VPACT has its disposal to encourage use of cost-effective technologies and discourage use of cost-ineffective ones.

References

Sources of Information

For information on VPACT see:

www.health.vic.gov.au/newtech/index.htm

For information on medical technology in Australia:

www.pc.gov.au/study/medicaltechnology/finalreport/index.html

For information on the Victorian Government position on medical technology assessment see:

www.pc.gov.au/study/medicaltechnology/subs/sub024.rtf

For a discussion on Australia's options for reform, see:

www.aushealthcare.com.au/documents/publications/110/issues/637/041029%20Pearse%20-%20Discussion%20Paper.pdf

Suggested citation for this online article

. "Introducing new technologies in Victoria: VPACT". Health Policy Monitor, April 2006. Available at http://www.hpm.org/survey/au/a7/4