Transparency in practice: Evidence from ‘verification analyses’ issued by the Polish Agency for Health Technology Assessment in 2012–2015

Abstract

Transparency is recognised to be a key underpinning of the work of health technology assessment (HTA) agencies, yet it has only recently become a subject of systematic inquiry. We contribute to this research field by considering the Polish Agency for Health Technology Assessment (AHTAPol). We situate the AHTAPol in a broader context by comparing it with the National Institute for Health and Care Excellence (NICE) in England. To this end, we analyse all 332 assessment reports, called verification analyses, that the AHTAPol issued from 2012 to 2015, and a stratified sample of 22 Evidence Review Group reports published by NICE in the same period. Overall, by increasingly presenting its key conclusions in assessment reports, the AHTAPol has reached the transparency standards set out by NICE in transparency of HTA outputs. The AHTAPol is more transparent than NICE in certain aspects of the HTA process, such as providing rationales for redacting assessment reports and providing summaries of expert opinions. Nevertheless, it is less transparent in other areas of the HTA process, such as including information on expert conflicts of interest. Our findings have important implications for understanding HTA in Poland and more broadly. We use them to formulate recommendations for policymakers.

NICE, in Confidence: An Assessment of Redaction to Obscure Confidential Information in Single Technology Appraisals by the National Institute for Health and Care Excellence

“…Ozierański et al, (2019) recently published a summary of the transparency of decisions made by the Polish Agency for Health Technology Assessment (AHTAPol). [10] The authors of this study found that of the 332 assessments they assessed, the relationship between costs, health effects and the threshold price was redacted in 290 (87.3%) of cases. However, unlike our findings, the proportion of AHTAPol assessments that were redacted appears to be decreasing on a per-year basis (100.0% of those conducted in 2012, versus 76.7% in 2015).…”

Accessibility and quality of drug company disclosures of payments to healthcare professionals and organisations in 37 countries: a European policy review

“…4 5 Consistently with research on disclosure of aspects of health policymaking by both public and private-sector actors, we find that achieving 'practical' or 'actionable' transparency is no less important than introducing transparency rules themselves. [60][61][62] Although EFPIA calls payment data generated via self-regulation 'open to public scrutiny', 63 establishing the entanglement of any recipient, let alone a systemlevel picture, is impossible given the dispersal of disclosures on company websites in most European countries. Additionally, documents published as PDFs, sometimes in ways suggesting deliberate attempts to impede user engagement, fall below the Australian industry-endorsed regulations, requiring firms to use an analysable format.…”

The Emerging Social Science Literature on Health Technology Assessment: A Narrative Review

“…70 A qualitative Hungarian case study explains the limited influence of HTA on P&R outcomes by the lack of transparency of the HTA process, although other factors (including institutional design, human resources-brain drain to the private sector, and key actors' disinterest in reform) were also mentioned. 71 Recent work on the "practical" transparency of HTA bodies [71][72][73] may perhaps contribute to making transparency a better-defined variable amenable to both qualitative and quantitative inquiry. As STS scholars emphasize, procedural choices and guidelines both reflect and result in privileging certain forms of rationality and certain voices and perspectives over others, amplifying or creating new power disparities in the process.…”