Health technology assessment in the United States

Luce, Bryan R.; Cohen, Rebecca

doi:10.1017/s0266462309090400

Cited by 23 publications

(17 citation statements)

References 8 publications

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“…[16] In the past decade in the US, there has been a mixture of public and private entities focused largely on CER. [17] As currently envisaged, CER in the US shares at least one of the same goals as HTA: to conduct and synthesize research comparing the benefits and harms of different interventions and strategies in order to prevent, diagnose, treat and monitor health conditions in 'real-world' settings. Such research gives ''clinicians and patients valid information to make decisions that will improve the performance of the US healthcare system.''…”

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confidence: 99%

International Comparison of Comparative Effectiveness Research in Five Jurisdictions

et al. 2010

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Spurred by a desire to improve quality of care and to understand the relative value of medical treatments, there has been a recent surge of interest in publicly funded comparative effectiveness research (CER) in the US. As health technology assessment (HTA) shares some of the same goals as CER, and publicly funded HTA has been a feature within other industrialized countries for many years, a review of HTA activities in some of these countries can be a helpful source of information for the US debate. Informed by a literature review, and in two cases augmented by informant interviews, we reviewed the organization of HTA activities in five jurisdictions: Canada, Sweden, Scotland, the Netherlands and Australia. We provide a summary description of the healthcare system in each country as well as a description of the key features of their HTA bodies, with a particular focus on the processes of HTA for listing medications on public formularies. Four of the committees evaluating medications for formulary inclusion are funded by, but remain at arm's length from, the government (Canada, Australia, Sweden and Scotland), while the process is fully embedded within the government in the Netherlands. Each of these jurisdictions has a stated preference for comparative outcomes evidence from randomized controlled trials, but will, under certain circumstances, accept randomized evidence using surrogate markers, other comparators that are not directly relevant or non-randomized evidence. Health technology evaluation committees largely comprise health professionals, with public representatives included in the Canadian, Australian and Scottish committees. Scotland is the only one of the five jurisdictions reviewed to have industry representation on the evaluation committee. We identified seven characteristics that are shared across the jurisdictions reviewed and that potentially serve as insights for development of CER in the US: (i) the process must be responsive to stakeholders' interests, in that the turn-around time for assessments must be minimized, transparency must be maximized, the process must be considered fair using universally agreed standards and the process must be modifiable based on stakeholders' requirements; (ii) the assessment of medical technologies other than drugs may present different challenges and is managed separately in other HTA organizations; (iii) because of the link between HTA and reimbursement decisions, completion of the HTA process following regulatory approval can delay market access to new technologies, thus closer integration between regulatory approval and HTA processes is being explored internationally; (iv) there is a direct or indirect link to reimbursement in the jurisdictions explored - without this link the role of CER in the US will remain advisory; (v) each jurisdiction reviewed benefits from a single payer that is informed by the process - given the diverse multipayer environment in the US, CER in the US may usefully focus on generating comparative effectiveness evidence; (vi) a common ...

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confidence: 99%

International Comparison of Comparative Effectiveness Research in Five Jurisdictions

et al. 2010

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“…National efforts to establish health technology assessment bodies have faltered [3]. The Medicare program, which provides health insurance to some 40 million, mostly older Americans, does not consider costs and costeffectiveness when deciding whether to cover a new technology.…”

Section: The Us As a Laggard In Health Policymentioning

confidence: 99%

Is the US “leading from behind” on health policy?

Neumann

Saret

2013

Eur J Health Econ

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“…This pioneering program was prominent internationally and lasted until 1995, when it was defunded. Luce and Singer Cohen (2009) describe several other federal efforts, including the National Center of Health Care Technology, which reported to the U.S. Public Health Service, and the Agency for Health Care Policy and Research (AHCPR), which engaged in a range of evaluative activities, many of which could be described as health technology assessment. Luce and Singer Cohen discuss why most of these federal efforts failed.…”

Section: The United Statesmentioning

confidence: 99%

“…The United Kingdom, in common with many European countries, and Canada and Australia, has embraced the notion of health technology assessment (HTA), a process that generates evidence on the clinical value and cost-effectiveness of health technologies, which can be used to inform coverage decisions. In the United States, by contrast, HTA historically has played only a minor role in such decisions (Luce and Singer Cohen 2009;Neumann 2004). Indeed, U.S. public policy has generally been much more oriented toward stimulating technology generation through the funding of basic research, rather than regulating technology adoption and diffusion.…”

Section: Introductionmentioning

confidence: 99%

Another Special Relationship? Interactions between Health Technology Policies and Health Care Systems in the United States and the United Kingdom

Sampat

Drummond²

2011

Journal of Health Politics, Policy and Law

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Confronted with similar challenges, the United States and the United Kingdom have adopted very different health technology policies. In the United States, the focus has been on technology creation, in particular the funding of basic biomedical research at the National Institutes of Health. This both reflects and reinforces an innovation-first culture in the United States, including in health. By contrast, the United Kingdom has been much more heavily committed to applied research and evaluative research, including health-technology assessment. That is, while U.S. policy has focused on technology creation, U.K. policy has been more oriented toward technology diffusion. This article surveys the sources of these differences. We consider the impacts of institutional, cultural, and other factors that may explain them, and emphasize that it is hard to disentangle the separate effects of those factors. We conclude with a discussion of the difficulties in drawing cross-national lessons in health technology policy.

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Health technology assessment in the United States

Cited by 23 publications

References 8 publications

International Comparison of Comparative Effectiveness Research in Five Jurisdictions

International Comparison of Comparative Effectiveness Research in Five Jurisdictions

Is the US “leading from behind” on health policy?

Another Special Relationship? Interactions between Health Technology Policies and Health Care Systems in the United States and the United Kingdom

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