Don't Sleep on HTA: From HTA to Clinical Guidelines Within Treatment of Obstructive Sleep Apnea

Problem Statement: In Denmark, clinical guidelines have traditionally been developed independently of HTAs, with the risk of creating inconsistency between clinical practice and the national recommendations made by policy makers. This may leave clinicians in a schisma, as clinical guidelines and policy may be based on different priorities, e.g. best clinical practice opposed to economic considerations. In 2023, The Danish Health Technology Council (DHTC) conducted an HTA within treatment of obstructive sleep apnea (OSA), demonstrating the use of HTA as the precursor for future development of national clinical guidelines.

Description: A comprehensive HTA concerning the treatment of OSA was conducted, systematically incorporating evidence regarding clinical effectiveness, patient experiences, organizational implications, and health economics for three subgroups; patients with mild, moderate, and severe OSA. The HTA was carried out by a writing group of methodology experts and a committee, including physicians, nurses, and patient representatives.

Lessons Learned: Based on the review of the evidence within the four perspectives, The DHTC has published national recommendations for the treatment of OSA in Denmark. The recommendations cover multiple treatment pathways differentiated based on OSA severity and emphasize that the recommendations are to be integrated into clinical guidelines, developed by the Danish medical societies, using the HTA as the scientific evidence base. What remains and is left to be decided in the development of clinical guidelines, is the identification of therapeutic indications for the individual treatment pathways as well as the selection and re-selection of treatments for individual patients. Employing HTA provided a comprehensive and in-depth evidence base for developing national clinical guidelines and concurrently enabled the integration of transparent and substantiated prioritization into clinical guidelines.

Stakeholder Perspective: This case demonstrates how HTA can constitute the evidence base in the development of clinical guidelines in Denmark, showcasing the potential of generating consistency across decision bases for policy makers and health care providers.