title: Effects and repercussions of local/hospital-based health technology assessment (HTA): a systematic review.
abstract: BACKGROUND
  Health technology assessment (HTA) is increasingly performed at the local or hospital level where the costs, impacts, and benefits of health technologies can be directly assessed. Although local/hospital-based HTA has been implemented for more than two decades in some jurisdictions, little is known about its effects and impact on hospital budget, clinical practices, and patient outcomes. We conducted a mixed-methods systematic review that aimed to synthesize current evidence regarding the effects and impact of local/hospital-based HTA.
  
  
  METHODS
  We identified articles through PubMed and Embase and by citation tracking of included studies. We selected qualitative, quantitative, or mixed-methods studies with empirical data about the effects or impact of local/hospital-based HTA on decision-making, budget, or perceptions of stakeholders. We extracted the following information from included studies: country, methodological approach, and use of conceptual framework; local/hospital HTA approach and activities described; reported effects and impacts of local/hospital-based HTA; factors facilitating/hampering the use of hospital-based HTA recommendations; and perceptions of stakeholders concerning local/hospital HTA. Due to the great heterogeneity among studies, we conducted a narrative synthesis of their results.
  
  
  RESULTS
  A total of 18 studies met the inclusion criteria. We reported the results according to the four approaches for performing HTA proposed by the Hospital Based HTA Interest Sub-Group: ambassador model, mini-HTA, internal committee, and HTA unit. Results showed that each of these approaches for performing HTA corresponds to specific needs and structures and has its strengths and limitations. Overall, studies showed positive impacts related to local/hospital-based HTA on hospital decisions and budgets, as well as positive perceptions from managers and clinicians.
  
  
  CONCLUSIONS
  Local/hospital-based HTA could influence decision-making on several aspects. It is difficult to evaluate the real impacts of local HTA at the different levels of health care given the relatively small number of evaluations with quantitative data and the lack of clear comparators. Further research is necessary to explore the conditions under which local/hospital-based HTA results and recommendations can impact hospital policies, clinical decisions, and quality of care and optimize the use of scarce resources.
authors.affiliation: Centre de recherche du CHU de Québec, 10 rue de l'Espinay, D6-726 Quebec City, QC G1L 3L5, Canada. Marie-pierre.gagnon@fsi.ulaval.ca.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Gagnon
authors.forename: Marie
authors.initials: M
authors.lastname: Desmartis
authors.forename: Thomas
authors.initials: T
authors.lastname: Poder
authors.forename: William
authors.initials: W
authors.lastname: Witteman
mesh_terms: D017046:Cost Savings; D003659:Decision Making, Organizational; D006739:Hospital Administration; D017721:Hospital Costs; D006764:Hospitals, Community / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D016134:Organizational Policy; D013673:Technology Assessment, Biomedical / Q000191:economics / Q000458:organization & administration