View source for Health technology assessment

{{short description|Field of policy analysis}}
{{For|the journal|Health Technology Assessment (journal)}}
{{Other uses of|HTA|HTA (disambiguation)}}
[[File:Faggan Singh Kulaste addressing at the inauguration of the DHR-ICMR- iDSI International Workshop on “Health Technology Assessment-Awareness and Topic Selection”, in New Delhi.jpg|thumb|287x287px|HTA conference and workshop]]

'''Health technology assessment''' ('''HTA''') is a multidisciplinary process that uses systematic and explicit methods to evaluate the properties and effects of a [[health technology]].<ref>{{Cite journal|last1=O'Rourke|first1=Brian|last2=Oortwijn|first2=Wija|last3=Schuller|first3=Tara|last4=Group|first4=the International Joint Task|date=June 2020|title=The new definition of health technology assessment: A milestone in international collaboration|journal=International Journal of Technology Assessment in Health Care|language=en|volume=36|issue=3|pages=187–190|doi=10.1017/S0266462320000215|pmid=32398176|s2cid=218617518|issn=0266-4623|doi-access=free}}</ref> Health technology is conceived as any intervention ([[Medical test|test]], [[Medical device|device]], [[Pharmaceutical drug|medicine]], [[vaccine]], [[Medical procedure|procedure]], [[Health care service|program]]) at any point in its lifecycle ([[Pre-market approval|pre-market]], regulatory approval, post-market, disinvestment).<ref>{{Cite web|title=The International Network of Agencies for Health Technology Assessment|url=https://www.inahta.org/|access-date=2021-10-27|website=INAHTA|language=en-US|archive-date=2021-10-27|archive-url=https://web.archive.org/web/20211027195341/https://www.inahta.org/|url-status=live}}</ref> The purpose of HTA is to inform "decision-making in order to promote an equitable, efficient, and high-quality health system''".''<ref>{{Cite web|title=The International Network of Agencies for Health Technology Assessment|url=https://www.inahta.org/|access-date=2021-10-27|website=INAHTA|language=en-US|archive-date=2021-10-27|archive-url=https://web.archive.org/web/20211027195341/https://www.inahta.org/|url-status=live}}</ref>'' '' It has other definitions including "a method of [[Systematic review|evidence synthesis]] that considers evidence regarding clinical effectiveness, safety, cost-effectiveness and, when broadly applied, includes [[Ethical, Legal and Social Aspects research|social, ethical, and legal aspects]] of the use of health technologies. The precise balance of these inputs depends on the purpose of each individual HTA. A major use of HTAs is in informing reimbursement and coverage decisions by [[Health insurance|insurers]] and national health systems, in which case HTAs should include benefit-harm assessment and economic evaluation."<ref>{{cite journal  |vauthors=Luce BR, etal | title=. EBM, HTA, and CER: clearing the confusion | journal=Milbank Q | date=2010 | volume=88 | pages=256–76 | pmid=20579285 | pmc=2980346 | issue=2 | doi=10.1111/j.1468-0009.2010.00598.x}}</ref>  And "a multidisciplinary process that summarises information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner. Its aim is to inform the formulation of safe, effective, [[health policies]] that are patient focused and seek to achieve best value. Despite its policy goals, HTA must always be firmly rooted in research and the [[scientific method]]".<ref>EUnetHTA (European network for Health Technology Assessment) https://www.eunethta.eu/about-eunethta/ {{Webarchive|url=https://web.archive.org/web/20210117095631/https://www.eunethta.eu/about-eunethta/ |date=2021-01-17 }}</ref>

