The ‘Top 10’ Challenges for Health Technology Assessment: INAHTA Viewpoint

2019 ◽  
Vol 36 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Brian O'Rourke ◽  
Sophie Söderholm Werkö ◽  
Tracy Merlin ◽  
Li Ying Huang ◽  
Tara Schuller
Keyword(s):  
Decision Making ◽  
Health Technology Assessment ◽  
Health System ◽  
Health Systems ◽  
Technology Assessment ◽  
Health Technology ◽  
Publicly Funded ◽  
Non Profit ◽  
The Many ◽  
National Governments

The International Network of Agencies for Health Technology Assessment (INAHTA) spans the globe as a network of 50 publicly-funded health technology assessment (HTA) agencies supporting health system decision making for 1.4 billion people in thirty countries. Agency members are non-profit HTA organizations that are part of, or directly support, regional or national governments. Recently, INAHTA surveyed its members to gather perspectives from agency leadership on the most important issues in HTA today. This paper describes the top 10 challenges identified by INAHTA members. Addressing these challenges requires a call for action from INAHTA member agencies and the many other actors involved in the HTA ecosystem. In opening this call for action, INAHTA will lead the way; however, a comprehensive undertaking from all players is needed to effectively address these challenges and to continue to evolve HTA in its role as a strong and effective contributor to health systems.

Hard choices: Reflections from the tomb of the unknown patient

2019 ◽  
Vol 32 (6) ◽  
pp. 288-292
Author(s):  
Christopher McCabe ◽  
Jeff Round
Keyword(s):  
Decision Making ◽  
Health Technology Assessment ◽  
Health System ◽  
Technology Assessment ◽  
New Technologies ◽  
Health Technology ◽  
Access To Healthcare ◽  
Decision Making Process ◽  
Fixed Costs

Health Technology Assessment (HTA) has always sought to incorporate the evidence of all patients affected in the decision-making process. While health system budgets could increase to cover costs of new technologies, the relevant patients are those benefitting from access to the technology being appraised. More recently, with health system budgets effectively fixed, costs of new technologies are covered by displacing other, currently funded care. This reallocation means the patients affected by the decision include those whose healthcare is displaced. These patients are typically unidentified, however, and so HTA in this instance involves choosing between identified and unidentified patients. We argue that HTA should take account of identifiability bias in this decision-making, to avoid promoting inequitable and inefficient access to healthcare.

PP495 Addressing The Interactions Between Health Regulation And Health Technology Assessment In Brazil

2020 ◽  
Vol 36 (S1) ◽  
pp. 38-38
Author(s):  
Maíra Catharina Ramos ◽  
Margarete Martins de Oliveira ◽  
Erica Tatiane da Silva ◽  
Daniella Cristina Rodrigues Pereira ◽  
Flávia Tavares da Silva Elias
Keyword(s):  
Decision Making ◽  
Health Technology Assessment ◽  
Health System ◽  
Technology Assessment ◽  
Low Cost ◽  
Health Technology ◽  
Essential Medicines ◽  
Regulatory Interaction ◽  
Unified Health System ◽  
Post Marketing

IntroductionThe interaction of health technology assessment (HTA) and health regulatory agencies has been widespread, especially for decision-making in health system coverage. The objective of this paper is to report the HTA-regulatory interaction in Brazil.MethodsThis is a case study on the interaction between HTA and regulation in Brazil. Technical documents and Brazilian legislation on health regulation and HTA were analyzed. The study was conducted in July 2019.ResultsHTA-Regulatory Interaction in Brazil is still incipient. There is no responsible agency for interaction between agencies, as there is in Europe and Canada, for example. In the last 4 years, cooperation has started between the Brazilian Health Surveillance Agency (Anvisa) and the Oswaldo Cruz Foundation (Fiocruz) for post-registration monitoring of medicines. During this partnership, 170 post-marketing drug opinions were prepared, assisting the regulatory agency in decision-making.ConclusionsBrazil legislation guarantees essential medicines at low cost or free. The interaction between HTA and regulation has the potential to reduce the time taken to incorporate technology to the patient, in addition to ensuring greater safety for users of the Unified Health System. In this sense, it was observed that the interaction between health regulation and science and technology institutions has innovative potential in this approach.

scholarly journals Ethical and Social Values for Paediatric Health Technology Assessment and Drug Policy

2020 ◽  
Author(s):  
Avram E. Denburg ◽  
Mita Giacomini ◽  
Wendy Ungar ◽  
Julia Abelson
Keyword(s):  
Decision Making ◽  
Child Health ◽  
Health Technology Assessment ◽  
Health Systems ◽  
Technology Assessment ◽  
Drug Policy ◽  
Social Values ◽  
Policy Decision ◽  
Health Technology ◽  
Structured Interviews

