Health Technology Assessment (HTA) and health policy making: a narrative review

Abstract

INTRODUCTION: Health Technology Assessment (HTA) is a policy tool for informed decision making that supports the entry and use of health-technologies. Three main forces have driven the development of HTA; rising healthcare demands and expectations, scarcity of resources, and increasing entry of new technologies to the healthcare market. With a commitment to Universal Health Coverage (UHC), decisions on allocations considering cost-effectiveness is crucial. OBJECTIVES: To evaluate the global evidence on the process, outcome and importance of HTA and evidence-based decision making in health policymaking and the potential way forward in Sri Lanka. METHODS: A narrative review on HTA and policy making was undertaken using the databases Medline, Embase, Biomedcentral, Science Direct, Web of Science. Useful websites, reports were looked up. The search was conducted during July- December 2019. The search strategy for scientific literature consisted of free text and MeSH terms related to keywords, namely, HTA, evidence-informed decision making, HTA-report and health policy. For the SWOT analysis and the way forward, literature review and expert opinion were obtained. RESULTS: HTA studies the medical, social, ethical, and economic implications of development and use of health-technology and guides the healthcare system in evidence-based decision making that is patient-centred and achieves the highest value for money. Once the topic nomination and prioritization of health-technology is done, it undergoes assessment, appraisal and decision making. Most countries have a process of collecting and analysing information about health technologies mainly for planning and budgeting purposes and most reports mainly on safety and clinical effectiveness, followed by economic and budgetary considerations. The findings generated through the HTA-process were used mainly to inform decision makers in most countries. Implementation of HTA needs the following; 1. A competent health information technology infrastructure, 2. Establish a core HTA team and building national capacity 3. Transparency of HTA agency and process and legislations 4. Extensive networks 5. Linking HTA to decision making the process. CONCLUSIONS: HTA is an essential tool for evidence-based decision making and allocating health budgets towards achieving UHC. HTA systematically evaluates the effectiveness, costs, and health impact, of a health-technology while considering ethical and equity issues. Institutionalizing HTA needs a conducive environment and commitment. KEYWORDS: HTA, Evidence-informed decision making, Health policy, Institutionalizing HTA