How to Avoid Giving the Right Answers to the Wrong Questions: The Need for Integrated Assessments of Complex Health Technologies

Abstract

Health technologies are becoming increasingly complex and contemporary health technology assessment (HTA) is only partly equipped to address this complexity. The project "Integrated assessments of complex health technologies" (INTEGRATE-HTA), funded by the European Commission, was initiated with the overall objective to develop concepts and methods to enable patient-centered, integrated assessments of the effectiveness, and the economic, social, cultural, and ethical issues of complex technologies that take context and implementation issues into account. The project resulted in a series of guidances that should support the work of HTA scientists and decision makers alike.This issue of the journal presents the main findings of the project. These are among others: integration needs to start from the beginning, stakeholder need to be involved throughout the process, and traditional methodologies in HTA need to be adapted to allow for integrated assessments. In addition, in this issue members of a Canadian HTA-agency describe the application of some of the guidances in real practice and members of a national HTA-agency, the HTAi Interest Group on Developing Countries, and the European network for Health Technology Assessment (EUnetHTA) offer reflections on the usefulness of INTEGRATE-HTA in providing meaningful and relevant HTA.The psychologist and Nobel laureate Daniel Kahneman has spent a great part of his career on analyzing how humans (be it "ordinary citizens" or academics) behave when confronted with difficult questions for which they do not have an immediate answer. Rather than trying to answer the difficult (and relevant) question we tend to simply substitute it for an easier question and answer the latter. For example, the question "How far will a certain candidate go in politics?" will often be substituted by the question "Does this candidate look like a political winner?" (1). As a result, we often end up answering the questions that we can answer, however, these are not necessarily the questions that we should answer. Do we also see this in health technology assessment (HTA)? The answer is yes, and in this theme issue of the journal we provide some steps toward solutions for this.Delivery of health care that is effective, efficient, and of good quality depends, among others, on the added value of the health technology. To inform decision makers regarding what is considered a valuable health technology, is the purpose of HTA. However, this is more difficult than it sounds. Among the questions HTA-researchers are typically confronted with are: Does this health technology work better for some people than for others? What qualifications or skills are needed to use the health technology? To what extent does a specific context enable or limit its potential? And what do we actually mean by a valuable health technology?The more complex a health technology and/or the conditions it is addressing, the more complex is its assessment. A pertinent case is palliative care: patients differ with regard to their underlyin...

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“…A recent European Union (EU)-funded project developed guidance specifically to address the challenge of evaluating complex intervention in HTAs (10). In future research, it would be interesting to see whether approaches to conducting and integrating systematic assessments of the different aspects important in HTAs evaluating public health interventions will become visible.…”

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