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

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.

scholarly journals Tackling ethical issues in health technology assessment: A proposed framework

2011 ◽  
Vol 27 (3) ◽  
pp. 230-237 ◽  
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.

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

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.

scholarly journals SOME ADDITIONAL THOUGHTS ON FORTHCOMING AMENDMENTS TO HTA IN POLAND

2017 ◽  
Vol 33 (3) ◽  
pp. 358-359
Author(s):  
Anna Zawada
Keyword(s):  
Health Technology Assessment ◽  
Healthcare System ◽  
Medical Devices ◽  
Technology Assessment ◽  
Health Technology ◽  
Additional Information

In reference to the article A Decade of Health Technology Assessment in Poland by I. Lipska et al. (1), I would like to provide you with some comments and additional information on the changes in reimbursement policies in the Polish healthcare system currently taking place, which is likely to lead to increased number of health technology assessments (HTAs) of medical devices (MDs).

scholarly journals Toward a new information infrastructure in health technology assessment: Communication, design, process, and results

2009 ◽  
Vol 25 (S2) ◽  
pp. 92-98 ◽  
Author(s):  
Susanna Allgurin Neikter ◽  
Nina Rehnqvist ◽  
Måns Rosén ◽  
Helena Dahlgren
Keyword(s):  
Information System ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Information Infrastructure ◽  
Communication Strategy ◽  
User Needs ◽  
Target Groups ◽  
New Information ◽  
Starting Point

Objectives: The aim of this study was to facilitate effective internal and external communication of an international network and to explore how to support communication and work processes in health technology assessment (HTA).Structure and Methods: European network for Health Technology Assessment (EUnetHTA) connected sixty-four HTA Partner organizations from thirty-three countries. User needs in the different steps of the HTA process were the starting point for developing an information system. A step-wise, interdisciplinary, creative approach was used in developing practical tools.Results: An Information Platform facilitated the exchange of scientific information between Partners and with external target groups. More than 200 virtual meetings were set up during the project using an e-meeting tool. A Clearinghouse prototype was developed with the intent to offering a single point of access to HTA relevant information. This evolved into a next step not planned from the outset: Developing a running HTA Information System including several Web-based tools to support communication and daily HTA processes. A communication strategy guided the communication effort, focusing on practical tools, creating added value, involving stakeholders, and avoiding duplication of effort.Conclusions: Modern technology enables a new information infrastructure for HTA. The potential of information and communication technology was used as a strategic tool. Several target groups were represented among the Partners, which supported collaboration and made it easier to identify user needs. A distinctive visual identity made it easier to gain and maintain visibility on a limited budget.

AGING AND HEALTH TECHNOLOGY ASSESSMENT: AN IDEA WHOSE TIME HAS COME

2018 ◽  
Vol 34 (5) ◽  
pp. 442-446 ◽  
Author(s):  
Don Juzwishin ◽  
Heather McNeil ◽  
Jeonghoon Ahn ◽  
Yingyao Chen ◽  
Americo Cicchetti ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Systems Approach ◽  
Health Technology ◽  
International Panel ◽  
Starting Point ◽  
Aging And Health ◽  
Health Institutions ◽  
The Individual

Objectives:With the increase in technologies to support an aging population, health technology assessment (HTA) of aging-related technologies warrants special consideration. At Health Technology Assessment international (HTAi) 2016 and HTAi 2017, an international panel explored interests in HTA focused on aging.Methods:Panelists from five countries shared the state of aging and HTA in their countries. Opportunities were provided for participants to discuss and rate the themes identified by the panelists.Results:In 2016, the highest ranked themes were: (i) identifying unmet needs of older adults that could be met by technology—how can HTA help?; (ii) differences in assessment of aging-related technologies—what is the scope?; and (iii) involvement of older adults and caregivers. These themes became the starting point for discussion in 2017, for which the highest ranked themes were: (i) identification of challenges in HTA and aging; and (ii) approaches to advancing effectiveness of HTA for aging.Conclusion:These discussions allowed for examination of future directions for HTA and aging: engagement of older adults to inform the agenda of HTA and the broader public policy enterprise; a systems approach to thinking about needs of older persons should support the type and level of care desired by the individual rather than the health institutions, and HTA should reflect these desires when evaluating technological aides; and there is potential for health information systems and “big data” to support HTA activities that assess usability of technologies for older adults. We hope to build on the momentum of this community to continue exploring opportunities for aging and HTA.

scholarly journals Different methods for ethical analysis in health technology assessment: An empirical study

2011 ◽  
Vol 27 (4) ◽  
pp. 305-312 ◽  
Author(s):  
Samuli I. Saarni ◽  
Annette Braunack-Mayer ◽  
Bjørn Hofmann ◽  
Gert Jan van der Wilt
Keyword(s):  
Empirical Study ◽  
Health Technology Assessment ◽  
Obesity Surgery ◽  
Technology Assessment ◽  
Ethical Issues ◽  
Personal Responsibility ◽  
Public Funding ◽  
Stakeholder Involvement ◽  
Health Technology ◽  
Ethical Analysis

