Health Technology Assessment in Latin America
An Assessment of HTA Programs in a Developing Region
Nov 15, 2009
Health technology assessment (HTA) is usually defined as an interdisciplinary applied research in the health sciences. HTA incorporates elements of clinical effectiveness; clinical safety; economical impact; and ethical, legal, and social analysis. In general, HTA involves a rigorous examination of the effectiveness, safety, cost, benefits, and risks associated with any new health care technology (NIH, 2008).
Although HTA has been embraced as an important tool for policy makers in North America and Western Europe, it has been slow to emerge in developing regions such as Latin America.
HTA in Latin America
HTA is a relatively new concept in Latin America. Among developing regions, Latin America is said to represent “one of the most important emerging markets for health technology” (Arellano et al., 2009). Furthermore, the importance of HTA seems to be recognized throughout the region.
If this assessment is accurate, then why has Latin America lagged behind other developed countries in establishing effective HTA programs?
The Problem With Introducing New Technologies in Latin America
The answer is a simple matter of economics. In many developing areas, basic technologies are scarce and expensive to introduce. During the 1980s, Latin American policy makers attempted to implement expensive health technologies, but failed to establish policies for regulation or to ensure equal access to health care for all citizens (Perry et al., 1992). By the 1990s, many Latin American countries began to reform their health care systems in order to improve efficiency, promote equality in treatment, and ensure financial stability.
Nevertheless, the Pan American Health Organization (1998) observed that developing regions still depend on the transfer of perfected technologies from developed countries. In many cases, “this transfer has been incomplete,” as many technologies have not been adapted to the “organizational, economic, social, and cultural situation of the receiving countries.”
How has HTA been implemented in Latin America over the last two decades?
A Content Analysis of HTA Programs in Latin America
Arellano et al. (2009) attempted to answer this question by identifying HTA programs within Latin America, reviewing the documents prepared by those programs, and then comparing the results with HTA goals. The research methodology was as follows:
- Six HTA programs were identified throughout Latin America: two programs in Mexico, two programs in Argentina, one program in Brazil, and one program in Chile.
- In all, 236 publications were reviewed over a seven-year period (2000–2007).
- HTA documents were assessed based on type of document (i.e., short summary document, systematic reviews, joint papers, or full HTA reports); technologies and issues assessed; and the target audiences for whom the documents were prepared.
Results of Content Analysis
During the seven-year study period, the number of HTA documents increased from 0 published in 2000 to 54 documents by the end of 2007. Most (82%) were short summary documents. Of the rest, 14% were systematic reviews, 3% were papers published jointly with another organization, and only 1% were fully-developed reports.
The HTA documents focused mainly on practical issues in health care. In general, 31% assessed drugs, while 18% analyzed diagnostic and screening technologies, and another 18% concentrated on medical procedures. Health services (5%) and vaccines (1%) received comparatively little attention during the study period.
Approximately 66% of all HTA documents focused on issues of clinical effectiveness or economic assessments. Ethical, social, or legal issues were rarely addressed (< 1%) by HTA programs.
Not surprisingly, the two largest target audiences were third-party payers (55%) and government policy makers (41%). No HTA program disseminated policy information to any patient or consumer group.
What is the State of HTA in Latin America?
The study by Arellano et al. (2009) revealed that HTA programs in Latin America did not produce the same in-depth analyses found in developed countries. Instead, Latin American programs generated short documents that focused on practical high-technology areas of importance for two specific target groups.
From its initial development in the 1970s, HTA has tended to focus more on clinical and economic outcomes than ethical analysis. In Latin America, clinical and economic considerations still take precedence over ethical, social, or legal issues. Thus, an integrated conceptual framework is still lacking 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.
Pan American Health Organization (PAHO). 1998. Developing Health Technology Assessment in Latin America and the Caribbean. Annapolis Junction, MD: PAHO.
Perry S, Marx ES. 1992. What Technologies for Health Care in Developing Countries? In: vol. 13, Geneva: World Health Forum. pp. 356–62.
United States National Institutes of Health (NIH). 2008. HTA 101: Introduction to Health Technology Assessment. Bethesda, MD: NIH.
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