national level, the conclusions and recommendations are
often quite global and far from the local and precise questions
of a hospital. New and relatively expensive technologies
arrive mainly at university hospitals which are under
immediate pressure from manufacturers, physicians and
patients to adopt them. Only later do they reach the national
agenda, while the assessment timeframe is often lengthy.
Moreover, hospitals have a direct interest (medical, economic
and organizational) to push and speed-up the process of
assessment and reimbursement at the national level.
HB-HTA can allow hospital managers to respond to three
different environmental "pressures"; such as improving the
level of efficiency and effectiveness (micro-economic
efficiency) as the key to improve the efficiency of the entire
system (macro-economic efficiency), to acknowledge the
progressive relevance of the "context" factor, and to spread
the concept of an "evidence-based medicine culture" (6).
The technical aspect of health assessment includes the
verification of the technology's ability to do what it was
conceived for and to help the implementation of equipment
or a device, something that is particularly relevant in a field
like oncology with extensive reliance on technology in both
its software and hardware forms.
The clinical aspects of health assessment include
knowledge about the intrinsic benefit/risk balance and
therapeutic progress (or relative effectiveness) in regard to
alternatives, something at the core of oncology practice and
decision-making.
The economic and social aspects of health assessment
help decision-makers to allocate resources in an optimal way
and the adoption and diffusion of technologies depends on
the local context, on organizational, ethical, legal,
"psychological" aspects, which is particularly useful in
developing countries with financial and cultural constraints.
So as a result of the absence of an integrated health care
system for cancer patients in Egypt, the need for hospitalbased
health technology assessments (HTA) has arisen as a
step towards de-centralization of cancer care in Egypt.
In this article, we present a single department's
experience (Ain Shams University, Clinical Oncology
department) as the nucleus of an oncology hospital-based
health technology assessment and the work done on
infrastructure development against the challenges of a
developing country. In many instances, the solutions and
their financial solutions are quite simple. They are based on
a large involvement from charity organizations and
corporate social responsibilities. The main benefit of these
resources is the applicability of decentralization when
funding our projects.
The development projects are centred on the three main
interests of a university hospital: research, education and
clinical practice.
Central chemotherapy independent unit
Problem: Until two years ago, chemotherapy was directly
prescribed by different specialized clinics in the department
and referred as a written protocol to the administration
office where nurses prepared and delivered the treatments.
Chemotherapy toxicity evaluation and quality of life
assessment data were very scarce and incomplete.
Mechanisms for avoidance of medicinal errors were almost
non-existant or dependent on personal effort. No statistical
data on consumption, problematic differences between
generic and original drugs, or costs were available.
Solution: An independent chemotherapy supervision unit
was established by the start of 2014. This unit is responsible
for chemotherapy prescription, preparation, administration,
managing toxicities and recording all related medical and
administrative data for analysis and autonomous correction
and external auditing. Personnel sharing in the unit activity
include consultants/specialists oncologists, clinical
pharmacists, dispensing pharmacists, nurses and medical
secretaries.
This was achieved via:
‰ standardized chemotherapy derived from evidencebased
medicine and compatible with international
guidelines;
‰ implementing job descriptions for all unit personnel;
‰ designating a standardized referencing and consultation
process;
‰ developing a drug information centre;
‰ computerized data entry with a local network
connecting the components of the unit including the
patients' reviewing clinic, the dispensing pharmacy, the
laminar flow room and the chemotherapy administration
hall, and also double recording of all patient data on both
computer and paper;
‰ chemotherapy preparation safe environment using
laminar flow class IIB (cytotoxic safety cabinet);
‰ mechanically adjusted chemotherapy infusion rates for
all patients;
‰ standardized toxicity assessments according to NCI
CTCAE latest version by specialized clinical pharmacists;
‰ both computer-based and paper-based patient data
archive;
‰ Recording of the trade names of all chemotherapeutics
used for every cycle to evaluate different toxicity
REGIONAL INITIATIVES
CANCER CONTROL 2015 121