International Journal of Technology Assessment in Health Care, 29:4 (2013), 353–359.
c Cambridge University Press 2013
THEME - HTA and Value
doi:10.1017/S0266462313000378
HEALTH TECHNOLOGY ASSESSMENT,
VALUE-BASED DECISION MAKING, AND
INNOVATION
Chris Henshall
University of York
On behalf of the HTAi Policy Forum
Tara Schuller
Health Technology Assessment International
Background: Identifying treatments that offer value and value for money is becoming increasingly important, with interest in how health technology assessment (HTA) and decision
makers can take appropriate account of what is of value to patients and to society, and in the relationship between innovation and assessments of value.
Methods: This study summarizes points from an Health Technology Assessment International (HTAi) Policy Forum discussion, drawing on presentations, discussions among
attendees, and background papers.
Results and Conclusions: Various perspectives on value were considered; most place patient health at the core of value. Wider elements of value comprise other benefits for:
patients; caregivers; the health and social care systems; and society. Most decision-making systems seek to take account of similar elements of value, although they are assessed
and combined in different ways. Judgment in decisions remains important and cannot be replaced by mathematical approaches. There was discussion of the value of innovation and
of the effects of value assessments on innovation. Discussion also included moving toward “progressive health system decision making,” an ongoing process whereby
evidence-based decisions on use would be made at various stages in the technology lifecycle. Five actions are identified: (i) development of a general framework for the definition
and assessment of value; development by HTA/coverage bodies and regulators of (ii) disease-specific guidance and (iii) further joint scientific advice for industry on demonstrating
value; (iv) development of a framework for progressive licensing, usage, and reimbursement; and (v) promoting work to better adapt HTA, coverage, and procurement approaches
to medical devices.
Keywords: Decision making, Technology assessment, Biomedical, Coverage, Reimbursement, Social values
The rapid development of new medicines, devices, procedures,
and care pathways means that the range of treatment options
continues to grow faster than the resources available to many
patients and healthcare systems, particularly as the impacts of
the global financial crisis are felt. Identifying treatment options
that offer value and value for money is therefore becoming
increasingly relevant (1–3).
Health technology assessment (HTA) is used to ensure that
healthcare decisions take account of relevant evidence in a systematic way (4). There is debate about how HTA can best assess
the various aspects of value and allow these to be factored into
decision-making processes, with particular interest in whether
HTA and decision makers are taking appropriate account of
what matters to patients and to society. Issues include variations
in methods and decisions across systems, and the relationship
between innovation and the assessment of value.
The Health Technology Assessment International (HTAi)
Policy Forum discussed these issues in Barcelona in February
2013. This study describes some of the key themes from that
discussion, and proposes areas where work is needed to improve
methods, alignment or agreement.
METHODS
HTAi Policy Forum
HTAi is the international professional society for producers
and users of HTA (5). The HTAi Policy Forum provides an
opportunity for leaders and senior management of for-profit and
not-for-profit organizations with strategic interests in HTA to
meet with invited experts for in-depth discussions about issues
of emerging international interest (6). A detailed description of
the Forum can be found elsewhere (7).
The Policy Forum met on February 3–5, 2013 to discuss the
topic of HTA and value. The meeting included presentations and
discussions among Forum members and guests invited because
of their standing as researchers, or as patients or members of
the public with relevant expertise and experience.
Development and analysis of the Forum discussion
The authors thank members and invited guests of the HTAi Policy Forum and members of the HTAi
Board of Directors for their contributions to this study, and acknowledge that funding to support
development of this study was provided by Health Technology Assessment International (HTAi).
The topic of HTA and value was chosen by Forum members
in March 2012. A half-day scoping meeting was held at the
main HTAi Annual Scientific Meeting in Bilbao in June 2012,
open to Forum members and all those attending the main HTAi
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Henshall and Schuller
meeting. A background paper (8) was then developed by the
HTAi Secretariat and Policy Forum Chair based on a review
of key references and discussion points identified before, and
during, the scoping meeting and by the Policy Forum Committee and Policy Forum members subsequently. The background
paper was circulated to attendees before the meeting, together
with a copy of the recent paper on value in health care by
Porter (1).
This report presents the authors’ view of the background
material and discussions at the meeting. It has been informed
by comments on drafts by those present, but it is not a consensus statement from those at the meeting or their organizations, and cannot be taken to represent the views of any of
those individuals attending or of the organizations they work
for. Supplementary Table 1, which can be viewed online at
www.journals.cambridge.org/thc2013XXX, lists all attendees
at the meeting.
