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

Published online by Cambridge University Press:  08 April 2019

Wija Oortwijn  and
Philip Klein
Wija Oortwijn*
Affiliation:
Partner, Ecorys Nederland B.V.; Assistant Professor, Radboud university medical centre, Department for Health Evidence
Philip Klein
Affiliation:
Consultant, Ecorys Nederland B.V.
*
Author for correspondence: Wija Oortwijn, E-mail: [email protected]
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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.

Keywords

Health technology assessmentHealth systemsLegitimate decision makingEvidence-informed deliberative processes
Type
Perspective
Information
International Journal of Technology Assessment in Health Care , Volume 35 , Issue 2 , 2019 , pp. 82 - 84
Copyright
Copyright © Cambridge University Press 2019 

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Footnotes

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.

References

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: 13–20.Google Scholar
2.Banta, HD (2003) The development of health technology assessment. Health Policy 63: 121–132.Google Scholar
3.Bielecki, A, Nieszporska, S (2017) The proposal of philosophical basis of the health care system. Med Health Care Philos 20: 23–35.Google Scholar
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.Google Scholar
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: 123–152.Google Scholar
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/.Google Scholar
7.Bertram, MY, Lauer, JA, De Joncheere, K, et al. (2016) Cost-effectiveness thresholds: Pros and cons. Bull World Health Organ 94: 925–930.Google Scholar
8.Abrishami, P, Oortwijn, W, Hofmann, B (2017) Ethics in HTA: Examining the “need for expansion.” Int J Health Policy Manag 6: 551–553.10.15171/ijhpm.2017.43Google Scholar
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, S1:179–192.Google Scholar
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: 1–17.Google Scholar
11.Löblová, O (2018) What has health technology assessment ever done for us? J Health Services Res Policy 23: 134–136.Google Scholar
12.Haycox, A (2016) Why Cancer? PharmacoEconomics 34: 625–627.Google Scholar
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: 957–965.Google Scholar
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.Google Scholar
15.Hoedemaekers, R, Oortwijn, W (2003) Problematic notions in Dutch health care package decisions. Health Care Anal 11: 287–294.Google Scholar
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: 731–744.Google Scholar
17.Hoffman, B (2013) Priority setting in health care: Trends and models from Scandinavian experiences. Med Health Care Philos 16: 349–356.Google Scholar
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: 375–382.Google Scholar
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.Google Scholar
20.Höglund, AT, Falkenström, E (2018) The status of ethics in Swedish health care management: A qualitative study. BMC Health Serv Res 18: 608.Google Scholar
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: 76–83.Google Scholar
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: 1–2.Google Scholar
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: 1121–1130.Google Scholar
24.Klein, R, Day, P, Redmayne, S (1996) Managing scarcity: Priority setting and rationing in the National Health Service. Buckingham: Open University Press, 1996.Google Scholar
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: 615–618.Google Scholar