Our evidence synthesis and evidence-based advice on the clinical and cost-effectiveness of health technologies supports health policy decisions at a national level. The topics and areas that these HTAs touch on can vary considerably, and this was highlighted in recent months when we published several important reports in areas including the use of multiplex antigen tests for respiratory diseases, adding screening for spinal muscular atrophy (SMA) to the National Newborn Bloodspot Screening Programme in Ireland and international approaches to health emergency stockpiling.
In our advice to the Minister for Health on the use of multiplex antigen near-patient tests to detect respiratory tract infections such as COVID-19, influenza and other illnesses in residential and primary care settings, we found that, as the technology was relatively new, evidence regarding its benefits was limited.
Our Deputy Director of Health Technology Assessment, Michelle O’Neill, said: “While the limited evidence suggests that multiplex antigen tests are quick, cheap and easy to perform, the advantages, disadvantages, feasibility and acceptability of their use in these settings remain unknown. As such, their effectiveness at accurately detecting infection is unclear.”
Continuing, Ms O’Neill added: “There is a real need for studies in primary and residential care settings to be carried out to assess the diagnostic performance and clinical utility of multiplex antigen near-patient tests before decisions on their use in these care settings can be made.”
Following a request from the Department of Health, we conducted an overview of international approaches to stockpiling medical countermeasures for public health emergencies, and last month we published that review.
We looked at stockpiling for public health emergencies in five countries: France, Latvia, Lithuania, the Netherlands and Norway and our review found that all five countries use physical stockpiles, where items are stored in a warehouse and can be sent to wherever they are needed quickly, in case of an emergency. Our review highlighted that these countries considered this approach to be less costly and quicker to access than using a ‘virtual stockpile’ – this is where companies store stock that the government can buy in an emergency.
Speaking about the review, Dr Eimear Burke, Public Health Fellow in HIQA, said: “One of the challenges faced by the countries reviewed was waste due to unused stock. Some countries were managing this by rotating this stock. This means that when stock is close to expiration, the stock is either sold or given away to hospitals or charities, so that it is not wasted.”
The information in this report will be used to help develop a national strategy for stockpiling medical countermeasures for public health emergencies for Ireland.
In issue 56 of this newsletter, we announced that we had commenced an assessment of the inclusion of spinal muscular atrophy (SMA) in the National Newborn Bloodspot Screening Programme. Our HTA on this topic was subsequently published in November.
The HTA was undertaken at the request of the National Screening Advisory Committee (NSAC) to inform its decision making. Following a positive recommendation from NSAC, the Minister for Health has now approved the addition of SMA to the National Newborn Bloodspot Screening Programme.
On the publication of this review, our Deputy CEO and Director of HTA, Dr Máirín Ryan, said: “Newborn screening for SMA through the National Newborn Bloodspot Screening Programme will help find infants before they present clinically, allowing for earlier access to treatment. It is expected that, on average, around seven children with SMA will be identified through the programme each year.”
Currently, cases of SMA are only found when symptoms develop or through family history, such as when a sibling has been diagnosed with the condition. Once symptoms of SMA develop, the damage to motor neurons is irreversible. HIQA’s review found that newborn screening can identify children with SMA. This would allow for treatment to start earlier which is expected to improve clinical outcomes.
It is estimated that introducing screening for SMA could cost the Health Service Executive (HSE) in the region of €17.7 million over the first five years. The majority of expenditure will be associated with the additional cost of drug treatment.
These reports can be found on our website at www.hiqa.ie