Bjørn Hofmann1, Irina Cleemput2, Kenneth Bond3, Tanja Krones4, Sigrid Droste5, Dario Sacchini6, Wija Oortwijn7. 1. University College of Gjøvik and University of Oslo,bjoern.hofmann@hig.no. 2. Hasselt University and Belgian Health Care Knowledge Centre (KCE). 3. Canadian Agency for Drugs and Technologies in Health. 4. University Hospital/University of Zürich. 5. Institute for Quality and Efficiency in Healthcare (IQWiG). 6. Institute of Bioethics,"Agostino Gemelli" School of Medicine,Universita Cattolica del Sacro Cuore. 7. Ecorys Netherlands.
Abstract
BACKGROUND: Although value issues are increasingly addressed in health technology assessment (HTA) reports, HTA is still seen as a scientific endeavor and sometimes contrasted with value judgments, which are considered arbitrary and unscientific. This article aims at illustrating how numerous value judgments are at play in the HTA process, and why it is important to acknowledge and address value judgments. METHODS: A panel of experts involved in HTA, including ethicists, scrutinized the HTA process with regard to implicit value judgments. It was analyzed whether these value judgments undermine the accountability of HTA results. The final results were obtained after several rounds of deliberation. RESULTS: Value judgments are identified before the assessment when identifying and selecting health technologies to assess, and as part of assessment. They are at play in the processes of deciding on how to select, frame, present, summarize or synthesize information in systematic reviews. Also, in economic analysis, value judgments are ubiquitous. Addressing the ethical, legal, and social issues of a given health technology involves moral, legal, and social value judgments by definition. So do the appraisal and the decision-making process. CONCLUSIONS: HTA by and large is a process of value judgments. However, the preponderance of value judgments does not render HTA biased or flawed. On the contrary they are basic elements of the HTA process. Acknowledging and explicitly addressing value judgments may improve the accountability of HTA.
BACKGROUND: Although value issues are increasingly addressed in health technology assessment (HTA) reports, HTA is still seen as a scientific endeavor and sometimes contrasted with value judgments, which are considered arbitrary and unscientific. This article aims at illustrating how numerous value judgments are at play in the HTA process, and why it is important to acknowledge and address value judgments. METHODS: A panel of experts involved in HTA, including ethicists, scrutinized the HTA process with regard to implicit value judgments. It was analyzed whether these value judgments undermine the accountability of HTA results. The final results were obtained after several rounds of deliberation. RESULTS: Value judgments are identified before the assessment when identifying and selecting health technologies to assess, and as part of assessment. They are at play in the processes of deciding on how to select, frame, present, summarize or synthesize information in systematic reviews. Also, in economic analysis, value judgments are ubiquitous. Addressing the ethical, legal, and social issues of a given health technology involves moral, legal, and social value judgments by definition. So do the appraisal and the decision-making process. CONCLUSIONS: HTA by and large is a process of value judgments. However, the preponderance of value judgments does not render HTA biased or flawed. On the contrary they are basic elements of the HTA process. Acknowledging and explicitly addressing value judgments may improve the accountability of HTA.
Authors: Henk Broekhuizen; Maarten J IJzerman; A Brett Hauber; Catharina G M Groothuis-Oudshoorn Journal: Pharmacoeconomics Date: 2017-03 Impact factor: 4.981
Authors: Monika Wagner; Dima Samaha; Roman Casciano; Matthew Brougham; Payam Abrishami; Charles Petrie; Bernard Avouac; Lorenzo Mantovani; Antonio Sarría-Santamera; Paul Kind; Michael Schlander; Michele Tringali Journal: Int J Health Policy Manag Date: 2019-07-01