|Implemented in this survey?|
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.
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:
The principles underpinning the deliberations and recommendations of VPACT are:
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.
Victorian health care service providers such as public hospitals
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
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.
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
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.
|Implemented in this survey?|
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.
The approach of the idea is described as:
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:
|State government||very supportive||strongly opposed|
|State government||very strong||none|
Whilst VPACT still is in the early stages of implementation, it has already set up a number of processes to guide applications. These include:
In addition, VPACT has developed a proforma for potential applicants to assist them in applying for funding.
VPACT will play a strong role in monitoring, including:
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
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||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:
For information on VPACT see:
For information on medical technology in Australia:
For information on the Victorian Government position on medical technology assessment see:
For a discussion on Australia's options for reform, see: