Skip to main content Accessibility help
×
Home

Addressing Health System Values in Health Technology Assessment: The Use of Evidence-Informed Deliberative Processes

  • Wija Oortwijn (a1) and Philip Klein (a2)

Abstract

Health technology assessment (HTA) is increasingly used around the globe to inform resource allocation decisions. Furthermore, the importance of using explicit and transparent criteria for coverage decision making in line with health system values has been acknowledged. However, the values of a health system are often not explicitly taken into account in the HTA process. This situation influences the allocation of scarce resources and could lead to a discord between the HTA outcome and the values of the health system. We describe how evidence-informed deliberative processes (EDPs) can help to improve this situation. EDPs are integrating two theoretical frameworks; multi-criteria decision-analysis and accountability for reasonableness. Through the use of EDPs, HTA agencies can ensure that health system values are more explicitly and consistently taken into account in the HTA process, enhancing the legitimacy of coverage decisions.

Copyright

Corresponding author

Author for correspondence: Wija Oortwijn, E-mail: w.oortwijn@radboudumc.nl

Footnotes

Hide All

We are thankful for the valuable comments and suggestions from the anonymous reviewers. They have encouraged significant improvement of the manuscript. The time for writing this Perspective was funded by a grant from Eli Lilly and Company (i.e., Lilly Corporate Center, Indianapolis, USA). The funding organization did not place any restrictions on the content of the manuscript. W.O., the corresponding author, confirms that she had final responsibility for decision to submit for publication.

Footnotes

References

Hide All
1.Børlum Kristensen, F, Husereau, D, Huić, M, et al. (2019) Identifying the need for good practices in health technology assessment: Summary of the ISPOR HTA Council Working Group Report on Good Practices in HTA. Value Health 22: 1320.
2.Banta, HD (2003) The development of health technology assessment. Health Policy 63: 121132.
3.Bielecki, A, Nieszporska, S (2017) The proposal of philosophical basis of the health care system. Med Health Care Philos 20: 2335.
4.Velasco Garrido, M, Børlum Kristensen, F, Palmhoj Nielsen, C, Busse, R (2008) Health technology assessment and health policy-making in Europe. Copenhagen, Denmark: WHO Regional Office for Europe.
5.Angelis, A, Lange, A, Kavanos, P (2018) Using health technology assessment to assess value of new medicines: Results of a systematic review and expert consultation across eight European countries. Eur J Health Econ 19: 123152.
6.Lysdahl, KB, Mozygemba, K, Burns, JBC, Brönneke, JB, Hofmann, B, eds. (2016) Guidance for assessing effectiveness, economic aspects, ethical aspects, socio-cultural aspects and legal aspects in complex technologies [Online]. http://www.integrate-hta.eu/downloads/.
7.Bertram, MY, Lauer, JA, De Joncheere, K, et al. (2016) Cost-effectiveness thresholds: Pros and cons. Bull World Health Organ 94: 925930.
8.Abrishami, P, Oortwijn, W, Hofmann, B (2017) Ethics in HTA: Examining the “need for expansion.” Int J Health Policy Manag 6: 551553.
9.Kaló, Z, Gheorghe, A, Huic, M, Csanádi, M, Borlum Kristensen, F (2016) HTA implementation roadmap in Central and Eastern European countries. Health Econ 25, S1:179192.
10.Goetghebeur, M, Wagner, M, Samaha, D, et al. (2017) Exploring values of health technology assessment agencies using reflective multicriteria and rare disease case. Int J Technol Assess Health Care 33: 117.
11.Löblová, O (2018) What has health technology assessment ever done for us? J Health Services Res Policy 23: 134136.
12.Haycox, A (2016) Why Cancer? PharmacoEconomics 34: 625627.
13.Hofmann, B, Bond, K, Sandman, L (2018) Evaluating facts and facting evaluations: On the fact-value relationship in HTA. J Eval Clin Pract 24: 957965.
14.Juzwishin, DWM (2005) Educating publics and policy makers: Epistemic communities and the politics of evidence-based reform in Alberta and Saskatchewan. Thesis. Alberta: University of Alberta, 2005, p. 55.
15.Hoedemaekers, R, Oortwijn, W (2003) Problematic notions in Dutch health care package decisions. Health Care Anal 11: 287294.
16.Kleinhout-Vliek, T, de Bont, A, Boer, B (2017) The bare necessities? A realist review of necessity argumentations used in health care coverage decisions. Health Policy 121: 731744.
17.Hoffman, B (2013) Priority setting in health care: Trends and models from Scandinavian experiences. Med Health Care Philos 16: 349356.
18.Heintz, E, Arnberg, K, Levin, LA, Liliemark, J, Davidson, T (2014) The impact of health economic evaluations in Sweden. Z Evid Fortbild Qual Gesundhwes 108: 375382.
19.Matar, A, Hansson, MG, Höglund, AT (2018) “A perfect society”— Swedish policymakers’ ethical and social views on preconception expanded carrier screening. J Community Genet https://doi.org/10.1007/s12687-018-0389-x.
20.Höglund, AT, Falkenström, E (2018) The status of ethics in Swedish health care management: A qualitative study. BMC Health Serv Res 18: 608.
21.Angelis, A, Kavanos, P, Montibeller, G (2017) Resource allocation and priority setting in health care: A multi-criteria decision analysis problem of value? Glob Policy 8: 7683.
22.Oortwijn, W, van der Wilt, GJ, on behalf of the Special Interest Group on HTA and Ethics (2016) Challenges in contemporary HTA. A view from the outside. Int J Technol Assess Health Care 32: 12.
23.Oortwijn, W, Determann, D, Schiffers, K, Tan, SS, van der Tuin, J (2017) Towards integrated health technology assessment for improving decision-making in selected countries. Value Health 20: 11211130.
24.Klein, R, Day, P, Redmayne, S (1996) Managing scarcity: Priority setting and rationing in the National Health Service. Buckingham: Open University Press, 1996.
25.Baltussen, R, Jansen, MP, Mikkelsen, E, et al. (2016) Priority setting for universal health coverage: We need evidence-informed deliberative processes, not just more evidence on cost-effectiveness. Int J Health Policy Manag 5: 615618.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed