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Toward a Strategy to Involve Patients in Health Technology Assessment in Spain

  • Ana Toledo-Chávarri (a1) (a2) (a3), Yolanda Alvarez-Perez (a1), Yolanda Triñanes (a4), Lilisbeth Perestelo-Pérez (a5), Mireia Espallargues (a2) (a6), Matilde Palma (a7) and Pedro Serrano-Aguilar (a2) (a5)...



The aim of this study was to develop a feasible and effective strategy to involve patients in the Spanish Network of Agencies of Health Technology Assessment (RedETS).


The framework for patient involvement (PI) in the assessment activities and processes of RedETS were developed through a research project that included: (i) a systematic search of the international literature describing a strategy and/or a methodology linking health technology assessment (HTA) and PI; (ii) a qualitative study through interviews with RedETS members to analyze the perceptions of PI among HTA managers in the Spanish context; (iii) a Delphi consultation with three large platforms of patients, carers and consumer organizations in Spain about their perspectives of PI; (iv) a consensus process with the members of the RedETS Governing Council to define the final strategy.


Three main themes were identified in the literature and Web site review: (i) PI methods for the different HTA phases; (ii) Participant definition and selection; (iii) Resources needed. A three-step implementation strategy was proposed: (i) short-term actions: piloting and testing patient participation in HTA and building patients' capacity; (ii) medium-term actions: broadening the participation of patients, and building internal capacity; (iii) long-term actions: consolidating and mainstreaming patient involvement


Patient participation can be incorporated into almost all the HTA phases and products with greater or lesser degrees of difficulty. However, a progressive implementation strategy is suggested for a feasible PI process.


Corresponding author

Author for correspondence: Ana Toledo-Chávarri, E-mail:


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1.Morrison, C, Dearden, A (2013) Beyond tokenistic participation: Using representational artefacts to enable meaningful public participation in health service design. Health Policy 112, 179186.
2.European Patients’ Forum (2015) Involvement in health technology assessment in Europe. Results of the EPF Survey.
3.OHTAC Public Engagement Subcommittee (2015) Public Engagement for Health Technology Assessment at Health Quality Ontario—Final Report From the Ontario Health Technology Advisory Committee Public Engagement Subcommittee.
4.Facey, K, Stafinski, T (2015) HTAi Interest Sub-Group for Patient/Citizen Involvement in HTA. In: G-I-N PUBLIC Toolkit Beyond Guidelines. G-I-N Public Working Group. (accessed February 16, 2019).
5.Ley 16/2003, de 28 de mayo, de Cohesión y Calidad del Sistema Nacional de Salud. BOE núm. 128, de 29 de mayo de 2003. Referencia: BOE-A-2003-10715. (accessed February 17, 2019).
6.Ley 33/2011, de 4 de octubre, General de Salud Pública Jefatura del Estado «BOE» núm. 240, de 5 de octubre de 2011 Referencia: BOE-A-2011-15623. (accessed February 16, 2019).
7.Caron-Flinterman, JF, Broerse, JEW, Bunders, JFG (2007). Patient partnership in decision-making on biomedical research. Sci Technol Hum Values 32, 339368.
8.Grupo de trabajo de implicación de pacientes en el desarrollo de GPC (2010) Implicación de Pacientes en el Desarrollo de Guías de Práctica Clínica: Manual Metodológico. Ministerio de Sanidad, Servicios Sociales e Igualdad. Instituto Aragonés de Ciencias de la Salud-IACS. Guías de Práctica Clínica en el SNS: IACS No 2010/01.
9.Perestelo-Pérez, L, Salcedo-Fernández, F, Toledo-Chávarri, A, et al. (2017) Desarrollo de herramientas de ayuda para la toma de decisiones compartida derivadas de las recomendaciones de las guías de práctica clínica. Ministerio de Sanidad, Servicios Sociales e Igualdad. Servicio de Evaluación del Servicio Canario de la Salud. Informes de Evaluación de Tecnologías Sanitarias.
10.Hermosilla-Gago, T, Grupo de Expertos de las Agencias de Evaluación de Tecnologías Sanitarias de España (2011) Manual para adaptar informes de evaluación de tecnologías sanitarias a los ciudadanos (MADETSCI). Sevilla: Agencia de Evaluación de Tecnologías Sanitarias de Andalucía. Consejería de Salud. Junta de Andalucía y Ministerio de Sanidad y Consumo.
11.Rodríguez, M, Espallargues, M (2014) Incorporación de pacientes, cuidadores y población en general en la evaluación de tecnologías sanitarias (ETS): experiencias de agencias y unidades de ETS en España. Barcelona: Agència de Qualitat i Avaluació Sanitàries de Catalunya.
12.Braun, V, Clarke, V (2006) Using thematic analysis in psychology. Qual Res Psychol 3, 77101.
13.Thomas, J, Harden, A (2008) Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol 8, 45.
14.Gauvin, F-P, Abelson, J, Giacomini, M, Eyles, J, Lavis, JN (2011) Moving cautiously: Public involvement and the health technology assessment community. Int J Technol Assess Health Care 27, 4349.
15.Menon, D (2011) Role of patient and public participation in health technology assessment and coverage decisions. Expert Rev Pharmacoeconomics Outcomes Res 11, 7589.
16.Lopes, E, Carter, D, Street, J (2015) Power relations and contrasting conceptions of evidence in patient-involvement processes used to inform health funding decisions in Australia. Soc Sci Med 135, 8491.
17.Boivin, A, Green, J, van der Meulen, J, Légaré, F, Nolte, E (2009) Why consider patients’ preferences? A discourse analysis of clinical practice guideline developers. Med Care 47, 908915.
18.Wortley, S, Tong, A, Howard, K (2016) Preferences for engagement in health technology assessment decision-making: a nominal group technique with members of the public. BMJ Open 6, e010265.
19.Martin, GP (2008) ‘Ordinary people only’: Knowledge, representativeness, and the publics of public participation in healthcare. Sociol Health Illn 30, 3554.
20.Gauvin, F-P, Abelson, J, Lavis, JN (2014) Evidence Brief: Strengthening Public and Patient Engagement in Health Technology Assessment in Ontario. Hamilton, Canada: McMaster Health Forum.
21.Moran, R, Davidson, P (2011) An uneven spread: a review of public involvement in the National Institute of Health Research's Health Technology Assessment program. Int J Technol Assess Health Care 27, 343347.
22.Staniszewska, S, Brett, J, Mockford, C, Barber, R (2011) The GRIPP checklist: Strengthening the quality of patient and public involvement reporting in research. Int J Technol Assess Health Care 27, 391399.
23.Weeks, L, Polisena, J, Scott, AM, Holtorf, A-P, Staniszewska, S, Facey, K (2017) Evaluation of patient and public involvement initiatives in health technology assessment: A survey of international agencies. Int J Technol Assess Health Care 33, 715723.
24.Abelson, J, Wagner, F, DeJean, D, et al. (2016) Public and patient involvement in health technology assessment: a framework for action. Int J Technol Assess Health Care 32, 256264.
25.Mamzer, M-F, Dubois, S, Saout, C, et al. (2018) How to strengthen the presence of patients in health technology assessments conducted by the health authorities. Therapie 73, 95105.
26.Facey, K, Hansen, H, Single, A (2017) Patient Involvement in Health Technology Assesment. Singapore: Adis.
27.Toledo-Chávarri, A, Perestelo-Pérez, L, Álvarez-Pérez, Y, et al. (2018) Participación de los pacientes en la Evaluación de Tecnologías Sanitarias: manual metodológico. Ministerio de Sanidad, Servicios Sociales e Igualdad. Servicio de Evaluación del Servicio Canario de la Salud, Informes de Evaluación de Tecnologías Sanitarias.


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