Health technology assessment in Europe

Abstract

Many European countries use health technology assessment (HTA) to assist in making decisions and policies in the health field, and public health and medical decision makers in Europe are now formally building HTA into certain policy, governance, reimbursement, or regulatory processes. A majority of European Union member states now have public sector HTA agencies that provide information for decision-making and policy-making at regional or national levels [1]. The Tallinn Charter adopted at the Ministerial Conference in the World Health Organization European Region, June 2008, stated that HTA should be used to support more informed decisionmaking [2], and in July 2008 the European Commission issued a proposal for a directive on the application of patient rights in cross-border healthcare. Article 17 of the proposal concerns cooperation on management of new health technologies, stating that Member States shall facilitate the development and functioning of a network connecting the national authorities or bodies responsible for health technology assessment [3]. In addition, discussion and conclusions on relative effectiveness in the so-called Pharmaceutical Forum lead in the direction of HTA methodology. The Steering Committee of this Forum acknowledged that a European network for HTA could take relative effectiveness assessment of pharmaceuticals forward [4]. Nationally appointed organisations from EU Member States and EFTA/ EEA states are developing a Joint Action on Health Technology Assessment between EU Member States and the European Commission from 2010. This happens under the Work Plan for 2009 for the implementation of the second programme of Community action in the field of health 2008-13. The European network for Health Technology Assessment (EUnetHTA) Collaboration is the basis for this Joint Action [5]. During the years 2006-08 EUnetHTA developed a framework and a suite of practical tools for transnational collaboration in HTA [6]. What, then, is HTA how does it relate to policy processes and how does it relate to public health, clinical, and health services research? Health technology is the application of scientific knowledge in healthcare and disease prevention. Health technology assessment is a multidisciplinary process, which in a systematic, transparent, unbiased, robust manner summarizes information about the medical, social, economic, and ethical issues related to the use of a health technology. Its aim is to inform the formulation of safe, effective health policies that are patient focused and seek to achieve best value. HTA seeks to provide structured, evidence-based input for making decisions on healthcare policy and practices through systematic, interdisciplinary processes. HTA covers all interventions and procedures in healthcare, including diagnostic and treatment methods, medical equipment, pharmaceuticals, rehabilitation, disease prevention methods, and organizational and supportive systems in healthcare. Despite its policy goals, HTA must always be firmly rooted in research and the scientific method [7, 8]. The role of HTA has been compared with that of a bridge between research and decision-making [9]. There is interdependence, yet division of work, between research-based assessment and decisionmaking. A successful process from a policy question to an HTA report that informs policy spans across