From Health Technology Assessment to Health Technology Sustainability

Abstract

This paper aims to propose a methodological lens to the assessment of technological innovations in healthcare based on the principles of social, economic, and political sustainability. Starting from the consideration of a lack of a unified interpretative framework of health technology assessment, using a content analysis of the relevant literature on the topic, we identified both the scientific perspectives adopted by the scholars and the most widely discussed topics. Consequently, the less explored scientific areas were framed, and, therefore, those more susceptible to further investigation came to light. The result is an overall picture which highlights the absence of unified and generally accepted approaches to evaluation, together with the lack of awareness on the fact that the multiplicity of methods adopted is essentially connected to the multiplicity of innovations, for each of which a method (or a set of methods) of preferable evaluation can be prefigured. Based on these observations, we propose a general reference framework for evaluation, based on the Viable Systems Approach (vSa), and a schematic outline of the connections between the complexity of innovations and the evaluation methodologies.Sustainability 2018, 10, 4748 2 of 22 other relates to the increasingly demanding policy makers and funders, who require greater evidence for new and existing therapies [6].Adopted primarily in the USA in the 1970s [7,8] and rapidly spread in Europe in the following decades, HTAs are currently being introduced in most countries of the world [3]. During the 1970s, the focus was to summarize the evidence concerning studies on the cost effectiveness of health interventions. Afterwards, at the end of the 1990s, HTA widened its focus from the evaluation of only large, expensive and machine-based technologies also to smaller technologies and healthcare, addressing broader issues (organizational, social implications, and ethics) [7]. Currently, the health technology assessment processes critically evaluate reimbursement submissions of pharmaceuticals, simple medical devices, and complex medical devices, such as hospital technologies [9], vaccines, procedures, health services, and public health interventions. Therefore, they are becoming an important tool to support health policy decisions in many countries [9].Nowadays, the importance of HTAs has increased further, also spreading in Central and Eastern European countries. HTA activities have a national focus associated with the Ministry of Health and, by influencing health policy documents of the European Commission, it seems likely that, in the future, the HTA will be institutionalized somehow as part of the EU's activities. The task of applying HTA techniques for the evaluation of new health technologies is devolved to the different government support bodies (e.g., NICE in the UK, IQWIG in Germany, and AGENAS in Italy).Thus, HTAs act to define a policy research approach that examines the short and long-term social, economic, and political consequences of the applicatio...

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