Deliberative Appraisal Processes in Health Technology Assessment

Abstract


 Deliberation — the bringing together of individuals with multiple perspectives, experiences, and values to critically examine evidence, share reasons and rationales, and reach a decision on a course of action — occurs at all stages of the health technology assessment (HTA) process.
 The focus of this report is on deliberation at the committee appraisal stage of HTA.
 The objectives are to review and conceptualize the evidence and key considerations for deliberative processes at the committee appraisal stage of HTA and the available guidance for assessing the quality of the deliberative process at this stage.
 National and international practices for deliberative processes at the committee appraisal stage of HTA vary depending on contextual considerations (e.g., type of health technology and the medical condition being treated), the mandate of the HTA organization, health system and funding structures, and societal values.
 Each aspect of the deliberative appraisal process should be rooted in the values of the health system and be principled, clear, transparent, purposeful, and reasoned.

Access to novel drugs and therapeutics for children and youth: Eliciting citizens' values to inform public funding decisions

“…In Canada, as elsewhere, the operationalization of DPE in HTA processes remains nascent. CADTH is actively reviewing the integration of deliberative processes into the appraisal stage of its HTA process, 39 while INESSS has recently instituted a flexible evaluation framework that can be adapted to integrate public perspectives 50 . Variability in defining the ‘public’ remains a key issue for scoping the specific role of participants, however 61–63 .…”

“…Structured and meaningful incorporation of these insights into health policy‐making processes helps to legitimize decisions that impact the populace. In many jurisdictions, including Canada, public engagement has been embraced as a component of HTA deliberations, but implementation is variable and best practices for evidence‐informed deliberation are still evolving 37–39 . Furthermore, input from non‐patient publics , particularly youth, is often neglected or underrepresented in HTA processes, which might erode the societal legitimacy of recommendations provided or decisions made.…”

“…In many jurisdictions, including Canada, public engagement has been embraced as a component of HTA deliberations, but implementation is variable and best practices for evidence-informed deliberation are still evolving. [37][38][39] Furthermore, input from non-patient publics, particularly youth, is often neglected or underrepresented in HTA processes, which might erode the societal legitimacy of recommendations provided or decisions made. We conducted a series of citizen panels with members of the Canadian public to elicit and prioritize values relevant to HTA for precision child health technologies.…”

How We Might Further Integrate Considerations of Environmental Impact When Assessing the Value of Health Technologies

“…Deliberation is carried out by an expert review committee comprising individuals with different experiences, perspectives, and values. A fulsome review of deliberative processes used by HTA committees to appraise the various types of data has been conducted by Richardson et al [12].…”

The adoption of ICT and robotic automation systems in the pharmaceutical industry

“…The healthcare industry (private and public) has long been utilising advanced digital equipment that is envisaged to advance medical progression on the one hand, while ensuring economic efficiency and cost pressure intensification on the other (Richardson, Mittmann & Kaunelis 2021).…”