Ethical Issues of Obesity Surgery—a Health Technology Assessment

Objectives: Ethical analysis can highlight important ethical issues related to implementing a technology, values inherent in the technology itself, and value-decisions underlying the health technology assessment (HTA) process. Ethical analysis is a well-acknowledged part of HTA, yet seldom included in practice. One reason for this is lack of knowledge about the properties and differences between the methods available. This study compares different methods for ethical analysis within HTA.Methods: Ethical issues related to bariatric (obesity) surgery were independently evaluated using axiological, casuist, principlist, and EUnetHTA models for ethical analysis within HTA. The methods and results are presented and compared.Results: Despite varying theoretical underpinnings and practical approaches, the four methods identified similar themes: personal responsibility, self-infliction, discrimination, justice, public funding, and stakeholder involvement. The axiological and EUnetHTA models identified a wider range of arguments, whereas casuistry and principlism concentrated more on analyzing a narrower set of arguments deemed more important.Conclusions: Different methods can be successfully used for conducting ethical analysis within HTA. Although our study does not show that different methods in ethics always produce similar results, it supports the view that different methods of ethics can yield relevantly similar results. This suggests that the key conclusions of ethical analyses within HTA can be transferable between methods and countries. The systematic and transparent use of some method of ethics appears more important than the choice of the exact method.

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OP101 Do We Need To Extend Health Technology Assessment To Health Enhancement Assessment?

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462317001714 ◽

2017 ◽

Vol 33 (S1) ◽

pp. 46-46

Author(s):

Bjørn Hofmann

Keyword(s):

Health Care ◽

Health Technology Assessment ◽

Technology Assessment ◽

Cognitive Abilities ◽

Literature Search ◽

Ethical Issues ◽

Health Technology ◽

Health Technologies ◽

Health And Wellbeing ◽

Wide Range

INTRODUCTION:Several health technologies used for therapy can also be used for health enhancement. Drugs stimulating cognitive abilities are but one example. Health Technology Assessment (HTA) has not been developed for assessing enhancements. This raises the question of how HTA should address the blurred distinction between therapy and enhancement. Should we (i) carve out a distinction between therapy and enhancement and limit HTA to therapy, (ii) use HTA for both therapy and enhancement (with some modifications), or (iii) should we develop a separate health enhancement assessment (HEA)?METHODS:A literature search of the medical, philosophical, and bioethical literature was conducted for debates, arguments, and suggested solutions to the issue of therapy versus enhancement.RESULTS:The same improvement in health may be therapeutic in one patient, but an enhancement in another. Moreover, both therapy and enhancement share the same goal: increased health and wellbeing. A wide range of arguments try to establish a difference between therapy and enhancement. They refer to naturalness, rehabilitation, normality, species-typical functioning/potential, disease, sustainability, and responsibility. On closer scrutiny few of these arguments do the job in bolstering the therapy-enhancement distinction. We already use a wide range of means to extend human abilities. Moreover, the therapy-enhancement distinction raises a wide range of ethical issues that are relevant for the assessment of a number of emerging health technologies.CONCLUSIONS:Existing HTA methodology can address a wide range of non-therapeutic health enhancements. However, a series of broader issues related to the goal of health care and responsibility for altering human evolution may not be addressed within traditional HTA frameworks. Specific HEAs may therefore be helpful.

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OP83 Thinking Explicitly About Ethical Issues In Health Technology Assessment: Lessons From The Canadian Agency For Drugs And Technologies In Health

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462318001204 ◽

2018 ◽

Vol 34 (S1) ◽

pp. 30-31

Author(s):

Ken Bond ◽

Katherine Duthie

Keyword(s):

Health Technology Assessment ◽

Technology Assessment ◽

Ethical Issues ◽

Health Technology ◽

Dna Mismatch ◽

Additional Information ◽

Obstructive Sleep ◽

Starting Point ◽

Explicit Analysis ◽

End Stage

Introduction:While methods for ethics analysis in health technology assessment (HTA) exist, there have been relatively few applications and assessments of these methods. The Canadian Agency for Drugs and Technologies in Health (CADTH) began to include an explicit analysis of ethical issues within its HTAs in 2015. To examine some of the differences among ethics analyses, we critically compared the conduct and contribution of the analysis of ethical issues for four CADTH HTAs.Methods:Two experts in ethics in HTA examined ethics analyses conducted by CADTH for four technologies: DNA mismatch repair testing for colorectal cancer, treatments for obstructive sleep apnea, dialysis for end-stage liver disease, and human papillomavirus screening for cervical cancer. The methods of analysis and presentation of results, extent to which the ethics analysis was used in committee deliberations was gathered via meeting notes, recommendation documents, and discussion, and were summarized narratively.Results:The amount of literature explicitly discussing ethical issues pertaining to particular technologies varied and was not predicted by the age and maturity of a technology. The axiological approach proved a helpful starting point for ethical reflection, but other methods were used for analysis and presentation. Explicit discussion of ethical issues identified the need for additional information to ensure robust deliberation. Committee members expressed the belief that ethics analysis “brought together” individual sections of the HTA.Conclusions:While many methods exist for ethics analysis, ethics expertise is required to identify and explicitly discuss the complete range of ethical issues relevant to a particular HTA. Ethics analyses create space to challenge assumptions underlying the clinical and economic evidence, raise issues about the value of technologies, and help to integrate the HTA results.

