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 Ensuring value for money in health care: The role of health technology assessment in the European Union
This report addresses the concepts and controversy surrounding health technology assessment (HTA) in Europe, with a particular focus on selected Member States including Sweden, the Netherlands, Finland, France, Germany and the United Kingdom.
Extensive review of these HTA systems produced a number of key findings relevant to a wide range of stakeholders including policy-makers, HTA bodies, manufacturers, health-care professionals and patient organizations.
1. HTA plays a major part in evidence-based decision-making. Without good evidence, the uptake and diffusion of health technologies is likely to be influenced by a range of social, financial and institutional factors. This may result in suboptimal health outcomes and inefficient use of resources.
2. Innovation and the actual needs of the health-care system should be linked more closely. Products that provide the most value for investment must be identified and supported and their manufacturers rewarded with appropriate reimbursement and pricing schemes.
3. Many countries have dedicated HTA bodies, but with somewhat unclear and disparate roles and responsibilities. Groups involved in reimbursement and pricing decisions often differ from those affiliated with independent HTA assessment and clinical guidance development. Divergent processes and roles may hinder the effectiveness and efficacy of the decision-making process and lead to unnecessary duplication of efforts and resource use.
4. Most review bodies involve a range of stakeholders including physicians, health economists, pharmacists and patient group representatives. Most agencies support some level of involvement from patients and consumers, and a greater role for industry representatives has been proposed. More stakeholder involvement is needed to improve the HTA processes and the implementation of decisions and related policy. This is true of broad HTA networks and partnerships (such as EUnetHTA) that can enhance collaboration between agencies and facilitate innovation in HTA processes and methods.
5. Some countries consider the evidence and resources required to conduct an assessment, as well as its relevance to the primary clinical and/or policy question. An assessment will not be helpful if there are insufficient data, and may delay access to new treatments. Clinical and policy relevance is especially important as HTAs are useful only if they are expected to contribute to the decision-making process. ...
Overall, HTA can play a valuable role in health care decision-making, but the process must be transparent, timely, relevant, in-depth and usable. Assessments need to use robust methods and be supplemented by other important criteria. Maximization of HTA will enhance potential decision-makers’ ability to implement decisions that capture the benefits of new technologies, overcome uncertainties and recognize the value of innovation, all within the constraints of overall health system resources.
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Corinna Sorenson, Michael Drummond, Panos Kanavos
Observatory Studies Series No 11
The European Observatory on Health Systems and Policies
About the Authors
Corinna Sorenson (MPH, MHSA) is a research officer at LSE Health, London School of Economics and Political Science and a Ph.D. candidate in the Department of Social Policy. Before joining LSE, Ms Sorenson served as a senior policy and planning analyst for the United States’ Food and Drug Administration. Also, she has held various consulting positions in health policy and health economics research.
Michael Drummond (D.Phil.) is a professor of Health Economics at the University of York, Centre for Health Economics. He has undertaken evaluations over a wide range of medical fields including care of the elderly, neonatal intensive care, immunization programmes, services for people with AIDS, eye health care and pharmaceuticals. In addition, Professor Drummond has authored more than 500 scientific papers and currently serves as President-Elect of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
Panos Kanavos (Ph.D.) is a senior lecturer in international health policy in the Department of Social Policy and Merck Fellow in Pharmaceutical Economics at LSE Health, London School of Economics and Political Science. He has acted as an adviser to a number of international governmental and non-governmental organizations including the World Bank, WHO, Organisation for Economic Co-operation and Development, American Association of Retired Persons and ministries of health in over 14 transition and developing countries.
About The European Observatory on Health Systems and Policies
The European Observatory on Health Systems and Policies supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of health systems in Europe. It brings together a wide range of policy-makers, academics and practitioners to analyse trends in health reform, drawing on experience from across Europe to illuminate policy issues.
The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Governments of Belgium, Finland, Greece, Norway, Slovenia, Spain and Sweden, the Veneto Region of Italy, the European Investment Bank, the Open Society Institute, the World Bank, the London School of Economics and Political Science and the London School of Hygiene & Tropical Medicine.
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