Health technology assessment: for whom the bell tolls?

Abstract

One of the oldest definitions of Health Technology Assessment (HTA) was given in 1985 by the Institute of Medicine in USA: ‘‘Any process of examining and reporting properties of a medical technology used in health care, such as safety, efficacy, feasibility, and indications for use, cost, and costeffectiveness, as well as social, economic, and ethical consequences whether intended or unintended’’ [1]. It is worth noting that the term health technology does not refer only to drugs, medical devices, and equipment, but involves any intervention related to prevention, diagnosis, therapy, and management of disorders [2, 3]. A recent, even more comprehensive definition has been developed by the International Network of Agencies of HTA: ‘‘HTA is a multidisciplinary field of policy analysis, which studies the medical, social, ethical and economic implications of development, diffusion, and use of health technology’’ [4]. This clearly states that the primary objective of HTA is to provide policy makers with reliable, documented information on the effectiveness, consequences, and costs of healthcare technologies [5]. Therefore, a vital component of HTA is documented, internationally recognized competence in economic evaluation. In general, HTA can be considered a ‘‘melting pot’’ of different disciplines dealing with various and somewhat contrasting needs [6]. Experts may include epidemiologists, economists, physicians, pharmacists, and health-care managers, brought together under the umbrella of public administration guidance. Since HTA activities often tend to be untargeted, uncoordinated, and without priorities [7], each country should appoint one organization of reference according to European directives [8]. The expected outcomes are recommendations bridging evidence-based medicine, economic evaluation, the experience of professionals, patients’ expectations, and the capabilities of national health-care systems [3, 9, 10]. It is not clear whether HTA has developed so fast ‘‘because of’’ or ‘‘despite’’ its multidisciplinary approach. However, it does appear nowadays to be an internationally recognized process. In 2004, the European Commission and Council of Ministers targeted HTA as ‘‘a political priority,’’ recognizing ‘‘...an urgent need for establishing a sustainable European network on HTA.’’ That led to the establishment of EunetHTA [11], a network of 35 organizations throughout Europe that aims at developing practical tools to transform HTA into useful policy advice for the EU and its Member States. Results are expected to be disclosed in December 2008, i.e., in the next few months. HTA is becoming more and more fashionable in Italy, too. Past experts and newcomers in health economics are actively following the HTA trend. A Google search on ‘‘health technology assessment’’ limited to Italian web sites resulted in about 10,600 references, despite the English wording. After checking only the first references, it is clear that there are many proponents, including industrial associations, pharmaceutical companies, scientific societies, and education providers. This calls for some considerations. The Italian National Health Service (INHS) is required to provide qualified health care, but also to keep costs under tight control. If the key task of HTA is to support public authorities in deciding on INHS coverage of a new technology, it could play a major role in selecting the new expensive technologies that are most likely to have real L. Garattini (&) G. Casadei CESAV, Centre for Health Economics, ‘‘Mario Negri’’ Institute for Pharmacological Research, Ranica (Bg), Italy e-mail: lgarattini@marionegri.it