Introduction to Health Technology Assessment (original) (raw)
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Developing Health Technology Assessment to address health care system needs
Health Policy, 2010
This article discusses the development of Heath Technology Assessment methods and HTA institutions, in regards to meeting the information needs of all levels and fields of health policy-making. On the one hand, HTA needs to expand and develop its methods. Although health products and health care services have been its preponderant focus to date, HTA should develop to increase its focus on the "technologies applied to health care" (i.e. the regulatory and policy measures for managing and organizing health care systems) and on policies in non-health care sectors. Such a knowledge synthesis for health policy should not necessarily be called HTA or conducted by narrowly defined HTA agencies. However, the trends observed in several European HTA agencies indicate the recognition of these development needs. Countries embarking on HTA should not consider establishing separate agencies for HTA, quality development, performance measurement, and health services development, but should rather combine these functions and goals into a common knowledge strategy for evidence-informed decision-making on health care and the health system.
International Journal of Technology Assessment in Health Care, 2005
Objectives: Health Technology Assessment (HTA) is defined as a policy research approach that examines the short-and long-term social consequences of the application or use of technology. Internationally different institutions have translated this definition to local contexts. In Denmark, HTA is comprehensive with focus on four aspects of the problem in question (technology [clinical evidence], economy, patient, and organization). The objective of this study is to study how the application of HTA differs across leading countries and to study the extent to which Danish HTA reports differ from foreign HTAs. Methods: A sample of 433 HTA reports published in the period 1989-2002 by eleven leading institutions or agencies in Denmark and eight other countries were reviewed. We looked at the characteristics of the HTA with respect to focus on the four main aspects and the manner in which each aspect has been approached. Results: The study shows health technology procedures to be the most common type of health technology assessed in HTAs and literature review to be the most often used method of analysis. Policy recommendations are only present in approximately half of the HTA reports. Conclusions: In the HTAs one generally sees a great focus on the clinical aspect of health technologies, leaving the economic, the patient-related, and the organizational aspect much more unanalyzed. The Danish HTAs generally have a wider scope than HTAs produced in other countries and tend to focus more frequently on patient-related and organizational dimensions.
Influence of Health Technology Assessment and Its Measurement
International journal of technology assessment in health care, 2016
The aim of this study was to obtain information on methods used to measure health technology assessment (HTA) influence, decisions that were influenced, and outcomes linked to HTA. Electronic databases were used to locate studies in which HTA influence had been demonstrated. Inclusion criteria were studies that reliably reported consideration by decision makers of HTA findings; comparative studies of technology use before and after HTA; and details of changes in policy, health outcomes, or research that could be credibly linked to an HTA. Fifty-one studies were selected for review. Settings were national (24), regional (12), both national and regional (3) hospitals (9), and multinational (3). The most common approach to appraisal of influence was review of policy or administrative decisions following HTA recommendations (51 percent). Eighteen studies (35 percent) reported interview or survey findings, thirteen (26 percent) reviewed administrative data, and six considered the influen...
Health-technology assessment: Its role in strengthening health systems in developing countries
Since the 1900s, there has been rapid generation, continuous innovation and incremental improvement of medical technologies. However, not all innovation and development result in overall health gains, nor does their implementation result in improved cost-efficient solutions. Health systems worldwide need to ensure efficiency and demonstrate value for investment, and when coupled with cost pressures and constrained resources they create a difficult decision-making environment for investing in health technology. To overcome these challenges there is a need to evaluate all technologies and eliminate those that are ineffective and not cost-effective, and that have been superseded. Evaluation should consider the availability of resources as well as the organisational, societal, legal and ethical issues pertaining to the country or the local setting. Starting in the 1950s, the concept of health-technology assessment (HTA) has been developed to generate evidence-based foundations to illustrate the relevant preconditions and consequences when using a health technology. It involves multidisciplinary teams applying a systematic approach that is grounded in the scientific method. The goal is to generate, or synthesise, the highest possible level of evidence to inform the decision-making process about health technologies. HTA offers a simple structure to unify the multiple dimensions (including clinical, patient-related, organisational, economic, ethical and legal aspects) in the consideration of complex problems/questions regarding technology deployment and reimbursement. However, its role has evolved to encompass technologies from inception to obsolescence as well as early awareness and alert systems, reassessment post introduction, evidence briefs and recommendation for disinvestment. HTA is increasingly seen as an innovative way to sustain and improve health systems. This process can contribute towards decision-making information at all levels of the healthcare system, including political, administrative and clinical. It is regarded as a ‘way of thinking’ to impr
Health technology assessment: history and demand
Journal of Public Health, 2003
Health technology assessment (HTA)--the provision to decision makers of information on the value of treatments and tests--has come of age in the last two decades. But it has deep roots in health care, with notable landmarks in (1) the mid eighteenth-century development of empiricism, (2) the twentieth century interest in outcomes and variation in health care, and (3) the pioneering work of Archie Cochrane and others in the 1970s. Three main forces have driven the recent developments of HTA: a combination of concerns about the adoption of unproven technologies, rising costs, and an inexorable rise in consumer expectations. The HTA response, essentially initiatives supporting the provision of reliable synthesised research information on the effects and costs of health technologies, have been well supported in the United Kingdom and internationally. We can be sure that HTA is here to stay.
