How does HTA addresses current social expectations? An international survey

Abstract

Objectives Integration of ethics into technology assessment in healthcare (HTA) reports is directly linked to the need of decision makers to provide rational grounds justifying their social choices. In a decision-making paradigm, facts and values are intertwined and the social role of HTA reports is to provide relevant information to decision makers. Since 2003, numerous surveys and discussions have addressed different aspects of the integration of ethics into HTA. This study aims to clarify how HTA professionals consider the integration of ethics into HTA, so an international survey was conducted in 2018 and the results are reported here. Methods A survey comprising twenty-two questions was designed and carried out from April 2018 to July 2018. Three hundred and twenty-eight HTA agencies from seventy-five countries were invited to participate in this survey. Results Eighty-nine participants completed the survey, representing a participation rate of twenty-seven percent. As to how HTA reports should fulfill their social role, over 84 percent of respondents agreed upon the necessity to address this role for decision makers, patients, and citizens. At a lower level, the same was found regarding the necessity to make value-judgments explicit in different report sections, including ethical analysis. This contrasts with the response-variability obtained on the status of ethical analysis with the exception of the expertise required. Variability in stakeholder-participation usefulness was also observed. Conclusions This study reveals the importance of a three-phase approach, including assessment, contextual data, and recommendations, and highlights the necessity to make explicit value-judgments and have a systematic ethical analysis in order to fulfill HTA's social role in guiding decision makers.

Learning and practicing more value-reflective, problem-setting health technology assessment: experiences and lessons from the VALIDATE project

“…Taking these things together, we think it is worthwhile to monitor and publish future uses of VALIDATE, their added value and the limits encountered. With due modesty, we encourage the field to scrutinize such experiences and lessons, and consider whether VALIDATE should become a more common element of the field, as a contribution to address normativity of HTA as reflected in the new definition of HTA (17) and the views expressed in by Gagnon et al’ s (15) survey. Essential for that would be to integrate it in curricula and to make attention to ethical assessment and diversity in background theories much more common in HTA research.…”

Assessing medical devices: a qualitative study from the validate perspective

“…This implies that the activities of HTA agencies and practitioners are not solely guided by established HTA guidelines but are also influenced by practitioners' views on how HTA can improve outcomes of health technology for society. Given that HTA is often presumed to provide information about the public value of health technology, transcending particular interests, HTA practitioners and agencies are committed to methodological principles presumed to guarantee a neutral or unbiased evidence base for decision-makers (13)(14)(15). These commitments may conflict with new types of evidence, outcome measures, and methodologies proposed for assessing medical devices.…”