Evaluating Public Health Interventions: A Neglected Area in Health Technology Assessment

Abstract

Introduction: Public health (PH) interventions are crucial for ensuring sustainable healthcare services. Nevertheless, they represent a neglected area in the field of health technology assessment (HTA) due to various methodological issues and their complex design that goes beyond clinical setting. The present study provides an environmental scan of HTA initiatives related to the assessment of PH technologies on a global level.Methods: We conducted a cross-sectional survey among 85 HTA-related European and international societies, health bodies, and networks from September 2018 to January 2019. The questionnaire contained four sections and 18 questions regarding activities related to the evaluation of PH technologies, information on existing PH technologies, and methodologies of assessment as well as barriers and facilitators to reaching a decision and implementing a PH technology.Results: Among 52 survey responses, the majority of the respondents came from European countries (35%), followed by North American (27%), and South American (19%) countries. The main type of organizations covered by our survey included HTA agencies, public administrations, and research institutes. Seventy-one % of the institutions reported engagement in any aspect of HTA in the area of PH (N = 37). Among those, 81% evaluated less than 5 PH technologies from 2013 to 2018. The most common barriers for reaching a decision on PH technologies were lack of data, conflicting stakeholder priorities, and methodological issues. A total of 76 PH interventions were reported, and most cited initiatives were related to chronic disease screening, prevention of infectious diseases, and maternal, prenatal, and neonatal screening.Conclusion: Our survey reported a rather limited involvement of HTA in the evaluation of PH technologies. In particular, an evaluation of behavioral and lifestyle interventions remains extremely rare. The implementation of collaborative HTA approaches in the setting of PH practice and policy needs to be prioritized and further strengthened. Moreover, ensuring reliable data structures and consolidation of HTA methods for the evaluation of PH technologies will be crucial for tackling the enormous burden of non-communicable diseases in societies.

Coding Public Health Interventions for Health Technology Assessments: A Pilot Experience With WHO's International Classification of Health Interventions (ICHI)

“…We aimed to evaluate the transferability of PH intervention data from 52 international HTA professionals to ICHI and to describe our coder experiences with the ICHI classification. We generally found that ICHI provides a good coverage of PH interventions, despite the challenges we faced due to the lack of detailed reporting in the original survey ( 5 ). The broader character of system wide interventions, often involving a variety of institutions and stakeholders, may have presented a hurdle to the application of ICHI coding (including actions, targets and means).…”

“…In total, 52 respondents from all continents answered the survey. The majority came from European countries (34%), followed by North American (26.9%) and South American countries (19.2%) ( 5 ). The obtained information was entered in a standard data collection extraction spread sheet (Microsoft Excel, version 2016) and categorized according to the ICHI.…”

“…Different authors have pointed out that HTA organizations do not frequently include PHIs among their portfolio of technologies to be assessed ( 3 , 4 ). Nevertheless, HTA agencies and units are increasingly including PHIs among the main topics of discussion and projects such as the HTAi's Interest Group on Public Health ( 5 ) and the European Public Health Association's HTA devoted group ( 6 ) with over 1,000 members. Moreover, the COVID-19 pandemic highlights the importance of public health interventions to all countries worldwide, increasing demand for evidence-based interventions to control a further outbreak of the coronavirus disease or future pandemics.…”

“…Furthermore, in the case of PHIs, ICHI categorization may be useful for stakeholders engaged in HTA reports by disentangling the complexity of these interventions as well as establishing a common HTA framework for their analysis. Based on this classification that will be translated in almost all languages and probably adopted by most systems, we have analyzed HTA reports on PHIs retrieved from a previous survey in which 76 PHIs were identified from 2013 to 2018 ( 5 ).…”

Systems thinking in health technology assessment: a scoping review

“…HTAs are most commonly undertaken to assess often narrowly defined decision problems for single classes of technologies including drugs, medical devices, and screening programs. Processes of care, public health interventions, and other complex interventions are less commonly assessed; however, the value of such analysis is recognized (2).…”