RESULTS
Defining value
Definitions and Stakeholder Perspectives. Definitions vary both for value
in general and for value in health; value is to an important
extent in the eye of the beholder and dependent on context. The
meeting therefore focused initially on understanding different
stakeholders’ perspectives on value.
Patient Perspective. For patients, the most important determinant of
value is improvement in the length and/or quality of their life.
Survival, freedom from pain, and the ability to undertake activities of daily living are therefore fundamental, but patients may
also value choice; convenience; reduced financial and other burdens for them, their caregivers, family, or society; and increased
certainty about diagnosis or outcomes. Patients’ views on value
tend to reflect the whole of their care pathway and the way
they experience a technology in their healthcare system, not the
value of the technology in isolation. Patients generally want to
be considered and treated as individuals, and to have access
to the treatments they need. Patients may acknowledge that resource constraints mean that system-level decision makers have
to consider the wider public good as well as individual patients’
wishes, although they may be distrustful of high-level decisions
to restrict access to treatments, especially if they do not believe
their voice has been heard.
General Public/Societal Perspective. Whereas the “societal perspective”
may be constructed theoretically in terms of maximizing the
“public good,” the actual views of the public are complex and
challenging to define, may change over time, and may be affected by media coverage of particular issues. The case is often
made to decision makers that the public supports giving increased weight in the determination of value to benefits for some
groups of patients over others, for example favoring groups such
as the young or those with serious or life-threatening illnesses
INTL. J. OF TECHNOLOGY ASSESSMENT IN HEALTH CARE 29:4, 2013
(the latter sometimes called the “rule of rescue”). The Forum
heard, however, that members of the general public can take
widely differing views and can think both in a manner that reflects the broad interests of society and in one that is more driven
by their personal interests, and may switch between these according to circumstances. Even the considered views of a group
of informed members of the general public convened specially
for the purpose of discussing and advising on citizens’ views of
healthcare priorities may vary markedly between members and
over time.
Health System Perspective. Decisions about the availability of treatments within a resource-limited system are typically the responsibility of government ministers or top managers. They
generally aim to allocate resources to care of proven value, but
can find the range of evidence and the range of views on value
and on appropriate methods for assessing it challenging. As a
result, they frequently seek advice from expert committees or
bodies. Such bodies tend to see the benefit of a treatment to patients in the “real world” of their own healthcare system as key to
its value, and they may consult or work with clinical experts, patients and patient organizations. They may also seek to balance
patients’ views with those of the wider public, and to balance the
value gained for patients receiving a treatment against the value
foregone through opportunity costs, typically the value lost from
treatments denied to other patients. The Forum also heard how
health system decision makers may need to take account of
political or commercial considerations when decisions become
the focus of public attention. The discussion emphasized that
system-level views on value involve complex judgments.
Industry Perspectives. The Forum meeting heard clearly from industry members that research-based companies aim to deliver value
for patients and believe profits will follow success there. Thus,
industry aims to focus on the value proposition for patients,
and sees technological advance (e.g., the development of new
molecules or devices) as the means to achieve that, rather than
the end in itself. At the same time, industry is increasingly understanding and addressing the need to demonstrate value to payers.
From the industry perspective, patient health outcomes are the
core of the value proposition, but “wider aspects” of value for
patients, caregivers, and society are also important (and viewed
by some in industry as not always recognized and valued by
payers). Innovative technologies may (also) deliver value to the
system (e.g., cost savings or improvements in safety or reliability) that merits their introduction. Innovative technologies play
a key role in improving health care, but the innovation process
is risky and expensive, so it is important that innovative technologies are properly valued and rewarded. The Forum heard
examples of how the current value or potential future value of
an innovative technology cannot always be clearly understood
at introduction. Industry members stressed the need to consider
the “promise” of a technology and its likely value once fully developed and established in use, as well as current demonstrated
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Elements of value
Core element of value
Health benefits for the patient:
Improved prognosis/survival
Symptom/pain relief
Improved functioning
Reduction in unwanted effects, or reduced risk of adverse events, or improved benefit/risk ratio
Approaches to measurement
Approaches to valuation
Various measures are used to capture health
benefits for patients, including:
Clinical outcome measures (survival,
progression of disease or disease markers,
symptoms, adverse events)
Patient related outcomes (functioning and
quality of life)
Measures of overall health state, e.g., EQ5D
Composite measures of health states and life
expectancy, e.g., QALY, DALY
Measures need to be calibrated/referenced in some way to provide indication
of value. This can be done in various ways, including:
Definition of clinically relevant changes on a scale (in absolute or relative
terms, e.g., standard deviations), as judged by clinicians and/or
patients, e.g., Oswestry Back Pain scale where clinically significant
change is defined as 8–12 percentage points.
