HTAs published by Irish HIQA in the third quarter of 2021

Health Information and Quality Authority (HIQA) develops national HTA guidelines to support decision-making in Ireland. In the third quarter of 2021, Health Information and Quality Authority published three reports in relation to in-vitro diagnostics, including newborn bloodspot screening (NBS), tests for hepatitis C and SARS-CoV-2.

On July 2, 2021, a report in relation to Processes in use to inform the expansion of newborn bloodspot screening programmes was published. The findings of the review highlight differences in the number of conditions screened for by countries internationally and in policy-making processes to support the expansion of NBS programs. The balance of benefit and harm associated with expansion requires careful consideration and will be dependent on factors specific to individual conditions. Regardless of the direction and extent of expansion of the national NBS program, efforts should be focused on protecting the existing screening processes in place. The report was provided to the National Screening Advisory Committee (NSAC) to help inform the development of their processes for the assessment of conditions being considered for inclusion in Ireland’s NBS program. The current National Newborn Bloodspot Screening Programme (NNBSP) in Ireland screens for eight conditions, with a ninth condition under implementation as of June 2021.

On July 29, 2021, an HTA of birth cohort testing for hepatitis C was released. Previously, people living in Ireland born between 1965 and 1985 have been identified as the target population for birth cohort testing based on nationally available epidemiological data. The HTA aimed to establish the clinical, cost-effectiveness, and budget impact of introducing birth cohort testing for hepatitis C virus (HCV) infection in Ireland. From published evidence, it is clear that the diagnostic tests used to detect chronic HCV are highly sensitive and specific; the currently available treatments are very effective. It was concluded that a birth cohort testing program to identify and treat those with undiagnosed HCV would be a cost-effective use of resources but would require a significant upfront investment. Over a five-year period, it was estimated that the budget impact of introducing birth cohort testing would be between €44 million and €65 million, depending on the type of birth cohort testing program introduced. Given substantial uncertainty regarding the prevalence of undiagnosed chronic HCV infection in the 1965 to 1985 birth cohort and the logistical challenges posed by a potential birth cohort testing program, consideration should be given to an initial pilot program. Further research (such as surveying members of the general public) could also be considered to reduce uncertainty around the likely test uptake rate.

On September 20, 2021, a report regarding Rapid antigen testing of asymptomatic individuals was published. The report aimed to evaluate the emerging evidence with regard to the effectiveness of rapid antigen detection testing (RADT) of asymptomatic populations to limit the spread of SARS-CoV-2. The following key conclusion was provided: given the uncertainty surrounding the clinical- and cost-effectiveness of RADT-based screening programs in asymptomatic individuals to limit the transmission of SARS-CoV-2, more real-world research evidence, including economic evaluation, is required to inform public policy on the widespread use of RADTs in asymptomatic individuals. Any decision to introduce such screening should consider the feasibility, potential benefits and harms, ethical and social issues, regulatory aspects, and value for money of such screening relative to other available mitigation measures.

The details of the published assessments can be found here.

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