Over the last few decades, rising health care expenditures have strained health care systems around the world. In the United States alone, Wilensky (2008) estimates that the annual growth in health care expenditures exceeds the economy's overall growth rate by 2.5%. Developing countries face a wider gap between costs and revenues, and so face difficult choices about which health care services to provide or to deny.
In addition to economic concerns, government decision makers have to answer questions about the role of technology in medicine and whether innovations improve the efficiency of health system services. To help answer these questions, health technology assessment (HTA) was created.
Definition and Origins of HTA
According to the International Network of Agencies for Health Technology Assessment (INAHTA), HTA is the process by which the impact of health care technology is systematically assessed by policy makers. The benefits and possible risks of technological advances need to be studied in order to “provide objective information to support health care decisions and policy making at the local, regional, national and international levels” (INAHTA, 2006).
HTA is a special type of policy research that evolved during the 1970s, in tandem with rising health care costs and concerns about the inefficiency of health care systems. In 1975, the U.S. Office of Technology Assessment published Development of Medical Technologies: Opportunities for Assessment. This publication is generally credited as the start of the HTA debate, as it outlined the primary objectives required for effective policy research.
Five Policy Goals of HTA
In general, HTA has five main policy goals (Arellano et al., 2009):
- Identification: monitoring advances in health care technologies and setting priorities for decision makers.
- Testing: collecting necessary data and analyzing the results.
- Synthesis: interpreting and assimilating existing information about available technologies.
- Dissemination: providing HTA information to users (e.g., insurance companies, biomedical researchers, government policy makers, and consumers).
- Implementation: helping to ensure the adoption of HTA recommendations.
In order for HTA to be successful, all five goals need to be coordinated and developed by committed HTA agencies.
Not all HTA agencies are affiliated with government agencies. Some are independent not-for-profit organizations that focus exclusively on HTA issues; others are agencies that serve different advisory functions, but may contain an HTA component.
HTA Issues are Diverse and Complex
HTA agencies are called on to assess a wide assortment of technology issues. Some examples of the diverse and complex technologies that may be reviewed by HTA agencies include
- diagnostic and screen technologies;
- medical procedures;
- surgical procedures;
- drugs administered, or prescribed;
- medical devices;
- vaccines; and
- health care services.
The assessment performed may be accomplished through short summary documents, systematic reviews, joint papers, or full HTA reports.
HTA Analysis is Subject to Pragmatic Pressures
Since its inception, HTA has received support from academicians and government bureaucrats, especially in North America and Western Europe. As Wilensky (2008) observed, decision makers accept that there is a need for more information about health care technology, as better information leads to improved policy making.
Despite widespread general support, however, HTA often has succumbed to pragmatic pressures from government organizations. Rather than focusing attention on conceptual issues such as creating a self-sustaining health care system, HTA agencies often are obliged to concentrate on solving specific and immediate problems.
For example, suppose a new breast cancer screening technology is proposed that costs twice as much as existing diagnostic tools, but perhaps is 10% more effective in detection. Government decision makers will turn to HTA agencies and ask them to assess whether the benefits obtained are worth the expense of supporting the new technique.
In such cases, problems are solved through simple cost-utility analysis. Rather than presenting decision makers with the best health care choice, HTA agencies are forced to make recommendations based largely on economic methods, which undermines the usefulness of the HTA process.
In order to be effective, HTA requires a conceptual framework in which economic analysis is balanced against medical, social, ethical, and organizational considerations. A case in point involves HTA agencies in Latin America.
References
Arellano LE, Reza M, Blasco JA, Andradas E. 2009. A content analysis of health technology assessment programs in Latin America. International Journal of Technology Assessment in Health Care. 25(4):570–76.
International Network of Agencies for Health Technology Assessment (INAHTA). 2006. Health Technology Assessment (HTA) Glossary. First Edition. INAHTA.
Wilensky GR. 2008. Comparative clinical effectiveness: leveraging innovation to improve health care quality for all Americans. Presented on behalf of Project HOPE before the Committee on Finance of the United States Senate, July 17, 2008.
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