Background: Public policy approaches to funding paediatric medicines in advanced health systems remain understudied. In particular, the ethical and social values dimensions of health technology assessment (HTA) and drug coverage decisions for children have received almost no attention in research or policy. Methods: To elicit and understand the social values that influence decision-making for public funding of paediatric drugs, we undertook a series of in-depth, semi-structured interviews with a stratified purposive sample (n = 22) of stakeholders involved with or affected by drug funding decisions for children at the provincial (Ontario) and national levels in Canada. Constructivist grounded theory methodology guided data collection and thematic analysis. Results: Our study provides empirical evidence about the unique ethical and social values dimensions of HTA for children, and describes a novel social values typology for paediatric drug policy decision-making. Three principal categories of values emerged from stakeholder reflections on HTA and drug policy-making for children: procedural values, structural values, and sociocultural values. Key findings include the importance of attention to the procedural legitimacy of HTA for children, with emphasis on the inclusion of child health voices in processes of technology appraisal and policy uptake; a role for HTA institutions to consider the equity impacts of technologies, both in setting review priorities and in assessing the value of technologies for public coverage; and the potential benefits of a distinct national framework to guide drug policy for children. Conclusion: Current approaches to HTA are not well designed for the realities of child health and illness, nor the societal priorities regarding children that our study identified. This research generates new knowledge to inform decision-making on paediatric drugs by HTA institutions and government payers in Canada and other publicly-funded health systems, through insights into the relevant social values for child drug funding decisions from varied stakeholder groups.

VP66 Perception Of Decision Makers And Researchers Towards Health Technology Assessment In Ghana

2017 ◽  
Vol 33 (S1) ◽  
pp. 179-180 ◽  
Author(s):  
Rebecca Addo ◽  
Jane Hall ◽  
Stephen Goodall ◽  
Marion Haas
Keyword(s):  
Decision Making ◽  
Health Technology Assessment ◽  
Health System ◽  
Human Resource ◽  
Technology Assessment ◽  
Health Technology ◽  
Decision Makers ◽  
Research Approach ◽  
Human Data ◽  
Effective Manner

INTRODUCTION:In recent years, the Ghana health system has been faced with the challenge of financial sustainability. New ways of making decisions in a cost-effective manner that ensure efficient use of available resources is being explored. Consequently, Ghana has been pursuing the formal introduction of Health Technology Assessment (HTA) for decision making in the health system.However, the limited use and impact of HTA on health systems has been associated with reasons including, and not restricted to, the knowledge and perception of decision makers towards it (1-3). Therefore as Ghana gears towards using HTA formally, it is important to assess the knowledge and attitude of potential users and producers of HTA. This will provide useful information for the setting up of an HTA agency.METHODS:A qualitative research approach using in-depth interviews was utilized. Twenty-three decision makers both at the national and district levels, and four researchers were interviewed. Thematic analysis was conducted using NVivo software.RESULTS:Only seven respondents had knowledge about HTA. Respondents perceived HTA differently, and the word ‘technology’, was often misconstrued as a device for communication such as mobile phone. Two main barriers to the use of HTA emerged; lack of resources (human, data, and finance) and politico-cultural issues. To address these barriers respondents recommended that stakeholders be involved in decisions concerning the guidelines for its conduct, composition of the appraisal team, and the focus of HTA. Generating of human, data and financial resources were also indicated.CONCLUSIONS:There is paucity of knowledge about HTA in Ghana. For Ghana to successfully introduce HTA for health decision making and realize its expected benefits, there will be a need to address the perceived barriers in a comprehensive manner. Also, to mitigate data and human resource barrier, Ghana will have to examine the available local data and human resource to build on.

RESPONSIVENESS, LANGUAGE, AND ALIGNMENT: REFLECTIONS ON SOME CHALLENGES FOR HEALTH TECHNOLOGY ASSESSMENT

2015 ◽  
Vol 31 (4) ◽  
pp. 223-225 ◽  
Author(s):  
Andrew Dillon
Keyword(s):  
Health Technology Assessment ◽  
Health System ◽  
Health Systems ◽  
Technology Assessment ◽  
New Technologies ◽  
New Technology ◽  
Health Technology ◽  
Decision Makers ◽  
The Face ◽  
The Right

Health systems around the world cope with the challenge of difficult economic times, and the value of health technology assessment (HTA) is increasing. Making the right choices, with limited resources, in the face of increasingly complex technologies requires decisions informed by data and analyses that help us to manage the risks involved. Those who undertake and use HTA can play a greater role in helping decision makers meet these challenges; they need to think how to define innovation and respond to it, how to communicate their analyses, and, critically, how to align their work with the ambitions of their health systems. HTA can become a key health system enabler without compromising its objectivity or independence. It can say that it is too early to determine the value of a new technology when the data simply will not support a safe decision. However, it can also be bold and recommend the managed introduction of new technologies, even when the when the data is immature, provided that the health system understands the risks and there is a plausible case for believing that further research will support the value proposition. The goal for HTA is to be able confidently to do both.