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Tackling ethical issues in health technology assessment: A proposed framework

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462311000250 ◽

2011 ◽

Vol 27 (3) ◽

pp. 230-237 ◽

Cited By ~ 26

Author(s):

Amanda Burls ◽

Lorraine Caron ◽

Ghislaine Cleret de Langavant ◽

Wybo Dondorp ◽

Christa Harstall ◽

...

Keyword(s):

Health Technology Assessment ◽

Technology Assessment ◽

Development Process ◽

Ethical Issues ◽

Health Technology ◽

Face To Face ◽

Context Sensitive ◽

Ethical Implications ◽

Starting Point ◽

Methodological Approaches

Objectives: Values are intrinsic to the use of health technology assessments (HTAs) in health policy, but neglecting value assumptions in HTA makes their results appear more robust or normatively neutral than may be the case. Results of a 2003 survey by the International Network of Agencies for Health Technology Assessment (INAHTA) revealed the existence of disparate methods for making values and ethical issues explicit when conducting HTA.Methods: An Ethics Working Group, with representation from sixteen agencies, was established to develop a framework for addressing ethical issues in HTA. Using an iterative approach, with email exchanges and face-to-face workshops, a report on Handling Ethical Issues was produced.Results: This study describes the development process and the agreed upon framework for reflexive ethical analysis that aims to uncover and explore the ethical implications of technologies through an integrated, context-sensitive approach and situates the proposed framework within previous work in the development of ethics analysis in HTA.Conclusions: It is important that methodological approaches to address ethical reflection in HTA be integrative and context sensitive. The question-based approach described and recommended here is meant to elicit this type of reflection in a way that can be used by HTA agencies. The questions proposed are considered only as a starting point for handling ethics issues, but their use would represent a significant improvement over much of the existing practice.

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Health Technology Assessment (HTA) and its ethical issues

Medicina e Morale ◽

10.4081/mem.2007.335 ◽

2007 ◽

Vol 56 (1) ◽

Author(s):

Dario Sacchini ◽

Pietro Refolo

Keyword(s):

Health Technology Assessment ◽

Technology Assessment ◽

Ethical Issues ◽

Health Technology

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Toward a procedure for integrating moral issues in health technology assessment

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462305050415 ◽

2005 ◽

Vol 21 (3) ◽

pp. 312-318 ◽

Cited By ~ 77

Author(s):

Bjørn Hofmann

Keyword(s):

Health Policy ◽

Health Technology Assessment ◽

Moral Philosophy ◽

Technology Assessment ◽

Policy Making ◽

Theoretical Foundation ◽

Ethical Issues ◽

Health Technology ◽

Moral Issues ◽

Wide Range

Objectives: Although ethics has been on the agenda in health technology assessment (HTA) since its inception, the integration of moral issues is still not standard and is performed in a vast variety of ways. Therefore, there is a need for a procedure for integrating moral issues in HTA.Methods: Literature review of existing approaches together with application of various theories in moral philosophy and axiology.Results: The article develops a set of questions that addresses a wide range of moral issues related to the assessment and implementation of health technology. The issues include general moral issues and moral issues related to stakeholders, methodology, characteristics of technology, and to the HTA process itself. The questions form a kind of checklist for use in HTAs.Conclusions: The presented approach for integrating moral issues in HTA has a broad theoretical foundation and has shown to be useful in practice. Integrating ethical issues in HTAs can be of great importance with respect to the dissemination of HTA results and in efficient health policy making.

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SUITABILITY OF CURRENT EVALUATION FRAMEWORKS FOR USE IN THE HEALTH TECHNOLOGY ASSESSMENT OF MOBILE MEDICAL APPLICATIONS: A SYSTEMATIC REVIEW

International Journal of Technology Assessment in Health Care ◽

10.1017/s026646231800051x ◽

2018 ◽

Vol 34 (5) ◽

pp. 464-475 ◽

Cited By ~ 11

Author(s):

Magdalena Ruth Moshi ◽

Rebecca Tooher ◽

Tracy Merlin

Keyword(s):

