Evidence-Informed Deliberative Processes for HTA Around the Globe: Exploring the Next Frontiers of HTA and Best Practices Comment on "Use of Evidence-informed Deliberative Processes by Health Technology Assessment Agencies Around the Globe".

Unni Gopinathan,Trygve Ottersen,Kalipso Chalkidou,Pascale-Renée Cyr

doi:10.34172/ijhpm.2020.145

Abstract

This comment reflects on an article by Oortwijn, Jansen, and Baltussen about the use and features of ‘evidence-informed deliberative processes’ (EDPs) among health technology assessment (HTA) agencies around the world and the need for more guidance. First, we highlight procedural aspects that are relevant across key steps of EDP, focusing on conflict of interest, the different roles of stakeholders throughout a HTA and public justification of decisions. Second, we discuss new knowledge and models needed to maximize the value of deliberative processes at the expanding frontiers of HTA, paying special attention to when HTA is applied in primary care, employed for public health interventions, and is produced through international collaboration.

Highlights

Healthcare needs exceed available resources in every country.[1]
Scholars have argued the need for deliberative processes that satisfy key qualities, including transparency, broad involvement of stakeholders, consideration of outcomes valued by stakeholders, and mechanisms for appeal, revision and enforcement.[3,4]
Oortwijn et al apply the term “evidence-informed deliberative processes” (EDPs) to describe how “HTA [health technology assessment] agencies should ideally organize their processes to achieve legitimate decision-making.”[7]. A general critique that can be leveled against the use of “EDP” to describe these processes is that it promotes the perception that it represents a “new” approach to explicitly addressing the issue of legitimacy, when it involves qualities that resemble deliberative processes that have been set up in the context of healthcare priority setting at least for several decades.[4,5]

Summary

Introduction

Healthcare needs exceed available resources in every country.[1]. Setting efficient and equitable health priorities require both appropriate substantive criteria and fair process.[2]. Countries at different income levels are increasingly setting up institutions to facilitate explicit priority setting processes informed by HTAs when allocating scarce health resources.[19,20,21,22] To facilitate sharing of country experiences and to identify factors that can promote the use of HTA, detailed national and regional assessments of HTA institutionalization haven taken place.[23,24] capacity among policy-makers to make use of HTA and deliberate with other stakeholders is sought strengthened in different settings.[23,25] Oortwijn et al promote a view that key features of a deliberative process should be present at every step of prioritizing health interventions and at every level where health interventions are prioritized This position is shared by many,[12,18] and promising experiences suggest that the frontiers of HTA is being expanded. The role of horizon scanning was the theme of the 2019 HTAi policy forum in Asia, which underscored the need for a transparent horizon scanning process that fosters early dialogue among HTA agencies, providers and industry about technologies in a clinical pathway, and the need for a shared Asian horizon scanning network.[35]

Conclusion

Findings

26. NOU 2018