Gutiérrez-Ibarluzea I, Chiumente M, Dauben HP
Frontiers in pharmacology
Health Technology Assessment (HTA) is “the systematic evaluation of the properties and effects of a health technology, addressing the direct and intended effects of this technology, as well as its indirect and unintended consequences, and aimed mainly at informing decision making regarding health technologies. HTA is conducted by interdisciplinary groups that use explicit analytical frameworks drawing on a variety of methods” (http://htaglossary.net). HTA was used to act when decisions on reimbursement were required and thus was called the fourth hurdle or the fourth guarantee (safety, efficacy, effectiveness, and efficiency). However, having in mind its definition and privileged position, HTA activities have evolved to more constructive approaches from health technology inception to its obsolescence. New concepts such as scientific advice, early dialogue, early awareness, and alert systems, post-introduction observation of health technologies, appropriateness, re-assessment, and disinvestment have gained ground. Health care systems have considered the introduction of health technologies a linear process in which different stakeholders (innovators, manufacturers, regulators, health technology assessors, reimbursement bodies, health care providers, health care professionals, patients, and citizens) did interact in each of the steps of the process, but were not involved in a continuous dialogue and knowledge exchange. This step by step approach generates inefficiency in many cases by means of: the isolation of innovators from real health care needs, the introduction of health technologies of doubtful value, the generation of unnecessary variability in practice, the maintenance of practices of no-added value, and the disregard of knowledge out of the practice, among others. These circumstances suppose an inefficient allocation of resources and investment, a hole in the waterline of health care systems, and their sustainability and what is more, a non-direct correlation between expected or theoretical outcomes and real health outcomes. Different initiatives have been put in place in the last years in order to mitigate the effects of the aforementioned issues. On the basis of the life cycle concept of health technologies, this article will go through some of these initiatives and define the role that Health Technology Assessment could play in each step.
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