Health Technology Assessment ◽

Technology Assessment ◽

Data Privacy ◽

Ethical Issues ◽

Health Technology ◽

Evaluation Framework ◽

Bibliographic Databases ◽

Medical Applications ◽

Inaccurate Information ◽

The Impact

Objectives:To identify and appraise existing evaluation frameworks for mobile medical applications (MMA) and determine their suitability for use in health technology assessment (HTA) of these technologies.Methods:Systematic searches were conducted of seven bibliographic databases to identify literature published between 2008 and 2016 on MMA evaluation frameworks. Frameworks were eligible if they were used to evaluate at least one of the HTA domains of effectiveness, safety, and/or cost and cost-effectiveness of an MMA. After inclusion, the frameworks were reviewed to determine the number and extent to which other elements of an HTA were addressed by the framework.Results:A total of forty-five frameworks were identified that assessed MMAs. All frameworks assessed whether the app was effective. Of the thirty-four frameworks that examined safety, only seven overtly evaluated potential harms from the MMA (e.g., the impact of inaccurate information). Only one framework explicitly considered a comparator. Technology specific domains were sporadically addressed.Conclusion:None of the evaluation frameworks could be used, unaltered, to guide the HTA of MMAs. To use these frameworks in HTA they would need to identify relevant comparators, improve assessments of harms and consider the ongoing effect of software updates on the safety and effectiveness of MMAs. Attention should also be paid to ethical issues, such as data privacy, and technology specific characteristics. Implications: Existing MMA evaluation frameworks are not suitable for use in HTA. Further research is needed before an MMA evaluation framework can be developed that will adequately inform policy makers.

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ETHICS EXPERTISE FOR HEALTH TECHNOLOGY ASSESSMENT: A CANADIAN NATIONAL SURVEY

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462314000014 ◽

2014 ◽

Vol 30 (2) ◽

pp. 131-136 ◽

Cited By ~ 4

Author(s):

Kenneth Bond ◽

Mark Oremus ◽

Katherine M. Duthie ◽

Glenn G. Griener

Keyword(s):

Health Technology Assessment ◽

Technology Assessment ◽

Work Experience ◽

Ethical Issues ◽

Applied Ethics ◽

Health Technology ◽

Work Related ◽

Health Agencies ◽

And Training ◽

Ethics Expertise

Objectives: The aim of this study was to identify individuals with expertise in ethics analysis in Canada, who might contribute to health technology assessment (HTA); to gauge these individuals’ familiarity with, and experience participating in, the production of HTA.Methods: A contact list was developed using the Canadian Bioethics Society membership list and faculty listings of Canadian universities, bioethics centers, and health agencies. An eighteen-question email survey was distributed to potential respondents to collect data on demographic information, education and work experience in applied ethics, and involvement in HTA.Results: The survey response rate was 52.8 percent (350/663). Respondents worked primarily in academic institutions (50.4 percent) or hospitals (15.4 percent). Many respondents (83.1 percent) had education, formal training, or work-related experience in practical ethics related to health care, with many having a doctorate (34.5 percent) or master's degree (19.0 percent). One quarter (24.5 percent; n = 87) of respondents indicated they had been involved in an analysis of ethical issues for HTA. Almost two-thirds (65.4 percent; n = 165) of those who had not previously participated in ethics analysis believed they might usefully contribute to an analysis of ethical issues in HTA. Experts who have conducted ethics analysis in HTA had more than twice the odds of having education and training in ethics and a PhD than those who might contribute to ethics analysis.Conclusion: Many people have contributed to ethics analysis in HTA in Canada, and more are willing to do so. Given the absence of a reliable credential for ethics expertise, HTA producers should exercise caution when enlisting ethics experts.

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HOW TO AVOID GIVING THE RIGHT ANSWERS TO THE WRONG QUESTIONS: THE NEED FOR INTEGRATED ASSESSMENTS OF COMPLEX HEALTH TECHNOLOGIES

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462317001040 ◽

2017 ◽

Vol 33 (5) ◽

pp. 541-543 ◽

Cited By ~ 2

Author(s):

Ansgar Gerhardus ◽

Wija Oortwijn ◽

Gert Jan van der Wilt

Keyword(s):

Health Technology Assessment ◽

European Commission ◽

Technology Assessment ◽

Ethical Issues ◽

Health Technology ◽

Decision Makers ◽

Patient Centered ◽

Health Technologies ◽

The Right ◽

Integrated Assessments

Health technologies are becoming increasingly complex and contemporary health technology assessment (HTA) is only partly equipped to address this complexity. The project “Integrated assessments of complex health technologies” (INTEGRATE-HTA), funded by the European Commission, was initiated with the overall objective to develop concepts and methods to enable patient-centered, integrated assessments of the effectiveness, and the economic, social, cultural, and ethical issues of complex technologies that take context and implementation issues into account. The project resulted in a series of guidances that should support the work of HTA scientists and decision makers alike.

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