Health technology assessment: the 2020 definition

Health technology assessment (HTA) is a multidisciplinary process that uses explicit methods to determine the value of a health technology. It can take place at different points in that technology's lifecycle. In the internationally agreed definition of 2020, its purpose is to inform decision-making in order to promote an equitable, efficient and high-quality health system.

An international joint task group developed that definition. The International Network of Agencies for Health Technology Assessment (INAHTA) and Health Technology Assessment International (HTAi) co-led it. The definition comes with four notes: what a health technology is, how the process works, what value means, and when an assessment can take place.

Why health technology assessment exists

The World Health Organization (WHO) starts from a plain problem. New interventions and technologies are developed and refined all the time, but their impacts on health are not always clear. Neither are their implications for health systems.

WHO describes HTA as a systematic and multidisciplinary evaluation of the properties of health technologies and interventions. That evaluation covers both their direct and indirect consequences. WHO also records one description of HTA: a bridge that connects the world of research to that of policy making.

The field has a long history. It first developed in a systematic way at the United States Office of Technology Assessment, which published its first report on HTA in 1976.

What counts as a health technology

The definition's first note answers this. A health technology is an intervention developed to prevent, diagnose or treat medical conditions, promote health, provide rehabilitation or organise healthcare delivery. The intervention can be a test, device, medicine, vaccine, procedure, programme or system.

The method therefore reaches well beyond medicines. A diagnostic test, a clinical procedure or a system for organising care is a health technology as well.

How a health technology assessment works

The second note describes the process as formal, systematic and transparent. It uses the most advanced methods to consider the best available evidence. During drafting, the task group changed this note's wording from all available evidence to the best available evidence.

WHO adds that HTA is a transparent and accountable process. Decision makers and other stakeholders can use it to support decision-making at the policy level, because it provides evidence about given technologies. The 2020 paper also notes that HTA can include several interrelated components: governance and structure, scoping, assessment, appraisal and implementation, and monitoring.

The dimensions of value

The third note turns to value. The dimensions of value may be assessed by examining the intended and unintended consequences of using a health technology, compared with existing alternatives. In the note's words, the dimensions of value often include the following.

• Clinical effectiveness and safety.
• Costs and economic implications.
• Ethical, social, cultural and legal issues.
• Organisational and environmental aspects.
• Wider implications for the patient, relatives, caregivers and the population.

The overall value may vary with the perspective taken, the stakeholders involved and the decision context. Likewise, the paper holds that each health system has to define equity, efficiency and quality in its own context.

When in the lifecycle an assessment can take place

The fourth note sets the timing. An assessment can come pre-market, during market approval, post-market, or at the point of disinvestment. For a developer, an assessment can therefore come before a product reaches the market as well as after it.

The paper also gives examples of the decisions HTA can inform. Among them are reimbursement decisions, clinical practice guidelines and essential medicine lists. Medical device and equipment procurement planning is another. Such decisions arise at national, regional or local levels, including hospitals.

Richnovex helps hospitals put smart healthcare solutions into daily use, as its work with hospitals sets out. The work covers the exact workflows, technical specifications and structures the solution needs, and its implementation and system integration. It also covers the training, performance monitoring and maintenance that follow go-live.

How the 2020 definition of health technology assessment was agreed

Before 2020, there was no global consensus on the definition of HTA, despite efforts to evolve its science and practice. Until then, practitioners most often quoted the HTA Glossary's version. It spoke of the systematic evaluation of the properties and effects of a health technology.

A teleconference in January 2018 tested whether the definition could be improved. Representatives of EUnetHTA, HTAsiaLink, RedETSA and the HTA Glossary Committee took part in the task group, the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) became a member, and WHO acted as an observer. The task group met on several occasions from May 2018 until September 2019. Its open consultation drew 172 responses, which fell into four groupings.

In the definition's first sentence, the task group put the word determine in place of assess. This avoids a duplication of concepts when the definition is translated: in Spanish, for example, assess the value becomes evaluar el valor. It also keeps the word assess out of the definition of assessment.

The method in one sentence

Health technology assessment determines the value of a health technology across dimensions that often include clinical, economic, ethical, social, organisational and wider implications. It can inform decisions at different points in that technology's lifecycle.

Sources

1. O'Rourke B, Oortwijn W, Schuller T, International Joint Task Group. The new definition of health technology assessment: a milestone in international collaboration. International Journal of Technology Assessment in Health Care, 2020;36(3):187-190
2. World Health Organization, Health technology assessment (health topic, overview)