DESCRIBE DECISION-MAKING SYSTEMS, ASSESS HEALTH TECHNOLOGY ASSESSMENT REPORTS

2012 ◽  
Vol 28 (2) ◽  
pp. 168-168 ◽  
Author(s):  
Chris Henshall
Keyword(s):  
Decision Making ◽  
Health Technology Assessment ◽  
Health System ◽  
Technology Assessment ◽  
Health Technology ◽  
Assessment Reports

The paper by Drummond et al. in this issue of the Journal discusses how the principles that have been proposed in previous papers by these authors might be used as the basis for benchmarking health technology assessment (HTA) organizations. This raises a number of important issues, some acknowledged and discussed by the authors, and some not. The commentary by Sampietro provides an analysis of many of these. Two issues strike me as fundamental in this debate: the need for an agreed and objective approach to describing health system decision-making systems; and the need for an agreed and objective approach to the assessment of the quality of HTA reports to support specific decisions.

scholarly journals Health technology assessment in sub-Saharan Africa: a descriptive analysis and narrative synthesis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Samantha Hollingworth ◽  
Ama Pokuaa Fenny ◽  
Su-Yeon Yu ◽  
Francis Ruiz ◽  
Kalipso Chalkidou
Keyword(s):  
Decision Making ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Technical Assistance ◽  
Health Technology ◽  
Sub Saharan Africa ◽  
Main Theme ◽  
Narrative Synthesis ◽  
Policy Makers ◽  
Sub Saharan

Abstract Background Countries in Sub-Saharan Africa (SSA) are moving towards universal health coverage. The process of Health Technology Assessment (HTA) can support decisions relating to benefit package design and service coverage. HTA involves institutional cooperation with agreed methods and procedural standards. We systematically reviewed the literature on policies and capacity building to support HTA institutionalisation in SSA. Methods We systematically reviewed the literature by searching major databases (PubMed, Embase, etc.) until June 2019 using terms considering three aspects: HTA; health policy, decision making; and SSA. We quantitatively extracted and descriptively analysed content and conducted a narrative synthesis eliciting themes from the selected literature, which varied in study type and apporach. Results Half of the 49 papers identified were primary research studies and mostly qualitative. Five countries were represented in six of ten studies; South Africa, Ghana, Uganda, Cameroon, and Ethiopia. Half of first authors were from SSA. Most informants were policy makers. Five themes emerged: (1) use of HTA; (2) decision-making in HTA; (3) values and criteria for setting priority areas in HTA; (4) involving stakeholders in HTA; and (5) specific examples of progress in HTA in SSA. The first one was the main theme where there was little use of evidence and research in making policy. The awareness of HTA and economic evaluation was low, with inadequate expertise and a lack of local data and tools. Conclusions Despite growing interest in HTA in SSA countries, awareness remains low and HTA-related activities are uncoordinated and often disconnected from policy. Further training and skills development are needed, firmly linked to a strategy focusing on strengthening within-country partnerships, particularly among researchers and policy makers. The international community has an important role here by supporting policy- relevant technical assistance, highlighting that sustainable financing demands evidence-based processes for effective resource allocation, and catalysing knowledge-sharing opportunities among countries facing similar challenges.

scholarly journals Determinants of Managed Entry Agreements in the context of Health Technology Assessment: a comparative analysis of oncology therapies in four countries

2021 ◽  
Vol 37 ◽  
Author(s):  
Olina Efthymiadou ◽  
Panos Kanavos
Keyword(s):  
Decision Making ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Best Practice ◽  
Health Technology ◽  
Future Research ◽  
Best Practice Guidelines ◽  
Chi Squared ◽  
Decision Making Factors ◽  
Managed Entry Agreements

Abstract Background Managed Entry Agreements (MEAs) are increasingly used to address uncertainties arising in the Health Technology Assessment (HTA) process due to immature evidence of new, high-cost medicines on their real-world performance and cost-effectiveness. The literature remains inconclusive on the HTA decision-making factors that influence the utilization of MEAs. We aimed to assess if the uptake of MEAs differs between countries and if so, to understand which HTA decision-making criteria play a role in determining such differences. Methods All oncology medicines approved since 2009 in Australia, England, Scotland, and Sweden were studied. Four categories of variables were collected from publicly available HTA reports of the above drugs: (i) Social Value Judgments (SVJs), (ii) Clinical/Economic evidence submitted, (iii) Interpretation of this evidence, and (iv) Funding decision. Conditional/restricted decisions were coded as Listed With Conditions (LWC) other than an MEA or LWC including an MEA (LWCMEA). Cohen's κ-scores measured the inter-rater agreement of countries on their LWCMEA outcomes and Pearson's chi-squared tests explored the association between HTA variables and LWCMEA outcomes. Results A total of 74 drug-indication pairs were found resulting in n = 296 observations; 8 percent (n = 23) were LWC and 55 percent (n = 163) were LWCMEA. A poor-to-moderate agreement existed between countries (−.29 < κ < .33) on LWCMEA decisions. Cross-country differences within the LWCMEA sample were partly driven by economic uncertainties and largely driven by SVJs considered across agencies. Conclusions A set of HTA-related variables driving the uptake of MEAs across countries was identified. These findings can be useful in future research aimed at informing country-specific, “best-practice” guidelines for successful MEA implementation.

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