Tackling ethical issues in health technology assessment: A proposed framework

Abstract

Objectives: Values are intrinsic to the use of health technology assessments (HTAs) in health policy, but neglecting value assumptions in HTA makes their results appear more robust or normatively neutral than may be the case. Results of a 2003 survey by the International Network of Agencies for Health Technology Assessment (INAHTA) revealed the existence of disparate methods for making values and ethical issues explicit when conducting HTA.Methods: An Ethics Working Group, with representation from sixteen agencies, was established to develop a framework for addressing ethical issues in HTA. Using an iterative approach, with email exchanges and face-to-face workshops, a report on Handling Ethical Issues was produced.Results: This study describes the development process and the agreed upon framework for reflexive ethical analysis that aims to uncover and explore the ethical implications of technologies through an integrated, context-sensitive approach and situates the proposed framework within previous work in the development of ethics analysis in HTA.Conclusions: It is important that methodological approaches to address ethical reflection in HTA be integrative and context sensitive. The question-based approach described and recommended here is meant to elicit this type of reflection in a way that can be used by HTA agencies. The questions proposed are considered only as a starting point for handling ethics issues, but their use would represent a significant improvement over much of the existing practice.

La evaluación de nuevas tecnologías en salud en hospitales: revisión narrativa

“…Esto se justifica por el hecho de que muchas de las decisiones relacionadas con las tecnologías de la salud (priorización, inversión, adopción, y desinversión) se realizan en los hospitales 42 .…”

Pitfalls in Reimbursement Decisions for Oncology Drugs in South Korea: Need for Addressing the Ethical Dimensions in Technology Assessment

“…In addition to evidentiary and scientific values, responsible decision-makers should make judgments using non-evidentiary and ethical values in a contextsensitive approach to determine what is good for society (Rawlins and Culyer, 2004;Burls et al, 2011). Moreover, people will accept drug coverage decisions only if they are assured that the rationales for the limits to new drug therapies are relevant to the society's needs under a fair and transparent decision-making process (Daniels et al, 2003;Drummond et al, 2009).…”

“…However, considering that both utilitarian and moral behaviours have the same goal (which is the production of maximal utility), it would not be an incongruous work to examine both cost-effectiveness and ethical aspects altogether in drug reimbursement assessment (Pinkerton, citizens' health per se, but it should be further increased by reinforcing the belief that they live in a system that cares their life and accepts their priorities (McKie and Richardson, 2003). Because ethics has only recently been emphasized as a part of the HTA, little consensus had been made on the methods for incorporating ethics into HTA systems (Hofmann, 2008;Burls et al, 2011). Final decisions could be different across different HTA systems because a drug could have different economic or ethical values depending on the society.…”

Evaluation of ethical aspects in health technology assessment: more methods than applications?

“…From its very beginning ethics was a constitutive part HTA, and early definitions of technology assessment explicitly enclose ethics [2][3][4][5]. Over the years a wide range of approaches have been applied to address ethical aspects of health technologies [6,7]. However, relatively few HTA reports include ethics in any systematic way [8,9].…”