==Purpose==
Health technology assessment is intended to provide a bridge between the world of research and the world of decision-making.<ref>Battista, RN: ''The scientific basis of health services''. BMJ Publishing Group, 1996.</ref> HTA is an active field internationally and has seen continued growth fostered by the need to support management, clinical, and policy decisions. It has also been advanced by the evolution of evaluative methods in the social and applied sciences, including [[clinical epidemiology]] and [[health economics]]. Health policy decisions are becoming increasingly important as the [[opportunity cost]]s from making wrong decisions continue to grow.<ref>{{cite journal | author=Menon D.| title=The internationalization of heath technology assessment | journal= International Journal of Technology Assessment in Health Care| date=1996 | volume=12 | pages=45–51 | pmid=8690561 | last2=Marshall | first2=D | issue=1| doi=10.1017/S0266462300009375 | s2cid=6982793 }}</ref> HTA is now also used in assessment of innovative medical technologies like telemedicine e.g. by use of the [[Model for assessment of telemedicine]] (MAST).

Health technology can be defined broadly as:
{{Blockquote|Any intervention that may be used to promote health, to prevent, diagnose or treat disease or for rehabilitation or long-term care. This includes the pharmaceuticals, devices, procedures and organizational systems used in health care.<ref>{{cite web | author=INAHTA (International Network of Agencies for Health Technology Assessment). | title=HTA glossary. | url=http://htaglossary.net/tiki-index.php?page=health%20technology | date=Oct 8, 2013 | publisher=HTAi | access-date=October 8, 2013 | archive-date=February 21, 2014 | archive-url=https://web.archive.org/web/20140221202424/http://htaglossary.net/tiki-index.php?page=health%20technology | url-status=live }}</ref>}}

==History==
The discipline of HTA was first developed in the U.S. Office of Technology Assessment, which published its first report in 1976.<ref>{{Cite journal|last1=O'Rourke|first1=Brian|last2=Oortwijn|first2=Wija|last3=Schuller|first3=Tara|last4=the International Joint Task Group|date=13 May 2020|title=The new definition of health technology assessment: A milestone in international collaboration|journal=International Journal of Technology Assessment in Health Care|language=en|volume=36|issue=3|pages=187–190|doi=10.1017/S0266462320000215|pmid=32398176|s2cid=218617518|issn=0266-4623|doi-access=free}}</ref> The growth of HTA internationally can be seen in the expanding membership of the International Network of Agencies for Health Technology Assessment (INAHTA), a non-profit umbrella organization established in 1993.{{Citation needed|date=February 2020}} Organizations and individuals involved in the production of HTA publications may also affiliated with international societies such as [[Health Technology Assessment International]] (HTAi)<ref>{{Cite web|title=Health Technology Assessment International (HTAi)|url=https://htai.org/|access-date=2022-01-10|website=HTAi|language=en-US|archive-date=2022-01-19|archive-url=https://web.archive.org/web/20220119003146/https://htai.org/|url-status=live}}</ref> and [[ISPOR|International Society for Pharmacoeconomics and Outcomes Research]] (ISPOR).<ref>{{cite web |title=International Society for Pharmacoeconomics and Outcomes Research |url=https://www.ispor.org/ |website=ISPOR |access-date=9 September 2018 |archive-date=10 September 2019 |archive-url=https://web.archive.org/web/20190910012437/http://www.ispor.org/ |url-status=live }}</ref> Academic courses, typically in Masters programs, are also offered in health technology assessment and management.<ref>{{Cite journal|last1=Lehoux|first1=Pascale|last2=Battista|first2=Renaldo N.|last3=Granados|first3=Alicia|last4=Gallo|first4=Pedro|last5=Tailliez|first5=Stéphanie|last6=Coyle|first6=Doug|last7=Marchetti|first7=Marco|last8=Borgia|first8=Piero|last9=Ricciardi|first9=Gualtiero|date=2005|title=International Master's Program in health technology assessment and management: assessment of the first edition (2001--2003)|url=https://pubmed.ncbi.nlm.nih.gov/15736521/|journal=International Journal of Technology Assessment in Health Care|volume=21|issue=1|pages=104–112|doi=10.1017/s0266462305050130|issn=0266-4623|pmid=15736521|s2cid=40682931|access-date=2021-10-27|archive-date=2021-10-27|archive-url=https://web.archive.org/web/20211027195340/https://pubmed.ncbi.nlm.nih.gov/15736521/|url-status=live}}</ref><ref>{{Cite web|title=A Tale of Two University-Based Health Technology Assessment Initiatives|url=https://www.cadth.ca/media/symposium_pdfs/cadth_symposium06_poster_BaPham.pdf|access-date=2021-10-27|archive-date=2014-10-19|archive-url=https://web.archive.org/web/20141019084811/http://www.cadth.ca/media/symposium_pdfs/cadth_symposium06_poster_BaPham.pdf|url-status=live}}</ref>

