Abstract
BackgroundHealth technology assessment (HTA) agencies have an important role to play in managing the rising demands on health systems. However, creating and running such agencies potentially diverts resources from frontline services. A large number of studies address the question of ‘what is the impact of HTA?’. Several points of heterogeneity in this literature include: purpose of the study, definition of HTA, definition of impact, and scope and rigour of evaluations. Our study seeks to address several limitations in this literature. This study aims to explore the mechanisms of impact of an HTA agency. In doing so, we consider HTA as an institution rather than a knowledge product to build an impact evaluation framework from an international, multi-stakeholder and multi-dimensional perspective.MethodsWe conducted 9 key informant interviews with experts from the international HTA community. We addressed several questions, informed by existing frameworks of impact within the literature, to understand their perspectives on the mechanisms of impact of an HTA agency. We analyse data using logic modelling and impact mapping, as tools to understand and visualise mechanisms of change.FindingsOur impact mapping highlights several distinct, but not necessarily mutually exclusive, mechanisms through which the overall impact of an HTA agency is achieved. These are: the effective conduct of HTA studies; effective use of HTA in agenda-setting and policy formulation processes; effective engagement and external communications; good institutional reputation and fit within the healthcare and policy-making system; effective use of HTA as a tool for the negotiation of health technology prices; and the effective implementation of policy change regarding health technologies. We also identify indicators of these effects.ConclusionsOur findings and resulting evaluation framework complement and add to existing literature by offering a new perspective on the mechanisms by which HTA agencies generate impact. This new perspective considers HTA as an institution rather than a knowledge product, is international, multi-dimensional, and includes multi-stakeholder views. We hope the analysis will be useful to countries interested in managing HTA performance.
Highlights
Health technology assessment (HTA) agencies have an important role to play in managing the rising demands on health systems
Following that are specific ‘attributes’ of each sub-objective which reflect in this case indicators of those effects leading to overall impact of an HTA agency from a multi-dimensional and multi-stakeholder perspective: we refer to these attributes in Fig. 2 as ‘indicators of effects’
We have developed a framework for the evaluation of the impact of an HTA agency which outlines several questions related to the mechanisms of impact derived from the impact mapping exercise and resulting indicators
Summary
Health technology assessment (HTA) agencies have an important role to play in managing the rising demands on health systems. HTA research can be conducted both by private (e.g. ICER in the United States) and by public actors, and the evidence HTA provides can inform decision makers about how best to ensure the health system is equitable, efficient, and of high quality. While HTA research conducted by private actors can be informative to policy makers, several countries prefer to rely primarily on advice from publicly-funded national ‘HTA agencies’ that aim to serve the public interest. Two examples of such agencies are the HTA agencies of England (the National Institute for Health and Care Excellence, or NICE) and Thailand (the Health Intervention and Technology Assessment Program, or HITAP). The authority and responsibility given to HTA agencies varies from country to country, their prevalence across widely differing health systems is indicative of the power of HTA to add value across different contexts
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