Abstract
Background: Evidence-informed deliberative processes (EDPs) were recently introduced to guide health technology assessment (HTA) agencies to improve their processes towards more legitimate decision-making. The EDP framework provides guidance that covers the HTA process, ie, contextual factors, installation of an appraisal committee, selecting health technologies and criteria, assessment, appraisal, and communication and appeal. The aims of this study were to identify the level of use of EDPs by HTA agencies, identify their needs for guidance, and to learn about best practices. Methods: A questionnaire for an online survey was developed based on the EDP framework, consisting of elements that reflect each part of the framework. The survey was sent to members of the International Network of Agencies for Health Technology Assessment (INAHTA). Two weeks following the invitation, a reminder was sent. The data collection took place between September-December 2018. Results: Contact persons from 27 member agencies filled out the survey (response rate: 54%), of which 25 completed all questions. We found that contextual factors to support HTA development and the critical elements regarding conducting and reporting on HTA are overall in place. Respondents indicated that guidance was needed for specific elements related to selecting technologies and criteria, appraisal, and communication and appeal. With regard to best practices, the Canadian Agency for Drugs and Technologies and the National Institute for Health and Care Excellence (NICE, UK) were most often mentioned. Conclusion: This is the first survey among HTA agencies regarding the use of EDPs and provides useful information for further developing a practical guide for HTA agencies around the globe. The results could support HTA agencies in improving their processes towards more legitimate decision-making, as they could serve as a baseline measurement for future monitoring and evaluation.
Highlights
Health technology assessment (HTA) is used to inform decision-making, such as coverage-decision making, and is described as a process that includes governance and structure, scoping, assessment, appraisal and implementation and monitoring.[1]
This manuscript provides insight in (a) how HTA agencies ideally should organise their processes in line with evidence-informed deliberative processes (EDPs), which could include the involvement of citizens and their views; and (b) to what extent this is currently being implemented by members of the International Network of Agencies for Health Technology Assessment (INAHTA)
We describe the EDP framework that consists of 5 steps and contextual factors for HTA development (Figure)
Summary
Health technology assessment (HTA) is used to inform decision-making, such as coverage-decision making, and is described as a process that includes governance and structure, scoping, assessment, appraisal and implementation and monitoring.[1]. EDPs draw on this earlier work and provide a structured process in which stakeholders participate throughout the HTA process to identify criteria for the selection of health technologies and assessment, to interpret forthcoming evidence, and to deliberate on recommendations and decisions.[10,11] EDPs are based on rational decision-making through evidence-informed evaluation of identified relevant values (reflected as criteria used in multi-criteria decision analyses [MCDAs]) as well as fair decision-making (as reflected in the accountability for reasonableness approach – A4R). The underlying premises of the EDP framework are: (1) that involvement of relevant stakeholders to identify, reflect, and learn about the meaning and importance of relevant values and questions, and (2) an evidence-informed evaluation of the identified values (criteria), can contribute to the legitimacy of recommendations and/or decisions by improving the quality, consistency and transparency of the HTA process
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