Use of Evidence-Informed Deliberative Processes by Health Technology Assessment Agencies Around the Globe

Abstract

Background: Evidence-informed deliberative processes (EDPs) were recently introduced to guide health technology assessment (HTA) agencies to improve their processes towards more legitimate decision-making. The EDP framework provides guidance that covers the HTA process, ie, contextual factors, installation of an appraisal committee, selecting health technologies and criteria, assessment, appraisal, and communication and appeal. The aims of this study were to identify the level of use of EDPs by HTA agencies, identify their needs for guidance, and to learn about best practices. Methods: A questionnaire for an online survey was developed based on the EDP framework, consisting of elements that reflect each part of the framework. The survey was sent to members of the International Network of Agencies for Health Technology Assessment (INAHTA). Two weeks following the invitation, a reminder was sent. The data collection took place between September-December 2018. Results: Contact persons from 27 member agencies filled out the survey (response rate: 54%), of which 25 completed all questions. We found that contextual factors to support HTA development and the critical elements regarding conducting and reporting on HTA are overall in place. Respondents indicated that guidance was needed for specific elements related to selecting technologies and criteria, appraisal, and communication and appeal. With regard to best practices, the Canadian Agency for Drugs and Technologies and the National Institute for Health and Care Excellence (NICE, UK) were most often mentioned. Conclusion: This is the first survey among HTA agencies regarding the use of EDPs and provides useful information for further developing a practical guide for HTA agencies around the globe. The results could support HTA agencies in improving their processes towards more legitimate decision-making, as they could serve as a baseline measurement for future monitoring and evaluation.

Principles for deliberative processes in health technology assessment

“…The ITO model describes a deliberative process in terms of five different aspects: (i) the way in which deliberators are identified and selected and the general conditions under which the committee will conduct deliberation and reach decisions; (ii) the collection of information that forms the basis for deliberation; (iii) the individual cognitive and relational aspects that enable the presentation and weighing of facts, values, and reasons that lead to a collective judgment (including formal decision frameworks such as MCDA); (iv) the way in which the content and result of the deliberation is communicated and learning is consolidated; and (v) the opportunities within the process where important stakeholders such as patients, clinicians, manufacturer representatives, and payers might provide input and participate in other ways to better fulfill the aims of the deliberative process. Some researchers consider deliberative processes in HTA to encompass a broad range of decision points and activities, including topic identification, scoping, and appeal (14). As illustrated in the ITO diagram, the deliberative process, as considered by GPF participants, was not this expansive.…”

Deliberative Processes by Health Technology Assessment Agencies: A Reflection on Legitimacy, Values and Patient and Public Involvement Comment on "Use of Evidence-informed Deliberative Processes by Health Technology Assessment Agencies Around the Globe"

“…Authors' affiliations 1 Department of management, Evaluation and Health Policy, School of Public Health, University of Montreal, Montreal, QC, Canada. 2 Research Center, University Hospital Center Ste Justine, Montreal, QC, Canada.…”

Evidence-Informed Deliberative Processes for HTA Around the Globe: Exploring the Next Frontiers of HTA and Best Practices Comment on "Use of Evidence-informed Deliberative Processes by Health Technology Assessment Agencies Around the Globe"

“…7 Oortwijn et al apply the term "evidence-informed deliberative processes" (EDPs) to describe how "HTA [health technology assessment] agencies should ideally organize their processes to achieve legitimate decision-making. " 7 A general critique that can be leveled against the use of "EDP" to describe these processes is that it promotes the perception that it represents a "new" approach to explicitly addressing the issue of legitimacy, when it in fact involves qualities that resemble deliberative processes that have been set up in the context of healthcare priority setting at least for several decades. 4,5 Oortwijn et al have previously developed a guide describing key steps of EDP: setting up an appraisal committee, defining decision criteria that reflect shared values and establishing a process for identifying and selecting health technologies for HTA, assessing and appraising a specific HTA, and finally communication and the opportunity for appeal.…”