Assessment of health technology assessment tools
The EU-funded ADVANCE_HTA (Advancing and strengthening the methodological tools and practices relating to the application and implementation of Health Technology Assessment (HTA)) project worked on improving the scope and relevance of HTA methodologies for various types of health care systems. Input was taken from all stakeholders, starting from decision makers and ending with patients. Topics covered included value-for-money, cost effectiveness, burden of disease and disease severity. Researchers analysed data and methodologies using decision analytic frameworks such as discrete choice experiments (DCEs) and multiple-criteria decision analysis (MCDA). HTA systems from ten EU countries were comprehensively analysed in terms of drug reimbursement systems on cancer, rheumatoid arthritis and multiple sclerosis. Project partners developed a taxonomy of important variables and a database on reimbursement decisions before performing econometric analysis. Results provided novel insight into factors affecting reimbursement decision outcomes such as stakeholder involvement, country-specific pricing system and patient age. In addition to the retrospective analysis framework for HTA, ADVANCE_HTA developed the MCDA-based Advance Value Framework© that incorporates social value judgements as well as innovation level. Its performance was tested for the treatment of metastatic colorectal cancer in two case studies. This model proved highly promising as it was comprehensive and methodologically robust while reducing ambiguity and motivational bias. Emphasis was placed on understanding and optimising HTA decision making with regard to rare diseases. For this purpose, ADVANCE_HTA forged strong links with other European initiatives associated with rare diseases, such as EPIRARE (European platform for rare disease registries) and EUNetHTA. DCE surveys were carried out to determine patient and decision-maker perceptions providing useful information on factors impacting benefit valuation. ADVANCE_HTA also addressed HTA on medical devices after factoring in social, ethical and legal aspects as well as risk and functionality. Potential HTA implementation in Eastern Europe as well as Latin America was also investigated. Project activities were widely disseminated via publications, workshops, the project website, twitter (@AdvanceHTA) and the Advance-HTA LinkedIn group. Overall, ADVANCE_HTA activities have highlighted the need for more robust and adaptable HTA methodologies to guide policies, future research agenda and best practices for both medicines and devices. This should help optimise resource allocation and ensure health system sustainability irrespective of system- or therapy-specific HTA-based decisions.
Keywords
Health technology assessment, methodology, discrete choice experiments, multiple-criteria decision analysis, Advance Value Framework©