Classification of changes in one or a group of measures into categories of
benefit, e.g., HAS ASMR scale from “major improvement to “no
improvement” and G-BA-IQWiG scale from “major added benefit” to
“reduced benefit” (note that categories of this kind may or may not be
constructed or used to make comparisons across different conditions).
Population preferences/utilities for health outcomes/states and
avoiding/reducing harm, measured quantitatively (e.g., QALY) or
qualitatively.
A range of approaches is used to measure
“wider” elements of value with relatively
little agreement or standardization. Various
health economic guidelines are available for
the measurement of health system costs
and, in some cases, other “wider”
elements of value. Those wider elements of
value involving health can be approached in
the same way as the core elements above.
Measures for some others can be adopted
from areas of research such as public health
(e.g., population health gain) and
economic development (e.g., measures of
employment and of economic benefit of
innovative technology sector). See Towse
and Barnsley (9) for further discussion of
various approaches to measuring elements
of value.
Approaches to assigning valuations to measures of the “wider” elements of
value vary, often relying more on qualitative methods or the implicit
judgment of the decision maker to a greater degree than for valuations of
measures of the “core” elements of value. As for the measures of “wider”
elements of value, techniques for valuation can be found in various health
economic guidelines and other areas of public policy research. See Towse
and Barnsley (9) for further discussion of various approaches to valuation
of elements for decision making.
Wider elements of value
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Non-health benefits for the patient
Reduced costs (e.g., out-of-pocket or co-payments for care, attendance at clinics etc.)
Return to work (broadly defined)
Convenience
Reduction in uncertainty
Availability of alternatives/Patient choice (?)
Benefits for caregiver/family
As above for patients, plus:
Reduced burden of care/support
Resulting health improvements for caregiver/family
Benefits for society
Support for needy/disadvantaged groups (e.g., rare diseases, diseases with high burdens, children,
elderly etc.)
Improved productivity arising from patient health improvements and from reduced care burden
outside health system
Promise of great population health benefits in future (either when benefits of current technology
are better understood, or when technology has improved further, or both); to be weighed
against risk of unrealized expectations of health benefits
Economic benefits of innovative technology sector
Benefits for health and social care systems
Improved efficiency/quality/organization of care
Net differential cost and consequent opportunity cost in other parts of the health or social care
system
(For systems aiming to maximize the public good) net gain (or loss) in public health and well-being
HTA, value-based decisions, and innovation
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Table 1. Summary of Core and Wider Elements of Value, and Approaches to Measurement and Valuation
Henshall and Schuller
value. This and other aspects of the definition and value of
innovation and innovative technologies are discussed in more
detail later in this study. Industry members also pointed out
that a technology with multiple indications may have different
values for each indication.
Elements of Value
Building on this discussion of different perspectives on value,
the Forum considered the various elements that comprise value.
Stakeholders appear to agree that patient health is central; it
was therefore considered helpful to distinguish between Core
Elements of Value comprising those elements relating to patient
health improvement, and Wider Elements of Value comprising
elements relating to other benefits for the patient, and to benefits
for caregivers, the health and social care systems, and society
more widely. Column 1 of Table 1 summarizes the Core and
Wider elements of value identified in the Forum discussion and
relevant background materials. The precise elements relevant to
the value of a particular technology will depend on the nature
of the technology and the perspective of the decision maker.
Assessing Value
Assessing value depends upon determining the elements to be
considered, the scales to measure each relevant element, and
how values will be attached to those scales. Columns 2 and 3
of Table 1 summarize the main approaches to measurement and
valuation for the various elements of value identified in column
1. Towse and Barnsley (9) present approaches to measuring
value for decision making.
Factoring Assessments of Value into Decisions
Nature of Decisions. Most health systems are subject to cost pressures.
Health system decision makers therefore have to decide either
(in systems that leave manufacturers free to set prices) whether
a technology at a given price offers clear and sufficient value
for money to justify coverage and for which patient groups, or
(in systems that set prices) what price is justified by the level of
value offered by a technology to a defined group of patients. In
practice, the distinction between these two types of decisions is
less clear-cut as there is increasing negotiation on price between
manufacturers and decision makers in both types of systems.
