MODULE 1: Introduction

Introduction to Health Technology Assessment

Reporters:
Dugenia, Ferdinand, *Gatoc, Ivy Monique,*Morandarte, Honey Jay, * Panis, Jannie Mae
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 What is HTA?
HTA is “the systematic evaluation of the
properties and effects of a health
technology, addressing the direct and
intended effects of this technology, as well

Introductio as its indirect and unintended

consequences, and aimed mainly at
informed decision making regarding health
n to Health technologies.” (NIHR)

Technology “The main purpose of HTA is to inform

policymaking for technology in health care,

Assessment where policymaking is used in the broad

sense to include decisions made at, e.g., the
individual or patient level, the level of the
health care provider or institution, or at the
regional, national and international levels.”
(HTA 101)
What is Health
Technology?
A health technology is the
application of organized
knowledge and skills in the
form of devices, medicines,
vaccines, procedures and
systems developed to solve a
health problem and improve
quality of lives.
Brief History of HTA:
• 1960s: Growing appreciation that technologies could have
harmful effects in additional to their intended benefits
• 1970s:Office of Technology Assessment established in the
USA. Growth in use of technology assessment.
• 1980s: Beginnings of health technology assessment (HTA) as a
formal discipline
• 1990s: Introduction of HTA programmes to support
reimbursement decisions
• 2000s: The European Commission and Council of Ministers
targeted HTA as ‘a political priority’

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Use of HTA
internationally
HTA is used for decision making by:
˗ Regulatory agencies (whether or not to
allow marketing of a technology) This Photo by Unknown author is licensed under CC BY-SA-NC.

˗ Payers (whether or not and how much to

pay for a technology)
˗ Providers (to support decisions about
acquisition and management)
˗ Clinicians and patients (to identify most
appropriate use of interventions)
˗ Government health department officials
(evaluating public health
Programmes)
˗ Health care technology companies
(identifying product development options)

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What is Universal Health
Coverage?

Universal health coverage means that all people have

access to the health services they need, when and where
they need them, without financial hardship. It includes the
full range of essential health services,
from health promotion to prevention, treatment,
rehabilitation, and palliative care.

Universal health coverage should be based on strong,

people-centred primary health care. Good health systems
are rooted in the communities they serve. They focus not
only on preventing and treating disease and illness, but
also on helping to improve well-being and quality of life
• 2015 Report of global survey on Health Technology Assessment
by National Authorities

This report summarizes the methods and main findings of the

WHO 2015 Global Survey on HTA. This survey was aimed at HTA
conducted by government or national institutes. It was
undertaken in response to World Health Assembly Resolution
67.23. This resolution, ‘Health intervention and technology
assessment in support of universal health coverage’ called on the
WHO Secretariat to assess the status of HTA globally
• 2015 Report of global survey on Health Technology Assessment by
National Authorities
The main findings are: 

• Human Methodology • Governance

resources and and linkage
institutional between HTA
capacity units/ networks
with policy
authorities

Impediments
to
strengthening Utilization of
capacity results
• 2015 Report of global survey on Health Technology Assessment
by National Authorities

METHOD : To ensure the suitability of the nominated respondent

(all members of a state), the request specified that the
respondent would ideally be engaged in one or more of the
following:

• Evidence-based decision making of public funding of health

services;
• Determining priority health interventions;
• Planning resources allocation; or
• HTA in a committee, a unit, a department or an established HTA
organization at a national or subnational level.
• 2015 Report of global survey on Health Technology Assessment by
National Authorities

The survey had five broad sections that aimed to measure:

Institutional
Utilization of HTA in Scope of HTA and
capacity and
public sector availability of
human resources
decision making; guidelines
supporting HTA

Requirements for
Governance of HTA
strengthening HTA
process; and
capacity.
CONCEPTS & PRINCIPLES
OF HTA (with
PHARMACOECONOMICS)

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 HTA FUNDAMENTAL CONCEPTS
A. Health Technology
1. Physical Nature
The practical application of knowledge in health care is quite
broad.  Main categories of health technology.
• Drugs:  e.g., aspirin, beta-blockers, antibiotics, cancer
chemotherapy
• Biologics:  e.g., vaccines, blood products, cellular and gene
therapies
• Devices, equipment and supplies:  e.g., cardiac pacemaker,
magnetic resonance imaging (MRI) scanner, surgical gloves,
diagnostic test kits, mosquito netting
• Medical and surgical procedures:  e.g., acupuncture, nutrition
counseling, psychotherapy, coronary angiography, gall bladder
removal, bariatric surgery, cesarean section

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1. Physical Nature
• Public health programs: e.g., water purification system,
immunization program, smoking prevention program
• Support systems:  e.g., clinical laboratory, blood bank,
electronic health record system, telemedicine systems,
drug formulary,
• Organizational and managerial systems:  e.g., medication
adherence program, prospective payment using diagnosis-
related groups, alternative health care delivery configurations