The Status of Health Technology Assessment Worldwide: Results of an International Survey
International Journal of Technology Assessment in Health Care, 1997
Health technology assessment (HTA) has increasingly become a valuable tool to examine effectiveness, quality of care, patient outcomes, and cost-effectiveness of health care technologies. In 1994 and 1995, a survey was conducted to document the scope of worldwide HTA activities; 103 organizations from 24 countries responded. This paper summarizes the results of this international survey, including a description of each country's program, types of technologies assessed, methodologies used, and dissemination approaches. Results for Canada, the United States, and European and other countries are presented separately.
The Value of Health Technology Assessment: a mixed methods framework
F1000Research, 2017
Whilst much research has been undertaken on establishing what factors influence improved decision-making including good governance structures, expertise, political and institutional factors, resources and participation, how such influences on decision-making interact with local context and health systems, leading to impact on health outcomes, is less understood. The focus of our research is on the impact of Health Technology Assessment (HTA) as a tool for priority-setting with its explicit consideration of costs and benefits. Where evaluations have been undertaken, they mainly focus on processes or outcomes at the decision-making level, with impact on health outcomes rarely measured. Even in countries where HTA programmes are well established, evidence which identifies their outcomes and impact in terms of health gains is limited. For countries with greater capacity constraints, how decision-making interacts with ‘context’ leading to health outcomes is even less explored and arguabl...
History of health technology assessment: A commentary
International Journal of Technology Assessment in Health Care, 2009
I have long felt the need for documentation on the global development—I could probably pin it to the moment I was visiting health technology assessment (HTA) institutions in the United States in 1995, and was looking forward to a trip to the Office of Technology Assessment, only to be told it had just been shut. Instead, I visited the Office of Health Technology Assessment in Washington. In addition, I have observed that some regular attendees of annual meetings of International Society of Technology Assessment in Health Care (ISTAHC) and then Health Technology Assessment International (HTAi), have been slowly dropping out, so that a lot of the history as well as their valuable experiences and expertise have been lost. To be fair, studies have been written about specific HTA institutions, programs, countries, and even regions. Attempts have also been made to chart the history of HTA, but these have, however, fizzled out. Why is this important? Going back to my personal experience, w...
MAPPING OF HEALTH TECHNOLOGY ASSESSMENT IN SELECTED COUNTRIES
International Journal of Technology Assessment in Health Care, 2013
Objectives: The aim of this study was to develop and apply an instrument to map the level of health technology assessment (HTA) development at country level in selected countries. We examined middle-income countries (Argentina, Brazil, India, Indonesia, Malaysia, Mexico, and Russia) and countries well-known for their comprehensive HTA programs (Australia, Canada, and United Kingdom). Methods: A review of relevant key documents regarding the HTA process was performed to develop the instrument which was then reviewed by selected HTAi members and revised. We identified and collected relevant information to map the level of HTA in the selected countries. This was supplemented by information from a structured survey among HTA experts in the selected countries (response rate: 65/385). Results: Mapping of HTA in a country can be done by focusing on the level of institutionalization and the HTA process (identification, priority setting, assessment, appraisal, reporting, dissemination, and implementation in policy and practice). Although HTA is most advanced in industrialized countries, there is a growing community in middle-income countries that uses HTA. For example, Brazil is rapidly developing effective HTA programs. India and Russia are at the very beginning of introducing HTA. The other middle-income countries show intermediate levels of HTA development compared with the reference countries. Conclusions: This study presents a set of indicators for documenting the current level and trends in HTA at country level. The findings can be used as a baseline measurement for future monitoring and evaluation. This will allow a variety of stakeholders to assess the development of HTA in their country, help inform strategies, and justify expenditure for HTA.