Dataset Information

Expanded HTA: Enhancing Fairness and Legitimacy.

ABSTRACT: All societies face the need to make judgments about what interventions (both public health and personal medical) to provide to their populations under reasonable resource constraints. Their decisions should be informed by good evidence and arguments from health technology assessment (HTA). But if HTA restricts itself to evaluations of safety, efficacy, and cost-effectiveness, it risks being viewed as insufficient to guide health decision-makers; if it addresses other issues, such as budget impact, equity, and financial protection, it may be accused of overreaching. But the risk of overreaching can be reduced by embedding HTA in a fair, deliberative process that meets the conditions required by accountability for reasonableness.

SUBMITTER: Daniels N

PROVIDER: S-EPMC4676965 | biostudies-other | 2015 Nov

REPOSITORIES: biostudies-other

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Expanded HTA: Enhancing Fairness and Legitimacy.

Daniels Norman N Porteny Thalia T Urritia Julian J

International journal of health policy and management 20151106 1

All societies face the need to make judgments about what interventions (both public health and personal medical) to provide to their populations under reasonable resource constraints. Their decisions should be informed by good evidence and arguments from health technology assessment (HTA). But if HTA restricts itself to evaluations of safety, efficacy, and cost-effectiveness, it risks being viewed as insufficient to guide health decision-makers; if it addresses other issues, such as budget impac ...[more]

PMID: 26673643

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Project description:Daniels, Porteny and Urrutia et al make a good case for the idea that that public decisions ought to be made not only "in the light of" evidence but also "on the basis of" budget impact, financial protection and equity. Health technology assessment (HTA) should, they say, be accordingly expanded to consider matters additional to safety and cost-effectiveness. They also complain that most HTA reports fail to develop ethical arguments and generally do not even mention ethical issues. This comment argues that some of these defects are more apparent than real and are not inherent in HTA - as distinct from being common characteristics found in poorly conducted HTAs. More generally, HTA does not need "extension" since (1) ethical issues are already embedded in HTA processes, not least in their scoping phases, and (2) HTA processes are already sufficiently flexible to accommodate evidence about a wide range of factors, and will not need fundamental change in order to accommodate the new forms of decision-relevant evidence about distributional impact and financial protection that are now starting to emerge. HTA and related techniques are there to support decision-makers who have authority to make decisions. Analysts like us are there to support and advise them (and not to assume the responsibilities for which they, and not we, are accountable). The required quality in HTA then becomes its effectiveness as a means of addressing the issues of concern to decision-makers. What is also required is adherence by competent analysts to a standard template of good analytical practice. The competencies include not merely those of the usual disciplines (particularly biostatistics, cognitive psychology, health economics, epidemiology, and ethics) but also the imaginative and interpersonal skills for exploring the "real" question behind the decision-maker's brief (actual or postulated) and eliciting the social values that necessarily pervade the entire analysis. The product of such exploration defines the authoritative scope of an HTA.

Dataset Information

Expanded HTA: Enhancing Fairness and Legitimacy.

Publications

Expanded HTA: Enhancing Fairness and Legitimacy.

Similar Datasets

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