Health technology assessment (HTA) methods and processes have been criticized for not being sufficiently ‘patient centric’. For example, Perfetto [1] argued that a proposed approach for assessing the value of health care interventions had not sufficiently incorporated a patient perspective and suggested that it represented a ‘missed opportunity’. A similar point was made about the other ‘value assessment frameworks’ developed recently in the United States [2]. In addition, Slejko et al. [3] proposed some key elements of a ‘patient informed’ reference case for conducting economic evaluations, which would supplement reference cases outlined by groups such as the second Panel on Cost-Effectiveness in Health and Medicine [4], by including consideration of elements such as convenience in receiving care, effects on the patient’s family, examination of whether quality of life instruments include the most relevant domains and a model structure for the economic evaluation that adequately reflects the patient’s journey through the various treatment options. While the case to consider the patient perspective is strong, the way in which it should be incorporated in HTA is not obvious. Most HTA analysts would argue that HTAs, with the possible exception of some that are undertaken to support the development of clinical guidelines, or initiatives such as shared (clinical) decision-making, are conducted for those making decisions about the allocation of health care resources for a given population. This population may be the enrollees of a given health plan or, in the case of national health services or national insurance schemes, the whole population of a given country. The population would include patients who currently have the disease of interest, their families, those who have been patients in the past and those who may contract the disease in the future, as well as those past, present and future sufferers of other diseases. Of course, there may be considerable similarity between the perspective of patients currently suffering from a disease and the population at large, but this is not necessarily the case [5, 6, 7]. Therefore, making HTA more patient centric may not be as simple as it appears. The case for considering the patient perspective may differ by type of health care system [8]. For example, in a private insurance-based system, where a substantial proportion of the payments may be made directly by the patients, one might expect more consideration of the patient perspective than in a publicly funded national health service. The empirical evidence generated in the recent years shows that there is greater awareness about the importance of patients’ views in HTA, but there is no common understanding of what “patient-centric HTA” actually means [9]. Here, we attempt to shed further light on the issue by conceptualizing “patient centricity” in two ways: (a) encouraging patients’ engagement in HTA process and (b) enlarging the scope of evidence in HTA to include patients’ outcomes and preferences (HTA methods). We discuss the opportunities and challenges of each, by providing some recent examples from different countries. Finally, we discuss some additional ways to make HTA more patient centric.

Should health technology assessment be more patient centric? If so, how?

Drummond, Michael
;
Torbica, Aleksandra;Tarricone, Rosanna
2020

Abstract

Health technology assessment (HTA) methods and processes have been criticized for not being sufficiently ‘patient centric’. For example, Perfetto [1] argued that a proposed approach for assessing the value of health care interventions had not sufficiently incorporated a patient perspective and suggested that it represented a ‘missed opportunity’. A similar point was made about the other ‘value assessment frameworks’ developed recently in the United States [2]. In addition, Slejko et al. [3] proposed some key elements of a ‘patient informed’ reference case for conducting economic evaluations, which would supplement reference cases outlined by groups such as the second Panel on Cost-Effectiveness in Health and Medicine [4], by including consideration of elements such as convenience in receiving care, effects on the patient’s family, examination of whether quality of life instruments include the most relevant domains and a model structure for the economic evaluation that adequately reflects the patient’s journey through the various treatment options. While the case to consider the patient perspective is strong, the way in which it should be incorporated in HTA is not obvious. Most HTA analysts would argue that HTAs, with the possible exception of some that are undertaken to support the development of clinical guidelines, or initiatives such as shared (clinical) decision-making, are conducted for those making decisions about the allocation of health care resources for a given population. This population may be the enrollees of a given health plan or, in the case of national health services or national insurance schemes, the whole population of a given country. The population would include patients who currently have the disease of interest, their families, those who have been patients in the past and those who may contract the disease in the future, as well as those past, present and future sufferers of other diseases. Of course, there may be considerable similarity between the perspective of patients currently suffering from a disease and the population at large, but this is not necessarily the case [5, 6, 7]. Therefore, making HTA more patient centric may not be as simple as it appears. The case for considering the patient perspective may differ by type of health care system [8]. For example, in a private insurance-based system, where a substantial proportion of the payments may be made directly by the patients, one might expect more consideration of the patient perspective than in a publicly funded national health service. The empirical evidence generated in the recent years shows that there is greater awareness about the importance of patients’ views in HTA, but there is no common understanding of what “patient-centric HTA” actually means [9]. Here, we attempt to shed further light on the issue by conceptualizing “patient centricity” in two ways: (a) encouraging patients’ engagement in HTA process and (b) enlarging the scope of evidence in HTA to include patients’ outcomes and preferences (HTA methods). We discuss the opportunities and challenges of each, by providing some recent examples from different countries. Finally, we discuss some additional ways to make HTA more patient centric.
2020
2020
Drummond, Michael; Torbica, Aleksandra; Tarricone, Rosanna
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11565/4026010
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