There are many definitions of Health Technology Assessment (HTA). Our preferred definition is the EUnetHTA definition which describes a HTA as a “multidisciplinary process that uses explicit methods to determine the value of a health technology at different points in its lifecycle. The purpose is to inform decision-making in order to promote an equitable, efficient, and high-quality health system“.
HTA is used to support regulatory, payer and patient decision making, by asking important questions about technologies such as: When is counselling better than drug treatment for depression? What is the best operation for aortic aneurysms? Should we screen for human papilloma virus when doing cervical smears? Should aspirin be used for the primary prevention of cardiovascular disease? It answers these questions by investigating four main factors: whether the technology works, for whom, at what cost and how it compares with the alternatives.
The assessment criteria used by HTA bodies differ between countries, in accordance with regional and national legislation. In the UK, HTA broadly focuses on two questions:
- Clinical effectiveness – How do the health outcomes of the new technology compare with available treatment alternatives?
- Cost-effectiveness – Are these improvements in health outcomes proportionate with the additional costs of the technology?
The use of HTA as a means of supporting health policy and reimbursement decisions is becoming increasingly common internationally thus gaining a greater influence on the access of novel medicines to patients across the globe. Some countries use HTAs to inform reimbursement recommendations, with some country’s decisions being influenced by other countries (e.g. France will look at decisions in Germany and the UK). Both, regional and national HTA bodies provide recommendations on health technologies that can be financed or reimbursed by the healthcare system in a particular country or region. Due to limited resources and increased pressure on healthcare budgets, decisions must be made regarding how to prioritise and pay for these efforts.
As HTA focuses on ‘the value’ (clinical and economic) of the technology relative to current (or best) clinical practice, payer objectives are focussed on ensuring that they deliver the best possible health outcomes from their budget. This means they are looking for products which offer “value for money”. Therefore, for HTA bodies to invest in a new technology means that it may be necessary to stop or reduce funding for another technology or service. To make that choice, it is important that manufacturers present accurate and reliable clinical and economic evidence to support their decision making.
Although most commonly performed when the new technology first enters the market, HTA can be applied at difference points in the lifecycle of a health technology, such as when the eligible patient population increases significantly, if/when new evidence is identified. HTA can also be used to inform decisions about discontinuing ineffective technologies.
The field of HTA was first developed systematically in the US office of technology assessment with the first HTA report published in 1976. As the field evolved, there have been numerous efforts to evaluate, improve and harmonise the science, methods and practice of HTA, most recently EUnetHTAs introduction HTA core model.
Since 2010, the European Medicines Agency (EMA) has been working closely with the (EUnetHTA), a network of government-appointed organisations from European Union Member States, the European Economic Area and accession countries and a large number of relevant regional agencies and non-for-profit organisations that produce or contribute to HTA in Europe. There is also discussion about developing an EU wide HTA, but this has run into delays . Read our previous articles here:
- Will an EU-wide HTA clinical assessment become a reality?
- A single, mandatory HTA assessment for Europe by 2026? The European commission gets serious about EU HTA cooperation.
Want to find out more? Our health technology assessment training enables learners to understand the concept of how HTA may be used to determine the price, reimbursement and/or access of a new pharmaceutical product and provides insights into what pharma companies should do to optimize outcomes for their products.
Read our other blogs in the educational series here