• Certainly, these categories are interdependent; for example,

vaccines are biologics that are used in immunization programs,
and screening tests for pathogens in donated blood are used
by blood banks.
2. Purpose or Application

Technologies can also be grouped according to their health care

purpose`

• Prevention:  protect against disease by preventing it from

occurring, reducing the risk of its occurrence, or limiting its
extent or sequelae (e.g., immunization, hospital infection
control program, fluoridated water supply)
• Screening:  detect a disease, abnormality, or associated risk
factors in asymptomatic people (e.g., Pap smear, tuberculin
test, screening mammography, serum cholesterol testing)
• Diagnosis:  identify the cause and nature or extent of disease
in a person with clinical signs or symptoms (e.g.,
electrocardiogram, serological test for typhoid, x-ray for
possible broken bone)

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2. Purpose of Application
• Treatment:  intended to improve or maintain health status or
avoid further deterioration (e.g., antiviral therapy,
coronary artery bypass graft surgery, psychotherapy)
• Rehabilitation:  restore, maintain or improve a physically or
mentally disabled person's function and well-being
(e.g., exercise program for post-stroke patients, assistive
device for severe speech impairment, incontinence aid)
• Palliation:  improve the quality of life of patients, particularly
for relief of pain, symptoms, discomfort, and stress of
serious illness, as well as psychological, social, and spiritual
problems.  (Although often provided for progressive, incurable
disease, palliation can be provided at any point in illness and
with treatment, e.g., patient-controlled analgesia, medication
for depression or insomnia, caregiver support.)
3. Stage of Diffusion

Technologies may be assessed at different stages of diffusion and maturity.  In general, health care technologies may
be described as being:
Future:  in a conceptual stage, anticipated, or in the earliest stages of development

Experimental:  undergoing bench or laboratory testing using animals or other models

Investigational:  undergoing initial clinical (i.e., in humans) evaluation for a particular condition or indication

Established:  considered by clinicians to be a standard approach to a particular condition or indication and diffused
into general use
Obsolete/outmoded/abandoned:  superseded by other technologies or demonstrated to be ineffective or harmful.
 B. Health Technology Assessment
The main purpose of HTA is to inform policymaking for technology in health
care, where policymaking is used in the broad sense to include decisions.  HTA
may address the direct and intended consequences of technologies as well as
their indirect and unintended consequences.  HTA is conducted by
interdisciplinary groups using explicit analytical frameworks, drawing from a
variety of methods. 

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 • HTA can be used in many ways to advise or inform
technology-related policies and decisions.  Among these are
1. Purposes to advise or inform:
• Regulatory agencies about whether to permit the
of HTA commercial use (e.g., marketing) of a drug, device or other
regulated technology
• Payers (health care authorities, health plans, drug
formularies, employers, etc.) about technology coverage
(whether or not to pay), coding (assigning proper codes to
enable reimbursement), and reimbursement (how much to
pay)
 • Government health department officials about undertaking
public health programs (e.g., immunization, screening, and
environmental protection programs)
• Lawmakers and other political leaders about policies
concerning technological innovation, research and
1. Purposes development, regulation, payment and delivery of health
care
of HTA • Health care technology companies about product
development and marketing decisions
• Investors and companies concerning venture capital
funding, acquisitions and divestitures, and other
transactions concerning health care product and service
companies
• Research agencies about evidence gaps and unmet health
needs
 • Clinicians and patients about the appropriate use of health
care interventions for a particular patient’s clinical needs
and circumstances
• Health professional associations about the role of a
1. Purposes technology in clinical protocols or practice guidelines

of HTA • Hospitals, health care networks, group purchasing

organizations, and other health care organizations about
decisions regarding technology acquisition and management
• Standards-setting organizations for health technology and
health care delivery regarding the manufacture,
performance, appropriate use, and other aspects of health
care technologies
2. Basic HTA Orientations

The impetus for an HTA is not necessarily a particular

technology.  Three basic orientations to HTA are as follows.

Technology-oriented assessments are intended to determine

the characteristics or impacts of particular technologies.

---For example, a government agency may want to determine

the clinical, economic, social, professional, or other impacts of
cochlear implants, cervical cancer screening, PET scanners, or
widespread adoption of electronic health record systems.