Those developing new technologies have to decide whether the
likely value of the technology for a particular indication and/or
patient group and health system will lead to a price and market
share that will provide an adequate return on the investment
required to bring the technology to market.
In all these situations, the decision maker is concerned with
the real world of the healthcare system, and is therefore interested in the incremental value and value for money associated
with the use of technology compared with current practice (even
if this current practice is to offer no treatment).
Approaches to Value-Based Decision Making. The Forum heard examples
of real-life HTA-based decision-making systems in the United
INTL. J. OF TECHNOLOGY ASSESSMENT IN HEALTH CARE 29:4, 2013
States, Canada, France, and Germany. These vary considerably
in the measures and methods they use, although most key aspects of value are considered in all systems and all involve a
mix of formulaic and deliberative processes and judgment.
Forum members believed it was important to distinguish
between two kinds of judgments in decisions: scientific judgments needed to interpret uncertainties and differing trends in
the scientific evidence; and value judgments about the relevant
elements of value for a technology, the relevance of the evidence
to these, and the weightings to be attached to them (10).
Most systems currently expect decision makers to consider
both those core and wider elements of value that are seen as relevant to understanding the benefits gained and those displaced
by the adoption of a technology. Decision makers may need
to factor a wide range of disparate elements into a decision,
and this can be challenging. Most systems seem to use a single measure to try to capture patient health gain, for example
quality-adjusted life-years (QALYs) or the categorical scales of
the French and German systems (11;12). Some systems are exploring numerical adjustments to these basic measures to take
account of some “wider elements of value,” such as severity of
illness (13). But, there are limits to the extent to which this can
be done and there is increasing interest in Multi Criteria Decision Analysis (MCDA) (14) as a tool to help decision makers
define the elements to be considered and the relative weights
to be given to each. MCDA can be applied in different ways;
factors relevant to a decision may be combined mathematically
and the product of numerical value scales and weights then used
to inform a decision, or factors may simply be set out to allow
them to be considered in a transparent manner without using
formulas or numerical weights. Most health systems take an
approach that falls somewhere between these two, by using formulas to combine some elements, and judgment to compensate
for known inadequacies in the formulas and to factor in other
elements to arrive at the overall decision.
Three main points emerged from the Forum’s discussion
of approaches to value-based decision making. The first is that
most systems seek to take account of broadly similar elements
of value (in particular, reductions in mortality and morbidity
and improvements in quality of life), although they assess and
combine them in different ways. The second is that systems vary
in the extent to which they bring all the relevant data together
for a decision at a single point (e.g., in the United Kingdom or
Australia where all the relevant information is put on the table at
a single meeting at which a decision is made on coverage and/or
price), as opposed to making a decision in steps (e.g., in France
and Germany where a decision is made on the added value
which then informs a decision on coverage and/or price). This
may be related to the involvement of single or multiple bodies
in the overall decision, with the approach and methods used
perhaps reflecting this, at least in part. The third, and perhaps
most important, point is the need for judgment in decisions
on value, and the need for those designing decision-making
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HTA, value-based decisions, and innovation
processes to accept this and find ways to help decision makers
make better judgments, rather than try to replace judgment with
rigid mathematical approaches that cannot adequately model
the complexity of the various factors and weights.
Value, Innovation, and HTA
Given its interest to many Forum members, a section of the
meeting was dedicated to an in-depth discussion of the relationship between value, innovation, and HTA.
It was believed important when considering innovation to
distinguish between innovative technologies and the innovation
processes involved in developing the technologies pre- and postadoption, and in adapting the health system to them. Although
the main focus of this discussion was innovative technologies,
various examples presented showed clearly that the value of
technologies can often only be understood by considering the
way in which the health system adapts to their introduction,
and the way the technologies themselves evolve in response
to system needs and further scientific developments. Although
there was no clear agreement on how an innovative technology
should be defined, there was a detailed discussion of the value
of innovation.
Value of Innovation. Well-conducted assessments addressing rele-
vant elements of value should capture the immediate health
and wider benefits arising from an innovative technology. Discussion focused on what (if any) value beyond this innovative
technologies may bring patients and healthcare systems.
There was agreement that there is often uncertainty at
launch about the benefit that a new technology may offer for
patients and the system in the longer term. This led some to suggest that assessments should explicitly consider the “promise”
of an innovation as well as the current value demonstrated.
Promise may take the form of (a) benefits that could reasonably be expected from the current version of the technology but
which cannot yet be demonstrated convincingly; (b) benefits
that could reasonably be expected from further refinements in
the use of a technology, or from developments in the technology itself; (c) benefits arising from new, previously unpredicted
indications for the technology; and (d) benefits realized through
accompanying structural or policy changes in the health system.