==By country==
===United Kingdom===
The United Kingdom's [[National Institute for Health and Care Research]] (NIHR) runs several research programmes that may be viewed as falling into the realm of Health Technology Assessment. Of particular note is the NIHR Health Technology Assessment programme, its longest running, which undertakes both conventional HTA in the form of Evidence Synthesis and modelling, and evidence generation with a large portfolio of pragmatic [[Randomized controlled trial|RCTs]] and [[Cohort study|cohort studies]].<ref>{{Cite web|title=Health Technology Assessment|url=https://www.nihr.ac.uk/explore-nihr/funding-programmes/health-technology-assessment.htm|access-date=2022-01-10|website=National Institute for Health Research|archive-date=2022-01-10|archive-url=https://web.archive.org/web/20220110150823/https://www.nihr.ac.uk/explore-nihr/funding-programmes/health-technology-assessment.htm|url-status=live}}</ref> The programme's research is regularly published in NIHR's journal [[Health Technology Assessment (journal)|Health Technology Assessment]].<ref>{{Cite web|title=About the HTA journal|url=https://www.journalslibrary.nihr.ac.uk/hta/about-the-hta-journal.htm|access-date=2022-01-10|website=NIHR Journals Library|archive-date=2022-01-10|archive-url=https://web.archive.org/web/20220110150824/https://www.journalslibrary.nihr.ac.uk/hta/about-the-hta-journal.htm|url-status=live}}</ref>

Also in the UK, the Multidisciplinary Assessment of Technology Centre for Healthcare carries out HTA in collaboration with the health service, the NHS and various industrial partners.  MATCH is organised into four themes addressing key HTA topics including Health Economics, Tools for Industry, User Needs and Procurement and Supply chain.

===Canada===
Canada also has a health technology assessment body called the Canadian Agency for Drugs and Technologies in Health (CADTH).<ref>{{Cite web|title=CADTH {{!}} CADTH|url=https://www.cadth.ca/|access-date=2021-10-27|website=www.cadth.ca|archive-date=2019-12-14|archive-url=https://web.archive.org/web/20191214055602/https://www.cadth.ca/|url-status=live}}</ref>

=== Italy ===
As of today, 11 Italian [[Regions of Italy|regions]] have issued specific regional laws or regulations to manage HTA activities and processes at regional level: Abruzzo, Basilicata, Emilia-Romagna, Lazio, Liguria, Lombardia, Piemonte, Puglia, Sicilia, Toscana, and Veneto. In another four regions (Calabria, Marche, Umbria, and Valle D'Aosta) and in the two [[Autonomous province#Italy|autonomous province]]s of Bolzano and Trento, HTA is performed at different levels, even if no legislation has yet been produced.<ref>{{Cite web|title=HTA in Italy: results from the national survey by Agenas and SIHTA. Read English summary produced by MTRC|url=https://mtrconsult.com/news/hta-italy-results-national-survey-agenas-and-sihta-read-english-summary-produced-mtrc|access-date=2021-06-27|website=Med Tech Reimbursement Consulting|language=en|archive-date=2021-06-27|archive-url=https://web.archive.org/web/20210627150808/https://mtrconsult.com/news/hta-italy-results-national-survey-agenas-and-sihta-read-english-summary-produced-mtrc|url-status=live}}</ref>

