Ethical health technology assessment in Latin America: lessons from Canada and Argentina

Abstract

A wide array of biomedical and genetic technologies is becoming available in both developed and developing nations. This situation is the cause of growing concern for health policy makers who must evaluate the utility of these technologies for their inclusion in public health insurance programs. Ideally, policy makers would have the information necessary to rationally allocate scarce resources, prioritise technologies, and ensure fair access to necessary health care services. The reality, however, is that policy makers often do not have such information. In this paper, we argue that the field of Health Technology Assessment (HTA), through the integration of ethical analyses (i.e., an "ethical HTA"), can enable Argentinean and other Latin American policy makers to better understand the soco-ethical concerns raised by new biotechnologies.Key words: health technology assessment, bioethics, policy, genetics, prenatal tests, Argentina, Canada Evaluación ética de la tecnología en salud de Latinoamérica: lecciones aprendidas de Canadá y ArgentinaResumen: Una amplia gama de tecnologías biomédicas y genéticas ya se encuentra disponible tanto en los países desarrollados como en vías de desarrollo. De allí la importancia de evaluar dichas tecnologías para su ulterior inclusión en los programas de salud pública. Idealmente, los responsables de formular políticas dispondrían de la información necesaria para asignar los escasos recursos de manera racional, priorizar tecnologías y asegurar un acceso equitativo a los servicios de salud. Sin embargo, la realidad es que los responsables de formular políticas carecen a menudo de dicha información. En este trabajo argumentamos que la evaluación ética de tecnologías sanitarias permitiría a los decisores políticos argentinos y de otros países latinoamericanos comprender mejor las inquietudes socio-éticas que las nuevas biotecnologías plantean.Palabras clave: evaluación tecnologías sanitarias, bioética, política, genética, pruebas prenatales, Argentina, Canadá Avaliação Ética da Tecnologia em Saúde na América Latina: Lições aprendidas do Canadá e ArgentinaResumo: Foi disponibilizada uma ampla coleção de tecnologias biomédicas e genéticas tanto em países desenvolvidos como nos países em desenvolvimento. Esta situação é a causa de preocupação crescente dos formuladores de políticas públicas de saúde sobre como avaliar a utilidade destas tecnologias para a sua inclusão em programas de saúde pública. Idealmente, os formuladores de políticas públicas deveriam ter a informação necessária para distribuir racionalmente os escassos recursos, priorizar tecnologias e garantir acesso justo aos serviços de cuidado à saúde necessários. A realidade, entretanto, é que os formuladores de políticas públicas em geral não têm tal informação. Neste artigo, argumentamos que o campo da avaliação de tecnologia de saúde (ATS), através da integração de análise ética (ex., uma "ATS ética"), pode capacitar os formuladores de políticas públicas da Argentina e de outros países latino-americanos, a entend...

How does HTA addresses current social expectations? An international survey

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Eliciting Value-Judgments in Health Technology Assessment: An Applied Ethics Decision Making Paradigm

“…The argument structure of the report involves decision concerning five steps (see Table 1 Steps 11 to 15). The distinction between assessment and appraisal proposes a way of reporting the research findings as reported by Martin and colleagues: "Following Blanquaert & Caron the process of HTA can be described as a combination of two phases: 1) assessment, which includes epidemiological studies, the collection of all available scientific information (e.g., literature review, cost-effectiveness analyses) and then a subsequent analysis and synthesis; and 2) appraisal, in which contextualised studies are conducted and recommendations made" (Martin et al, 2011). In this scheme, the report's structure is based on a distinction between "scientific information" and "contextualized studies".…”

“…However, in this scheme, it is not clear how the results of contextualized studies should be presented. Finally, since recommendations are a part of the appraisal phase, the assessment phase's results should be integrated with those of contextual studies in the recommendations according to this scheme (Martin et al, 2011).…”

Desafíos éticos en investigación genómica y biotecnología. Veinte años de Acta Bioethica

“…El manejo sensacionalista de los medios produce un desajuste en relación con las medidas que podrían tomarse para mejoras en salud y desarrollo social, de acuerdo con bases científicas y participación ciudadana (27). Contar con la información adecuada, posibilitaría que los responsables de formular políticas pudieran asignar, de una manera racional, los escasos recursos disponibles en países en desarrollo, priorizando tecnologías y asegurando acceso equitativo, pero esto a menudo no ocurre (28).…”