Examples of (b) were provided by several medical devices, for
example, LVADs, for which rapid improvements in pump and
battery technologies appear to be leading to important improvements in clinical and cost effectiveness. It was argued that a
similar case can be made for drugs where, for example, combination therapies developed for HIV/AIDS and some cancers
have led to better outcomes (and cost-effectiveness) than could
have been achieved by individual agents alone.
Time did not allow a detailed discussion at the meeting
of the implications of considering the future value or “promise”
of technologies. Health systems with limited resources would
need to identify those technologies for which there are good
grounds to expect significant future value. The challenge for
HTA is to develop scientifically sound methods for estimating future benefits and risks. Managed entry and coverage with
evidence development approaches (15–18) already attempt to
address uncertainties in current value. It was noted in discussion
that technology assessment as originally conceived (4) focused
more on the technology and its likely developmental trajectory and impacts than is commonly found in HTA as currently
practiced.
Accurate predictions about the future value of technology
have proved extremely challenging. Without clear methodologies for identifying technologies with significant “promise,”
health systems are likely to remain reluctant to allocate scarce
resources to technologies solely on this basis. Some also questioned why the healthcare system “customer” should pay for
“promise” when in other technology sectors the manufacturer, capital markets, or both take the risk. Manufacturers and
health systems could explore the development of a joint investment approach to adopting and developing promising technologies in the healthcare system (some proposing the term
“pro-imbursement” for this).
HTA, Reimbursement/Procurement, and Innovation. The meeting discussed
ways in which HTA, reimbursement, and procurement can affect innovation. Industry delegates emphasized that technology
developers work on long timescales, with the consequent need
for clear and consistent signals about how value will be assessed
and rewarded.
There was extensive discussion of innovation in medical devices and procedures. Patent exclusivity and some aspects of the
regulatory and HTA systems work less effectively to reward and
promote innovation in medical devices than for medicines (19).
For example, new medicines in the same class as a licensed
product generally have to provide similar evidence as first in
class whereas, for devices, some HTA and payer bodies allow
follow-on products to demonstrate benefits and value by reference to evidence collected for the first in class. This can significantly reduce the development costs of follow-on products and,
in some cases, may lead to a rapid downward price spiral shortly
after the introduction of a new device. While this may promote
value for patients and the system, it can dis-incentivize disruptive innovation by reducing the lead manufacturer’s opportunity
to recoup major development costs. Another challenge of innovation in medical devices is the rapid and ongoing technological
development and improvement of devices and equipment after
initial launch. This makes the issues discussed in the previous
section on technology “promise” particularly relevant to devices
and equipment.
While this discussion focused mainly on medical devices,
similar concerns can arise in relation to drugs. In particular,
concerns were noted about incentives for innovations addressing
unmet medical needs when the main current treatment, and
therefore comparator, is a low cost generic. In this situation (and
particularly in systems that base decisions on assessments of
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Henshall and Schuller
incremental cost-utility), a new treatment offering worthwhile
improvements in outcomes may not be seen to justify a price
that would allow a manufacturer to make an adequate return on
investment.
The Forum considered how innovation of value can be
incentivized and supported. Governments support technology
innovation in many ways, most importantly through publicly
funded research and development and legal protection for intellectual property.
A development that could have a major positive impact on
innovations of value in health care is improved alignment of the
evidence expectations of different HTA and coverage bodies
and, in so far as it is possible, the alignment of HTA/coverage
bodies’ expectations with the requirements of regulatory bodies. Various initiatives, such as EUnetHTA (20) and the Green
Park Collaborative (21) are attempting to align expectations
and requirements around the core of value: the elements concerned with health outcomes for patients. These developments
were seen as important, but some wondered if there are ways to
accelerate, focus, and improve coordination of work in this area.
The discussion also covered what might be done to improve
alignment of evidence requirements for the “wider elements”
of value. Values and culture vary across countries and health
systems, so that systems will take different views on which
“wider elements” of value are important and how they should
be weighted in decisions. It was believed there should nevertheless be scope to improve alignment of definitions, evidence
requirements and methods for these wider aspects, as well as
for the core elements.