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.

scholarly journals WHAT’S IN A NAME? DEVELOPING DEFINITIONS FOR COMMON HEALTH TECHNOLOGY ASSESSMENT PRODUCT TYPES OF THE INTERNATIONAL NETWORK OF AGENCIES FOR HEALTH TECHNOLOGY ASSESSMENT (INAHTA)

2014 ◽  
Vol 30 (4) ◽  
pp. 430-437 ◽  
Author(s):  
Tracy Merlin ◽  
David Tamblyn ◽  
Benjamin Ellery ◽  
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Product Type ◽  
Product Label ◽  
International Network ◽  
Additional Information ◽  
Rapid Reviews ◽  
Final Agreement ◽  
Mapping Exercise

Objectives: A mapping exercise was undertaken to determine how HTA is being described and conducted across the International Network of Agencies for Health Technology Assessment (INAHTA), with the aim of harmonizing terminologies and approaches.Methods: Three progressive surveys were undertaken. In 2010, INAHTA agencies were asked to provide details on all of their HTA products. In 2013, additional information was sought on key methodological characteristics of five of the most common HTA product types. Subsequently, final agreement was sought on three proposed product types.Results: Forty-five HTA agencies responded to at least one of the surveys. In 2010, twenty-one agencies reported publishing over seventy named HTA products. Core domains associated with full HTA reports were reported by a third of agencies but were labeled differently, so products were classified according to product type (n = 17). Agencies producing short, tailored products increased between 2010 and 2013, with the publication of rapid reviews doubling from 33 percent to 66 percent. In 2013, half of the agencies adapted their common HTA products from documents produced by other agencies. A consensus (>70 percent) was achieved on definitions for HTA reports, mini-HTAs, and rapid reviews.Conclusions: The product label for an HTA is not always indicative of its content. Terminology has, therefore, been agreed to make explicit the trade-off between rigor and timeliness in three common HTA product types. An INAHTA Product Type (IPT) Mark has been created to identify each of these. It is hoped this will further facilitate HTA adaptation between agencies and reduce duplication of effort.

scholarly journals Internal evaluation of the European network for Health Technology Assessment project

2009 ◽  
Vol 25 (S2) ◽  
pp. 99-106 ◽  
Author(s):  
Lise Lund Håheim ◽  
Iñaki Imaz ◽  
Marlène Läubli Loud ◽  
Teresa Gasparetto ◽  
Jesús González-Enriquez ◽  
...  
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Steering Committee ◽  
Solid Base ◽  
European Network ◽  
Work Package ◽  
Cross Sectional ◽  
Internal Evaluation ◽  
Additional Information

Objectives: The internal evaluation studied the development of the European network for Health Technology Assessment (EUnetHTA) Project in achieving the general objective of establishing an effective and a sustainable network of health technology assessment (HTA) in Europe.Methods: The Work Package 3 group was dedicated to this task and performed the work. Information on activities during the project was collected from three sources. First, three yearly cross-sectional studies surveyed the participants’ opinions. Responses were by individuals or by institutions. The last round included surveys to the Steering Committee, the Stakeholder Forum, and the Secretariat. Second, the Work Package Lead Partners were interviewed bi-annually, five times in total, to update the information on the Project's progress. Third, additional information was sought in available documents.Results: The organizational structure remained stable. The Project succeeded in developing tools aimed at providing common methodology with intent to establish a standard of conducting and reporting HTA and to facilitate greater collaboration among agencies. The participants/agencies expressed their belief in a network and in maintaining local/national autonomy. The Work Package Leaders expressed a strong belief in the solid base of the Project for a future network on which to build, but were aware of the need for funding and governmental support.Conclusions: Participants and Work Package Leaders have expressed support for a future network that will improve national and international collaboration in HTA based on the experience from the EUnetHTA project.

Primary data collection in health technology assessment

2007 ◽  
Vol 23 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Michelle L. McIsaac ◽  
Ron Goeree ◽  
James M. Brophy
Keyword(s):  
Data Collection ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Primary Data ◽  
Evidence Based ◽  
Information Need ◽  
Methodological Issues ◽  
Additional Information ◽  
Evidence Based Decision Making

This study discusses the value of primary data collection as part of health technology assessment (HTA). Primary data collection can help reduce uncertainty in HTA and better inform evidence-based decision making. However, methodological issues such as choosing appropriate study design and practical concerns such as the value of collecting additional information need to be addressed. The authors emphasize the conditions required for successful primary data collection in HTA: experienced researchers, sufficient funding, and coordination among stakeholders, government, and researchers. The authors conclude that, under specific conditions, primary data collection is a worthwhile endeavor in the HTA process.

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