Assessing the added value of health technologies: reconciling different perspectives

Providing universal access to innovative, high-cost technologies leads to tensions in today’s healthcare systems. The tension becomes particularly evident in the context of scarce resources, where the risk of taking contentious coverage decisions increases rapidly, In order to ensure economic sustainability, the payers of health care l think that the benefits from the use of the new technologies need to be commensurate with the costs. Therefore, many jurisdictions have programmes of health technology assessment (HTA), which often result in restrictions of access to care, either through complete refusal to reimburse the technology, or its restriction of use to only a sub-set of the eligible patient population. On the other hand, manufacturers feel that they should be adequately rewarded for their innovations and require sufficient funds to invest in further research. Finally, patients perceive these technologies to have added benefits, so are concerned when they are denied access. If sustainable access to health care is to be maintained in the future, approaches are needed to reconcile these different perspectives. This paper explores the approaches, in both methods and policy, to help bring about this reconciliation. These include rethinking the notion of social value (on the part of payers), aligning manufacturers’ research more closely with societal objectives and increasing patient participation in HTA.