Thinking more radically, many believed that it was important now to move from conceiving and practicing HTA and
reimbursement as one-off events (snapshots), to seeing them
as ongoing processes aiming to provide greater certainty and
increasing clarity on appropriate use (and price) as real-world
evidence is collected and analyzed. “Progressive health system
decision making” of this kind could align well with thinking
in the regulatory community on “progressive” or “adaptive”
licensing (21), and build on existing approaches to managed
entry or access with evidence development to create a system
that better reflects the technology and evidence lifecycle. There
are many practical problems to be addressed in putting such
systems in place on the ground. These include agreeing responsibilities for funding products and information collection,
developing fit-for-purpose low cost systems to collect key information routinely, managing the demands on HTA capacity and
efficient deployment of that capacity, and agreed approaches to
handling price adjustments when value is shown to be higher
or lower than expected, and to managing unsuccessful products
out of the system (disinvestment) (22).
Possible actions
What could be done to address the challenges identified and
to improve alignment in definitions and assessments of value,
INTL. J. OF TECHNOLOGY ASSESSMENT IN HEALTH CARE 29:4, 2013
and improve assessment and decision making around innovative technologies? The following five actions were identified.
Time did not allow discussion of who should be responsible for
each, but there is need for the active involvement of HTA and
payer bodies, regulators, industry, patients, and other relevant
stakeholders:
1. Promote the development of a general framework for the definition and
assessment of value by HTA/coverage bodies and regulators, recognizing
that different HTA/coverage bodies work in different systems with different
values. Key components would include: (a) Work to improve convergence
on definitions, measures, and methods to assess health benefits for patients;
(b) Start discussion of definitions and measures of wider elements of value;
and (c) Building on and supporting the work of European Network for
Health Technology Assessment (EUnetHTA) and the European Medicines
Agency (EMA) in these areas, and the Green Park Collaborative (GPC).
2. Promote development of disease-specific guidance for industry from regulators and HTA/payer bodies on measures to capture value for specific conditions, building on GPC Pilot Alzheimer’s Guidance (23) and EUnetHTA
proposed work in Joint Action 2 (24). Although the general framework
proposed above would help to frame and focus discussion, much of the
challenge will be in agreeing the detail of measures for specific conditions.
3. Further develop joint scientific advice for industry from HTA/payer bodies
and regulators. This needs to take place at appropriate steps in the product
development pathway (including before phase 2/3 trials). There is also a
need for feedback in both directions from discussions so each party can
learn about the challenges for the others and consider how it might develop
its current requirements and processes to reduce these. All parties have
limited resources and the process must be run efficiently.
4. Explore development of a framework for progressive licensing, usage, and
reimbursement, including: (a) Methods to assess the trajectory and expected future performance of a technology, and hence its future potential;
(b) Practical approaches to challenges such as progressive pricing, withdrawal of technologies not meeting promise, etc.; (c) Ways to improve
and use registries and routine health information collection systems; (d)
Methods for analysis and use of observational data in decisions; and (e)
Development of systems to promote appropriate use of a technology at all
stages in the process. This work should build on the experience of current
approaches to managed entry and coverage with evidence development.
5. Promote work to better adapt HTA and coverage and procurement approaches to medical devices.
CONCLUSIONS
For many of those present, the key outcome of the discussion
was a clearer understanding of the issues related to value and
what might be done to move forward.
There is much common ground between industry and HTA
and coverage bodies, but there are also some important areas of
disagreement that require further discussion and, where possible, resolution. Toward the end of the meeting, Forum members
from HTA and coverage bodies were asked if they believe that
they consider all relevant elements of value in their assessments, and coverage, and pricing decisions; most believed they
did. Forum members from industry were asked if they believed
that all relevant elements of value were considered by HTA
and coverage bodies, and most indicated they did not. The actions suggested by the Forum should help to address this gap
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HTA, value-based decisions, and innovation
and hopefully ensure that valuable innovations are incentivized,
made quickly available to patients, and appropriately rewarded.
SUPPLEMENTARY MATERIAL
Supplementary Table 1:
www.journals.cambridge.org/thc2013XXX
CONTACT INFORMATION
Chris Henshall, PhD HTAi Policy Forum Chair and Honorary
Fellow (consulting@chrishenshall.co.uk), Centre for Health
Economics, University of York
Tara Schuller, MSc Manager of Policy Programs, Health Technology Assessment International Secretariat
CONFLICTS OF INTEREST
Chris Henshall has received funding from HTAi for the work
reported in this paper, and consultancy fees from several medical
companies for chairing Advisory Board on specific technologies
and advice on global HTA developments and strategy. Tara
Schuller is employed by the Health Technology Assessment
International Secretariat.
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https://doi.org/10.1017/S0266462313000378