Résumé
La adquisición de tecnologías en salud es un proceso complejo enfocado al mejoramiento en la calidad y la eficiencia en la prestación de los servicios de salud a través de la adquisición de tecnología efectiva. Dentro de los procesos de adquisición de tecnologías en salud se destacan la evaluación técnica y clínica. El objetivo de la evaluación de tecnologías en salud es recolectar, analizar y sintetizar información y conocimiento para contribuir a mejorar la toma de decisiones en la práctica médica y en las políticas de salud. Este artículo ofrece un procedimiento de adquisición de tecnología biomédica con énfasis en la evaluación técnica y clínica basado en metodologías de evaluación de tecnologías en salud. También ofrece una estructura detallada sobre los conceptos técnicos y clínicos que servirán de base para la toma de decisiones en procesos de adquisición dentro del ambiente prestador de salud. De igual manera, pretende impulsar en los departamentos de ingeniería clínica la implementación de procesos metodológicos de amplia aceptación y efectividad que tienen como objetivo primordial la adquisición de tecnologías en salud basados en la evidencia. Asimismo, se promueve la participación activa del personal asistencial y técnico con el fin de enfocar el proceso a un ambiente multidisciplinario y obtener retroalimentación específica sobre las tecnologías en salud en áreas de uso a través de usuarios representativos.
The acquisition of healthcare technologies is a complex process focused in the improvement of quality and efficiency in delivering health services through the acquisition of technology in an effective manner. Within the acquisition processes of healthcare technologies, the technical and clinical evaluation highlights. The objective of the health technology assessment is to collect, analyze and synthesize information and knowledge to help improve decision-making in medical practice and health policies. This article provides a procedure for healthcare technologies acquisition with emphasis in technical and clinical evaluation based on health technology assessment methodologies. This presents a detailed structure on technical and clinical concepts that serve as a basis for decision-making procurement processes within healthcare environment. Likewise, it is expected to motivate in clinical engineering departments, the implementation of broad acceptance and effective methodological process that have as its primary objective the acquisition of healthcare technologies based on evidence. It also promotes the active participation of clinical and technical staff in order to approach the process to a multidisciplinary environment and obtain feedback on specific areas of the healthcare technologies trough representative users.
Résumé
Objective : A major challenge to the usefulness of economic evaluation for decision-making is concern over the generalisability of the results. The purpose of this paper is to review the methodological issue of generalisability within economic evaluation and to discuss approaches for facilitating the generalisability of economic analysis to the Japanese context.<BR>Methods : Electronic searches of key databases (MEDLINE, HEALTHSTAR, OHE, NHS EED) and handsearches of key health economics and health technology journals (ISTAHC, Pharmacoeconomics, Health Economics) in the period 1990-2000 were conducted to identify papers relating to factors affecting and methods for enhancing generalisability across three dimensions : (i) from study to practice, (ii) between location and (iii) across time. These papers were critically reviewed and the information combined into a structured commentary.<BR>Results : Several factors can potentially limit the generalisability of results including differences in epidemiology, the availability of treatments, clinical practice patterns, relative prices and incentives to healthcare professionals and institutions. Several analytical approaches are in existence, which allow the generalisation of health economic data to any local decision-making context. These include statistical analysis of data from multinational clinical-economic trials, the use of economic modelling and the systematic review of economic data.<BR>Conclusion : Further research in the area of generalisability will add to the credibility and usefulness of economic evaluations in general and give decision-makers confidence that the data are suitable for use as a basis for resource-allocation decisions and provide some comfort that the actions arising from their use are not misguided.