The [[World Health Organization]] provides an overview of countries and their corresponding HTA agencies.<ref>{{Cite web |date=2021-04-08 |title=Countries with National agency/unit/committee that produces HTA reports for the Ministry of Health |url=https://cdn.who.int/media/docs/default-source/health-economics/nationalagenciehta.pdf |url-status=live |archive-url=https://web.archive.org/web/20240203150717/https://cdn.who.int/media/docs/default-source/health-economics/nationalagenciehta.pdf |archive-date=2024-02-03 |access-date=2024-02-03 |website=WHO}}</ref>

== Impact of HTA implementation ==
{{Undue weight section|a single study focused on three countries|date=February 2024}}
A recent study<ref name=":0">{{Cite journal |last=Fasseeh |first=Ahmad Nader |last2=Saragih |first2=Sarah Maria |last3=Hayek |first3=Noha |last4=Brodovska |first4=Sasha |last5=Ismail |first5=Adham |last6=ElShalakani |first6=Amr |last7=Abaza |first7=Sherif |last8=Obeng |first8=George Dennis |last9=Ameyaw |first9=David |last10=Kalo |first10=Zoltan |date=2022-12-01 |title=Impact of health technology assessment implementation with a special focus on middle-income countries |url=https://www.sciencedirect.com/science/article/pii/S2211883722000958 |journal=Health Policy and Technology |volume=11 |issue=4 |pages=100688 |doi=10.1016/j.hlpt.2022.100688 |issn=2211-8837|hdl=10831/89813 |hdl-access=free }}</ref> explored the implementation of HTA in three Middle-Income Countries (MICs) and its influence on health system objectives. The study<ref name=":0" /> investigated the impact of '''HTA globally''' through a '''systematic literature''' '''review'''. Also, the study<ref name=":0" /> '''surveyed stakeholders from the Middle-Income countries'''. 

'''The results indicated that the benefits of HTA implementation in these countries largely outweigh the drawbacks'''. The major advantages identified include enhanced transparency and accountability in healthcare decisions, leading to more informed and equitable healthcare policies.

'''<u>The study has shown that HTA has a positive impact on several aspects of healthcare systems</u>:'''

* '''Improved Decision Making''': HTA aids in making better health financing decisions, including resource allocation and policy formulation.
* '''Enhanced Transparency and Accountability''': The most evident benefit of HTA is its role in improving the clarity and responsibility of healthcare decisions.
* '''Economic Impact''': While HTA can generate cost savings in specific areas, its overall impact on the fiscal sustainability of healthcare systems in MICs remains unclear.

It was also noted that '''HTA's influence extends to the broader health system goals,''' such as health gain, equity in health, and responsiveness to patient needs. However, the impact on direct health gains and financial protection of households is less pronounced.

The study emphasizes the gradual adoption of HTA in MICs and the necessity for continuous assessment of its impact. It also acknowledges the limited but growing body of literature on the subject, highlighting a need for further research, especially in quantitative analysis of HTA's impact.

In conclusion, while HTA implementation in MICs shows promising results in improving healthcare decision-making and policy formulation, its overall impact, particularly in terms of economic savings, requires further investigation.
==See also==
* [[Horizon scanning]]
* [[Pharmacoeconomics]]

== References ==
{{Reflist}}

==External links==
{{Prone to spam|date=September 2018}}

* [http://www.htai.org Health Technology Assessment International (HTAi)]
* [http://www.inahta.org  International Network of Agencies for Health Technology Assessment (INAHTA)]
* [https://www.eunethta.eu/ European Network for Health Technology Assessment (EUnetHTA)]

{{Evidence-based practice}}

[[Category:Impact assessment]]
[[Category:Medical technology]]
[[Category:Technology assessment]]
[[Category:Life sciences industry]]