Harmonization of HTA Methodology

HTA agencies have been collaborating for several years. One such example is the European network for Health Technology Assessment (EUnetHTA) Project (4;Reference Kristensen, Mäkelä and Neikter7), which was set up to create an effective and sustainable network for HTA across Europe. The project aims to develop and implement practical tools that provide reliable, timely, transparent, and transferable information for HTA. EUnetHTA now forms a permanent network and also has partners outside Europe. EUnetHTA Joint Action on HTA is a key mechanism for collaboration from 2010 to 2012.

One of the main results of the EUnetHTA Project is the HTA Core Model^® (2;3) which provides a framework for producing and sharing results of HTA. This model consists of nine domains: Health problem and current use of the technology; Description and technical characteristics of technology; Safety; Clinical effectiveness; Costs and economic evaluation; Ethical analysis; Organizational aspects; Social aspects; and Legal aspects. These domains are subsequently divided into Topics and Issues. An online pilot version of the HTA Core Model^® is currently only available to EUnetHTA member agencies. Guidance on the use of the HTA Core Model^® and how to answer actual research questions is compiled into the HTA Core Model^® Handbook (5). The Handbook also contains general guidelines on searching and information sources.

Toward International Standardization of Search Methods

HTA organizations, and in particular information specialists, would benefit from greater standardization in searching and reporting search processes. Such standardization would serve as guidance for those who conduct searches for HTA and would also increase the transparency of search methods. Admittedly, the scope of searches is inevitably influenced by the type of assessment, the available resources (time, budget, and expertise), and the particular needs of the HTA agencies. However, within this variation harmonization of search methods internationally would contribute to more effective collaboration and increase the transferability of search results and in this way be beneficial to all HTA organizations.

The HTA Core Model® could potentially evolve into such a standard and become a common tool for HTA information specialists. Certainly the Core Model already provides useful suggestions and recommendations for information sources and search methods within most domains and for most issues.

There is a great need for the expertise of information specialists. For example, they could contribute to and enhance the HTA Core Model® by developing and updating search guidelines. Search guidelines for some domains (e.g., Legal and Social domains) are currently lacking and new applications (e.g., for screening and rehabilitation) of the HTA Core Model® still need to be developed. Information specialists could also help in testing and validating the Core Model and search guidelines when they conduct HTA searches within their own organizations.

It is important to avoid duplication of effort when developing search guidelines. International collaboration is needed to obtain an overview of existing tools, Web sites, and handbooks such as the HTAi Vortal, the InterTASC Information Specialists' Sub-group Search Filter Resource, the searching for studies chapters of the Cochrane Handbook for Systematic Reviews of Interventions and the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy (Reference de Vet, Eisinga, Riphagen, Aertgeerts and Pewsner1;6;Reference Lefebvre, Manheimer, Glanville, Higgins and Green8;9). In the HTA Core Model®, links to such resources could be embedded in the search guidelines to facilitate access. The search guidelines could also be used for educational purposes. New information specialists with little or no previous knowledge of HTA could quickly and easily become acquainted with recommended, up-to-date search methodology.

Search guidelines need to be created carefully to avoid making them too restrictive. Different types of searches are needed for full versus rapid reviews, and different information sources need to be used when assessing new and emerging health technologies. In addition to recommended information sources, guidelines should allow for the use of local information resources such as national databases, registers, and statistics. It is also recognized that different review topics require different approaches. For example, searching for pharmaceutical information differs considerably from searching for interventions related to the organization of health services.

Although produced within a predominantly European network, the EUnetHTA search guidelines and the HTA Core Model® is an important opportunity for developing a global tool for all HTA information specialists. The HTAi Interest Sub-group on Information Resources (IRG) could serve as a medium for collaboration between information specialists and EUnetHTA. The HTA Core Model® offers both an exciting opportunity and challenge for information specialists who wish to become actively involved in the further development of this work.