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2. Basic HTA Orientations
• Problem-oriented assessments focus on
solutions or strategies for managing a
particular disease, condition, or other
problem for which alternative or
complementary technologies might be
used.
---- For example, clinicians and other
providers concerned with the problem of
diagnosis of dementia may call for HTA to
inform the development of clinical practice
guidelines involving some combination or
sequence of clinical history, neurological
examination, and diagnostic imaging using
various modalities.
2. Basic HTA Orientations
• Project-oriented assessments focus on a
local placement or use of a technology in
a particular institution, program, or other
designated project. ----- For example, this
may arise when a hospital must decide
whether or not to purchase a PET
scanner, considering the facilities,
personnel, and other resources needed
to install and operate a PET scanner; the
hospital’s financial status; local market
potential for PET services; competitive
factors; etc.
C. Properties and Impacts Assessed
What does HTA assess?  HTA may involve the investigation of one or more properties, impacts, or other
attributes of health technologies or applications.  In general, these include the following .

Technical Efficacy and/or

properties effectiveness

Safety

Economic Social, legal,

attributes or ethical and/or
impacts political impacts
Technical properties - Performance characteristics
and conformity with specifications for design,
composition, manufacturing, tolerances, reliability,
ease of use, maintenance, etc. 

Safety - Judgment of the acceptability of risk (a

measure of the probability of an adverse outcome
and its severity) associated with using a technology in
a given situation, e.g., for a patient with a particular
health problem, by a clinician with certain training, or
in a specified treatment setting. 
• Efficacy and/or effectiveness - Both refer to how well a
technology works, i.e., accomplishes its intended purpose,
usually based on changes in one or more specified health
outcomes or “endpoints” as described below.  A technology
that works under carefully managed conditions does not
always work as well under more heterogeneous or less
controlled conditions
• Economic attributes or impacts 
- Can be microeconomic and macroeconomic.  Microeconomic
concerns include costs, prices, charges, and payment levels
associated with individual technologies.  Other concerns include
comparisons of resource requirements and outcomes (or
benefits) of technologies for particular applications, such as cost
effectiveness, cost utility, and cost benefit. (Health technology
can have or contribute to a broad range of macroeconomic
impacts.  These include impacts on:  a nation’s gross domestic
product, national health care costs, and resource allocation
across health care and other industrial sectors, and international
trade.  Health technology can also be a factor in national and
global patterns of investment, innovation, competitiveness,
technology transfer, and employment (e.g., workforce size and
mobility).  Other macroeconomic issues that pertain to health
technologies include the effects of intellectual property policies
(e.g., for patent protection), regulation, third-party payment,
and other policy changes that affect technological innovation,
adoption, diffusion, and use. 
• Social, legal, ethical and/or political impacts - HTA in the form
of normative concepts

(e.g., valuation of human life);

choices about how and when to use technologies; research and
the advancement of knowledge; resource allocation; and the
integrity of HTA processes themselves .  Indeed, the origins of
technology assessment called for the field to support
policymakers’ broader considerations of technological impacts,
such as the “social, economic, and legal implications of any
course of action” and the “short- and long-term social
consequences (for example, societal, economic, ethical, legal) of
the application of technology.”
D. Expertise for Conducting HTA
Given the variety of impacts addressed and the range of methods that may be used in an
assessment, multiple types of experts are needed in HTA.  Depending upon the topic and
scope of assessment, these include a selection of the following:

Physicians, Biomedical • Biostatisticians

Pharmacists and • Epidemiologist
nurses, other and clinical
pharmacologists • Economists
clinicians engineers
• Social Scientists
Ethnicists
Biomedical Patients and Physicians,
and clinical community nurses, other
engineers representatives clinicians
• Lawyers,
• Computer Scientists/programmers
Managers of hospitals, • Librarians/information specialists,
Laboratory technicians,
clinics, nursing homes, • Patients and community
radiology technicians, and
and other health care representatives
other allied health
institutions professionals
E. Basic HTA Frameworks
There is great variation in the scope, selection of
methods and level of detail in the practice of HTA. 
Nevertheless, most HTA activity involves some form of
the following basic steps. 
1.    Identify assessment topics
2.    Specify the assessment problem or questions
3.    Determine organizational locus or responsibility
for assessment
4.    Retrieve available relevant evidence
5.    Generate or collect new evidence (as appropriate)
6.    Appraise/interpret quality of the evidence
7.    Integrate/synthesize evidence
8.    Formulate findings and recommendations
9.    Disseminate findings and recommendations
10.  Monitor impact
 • Relevant
 Regulatory agencies (whether or not to allow marketing of a technology)
 Payers (whether or not and how much to pay for a technology)
 Providers (to support decisions about acquisition and management)
 Clinicians and patients (to identify most appropriate use of interventions)
  Government health department officials (evaluating public health programmes)
 Health care technology companies (identifying product development options)
• Transparent  

Key Principle   The findings of a HTA can have major implications for patients, clinicians, service
providers, manufacturers, etc 
 HTA is intended to be accessible, inclusive, transparent and unbiased. 
 To achieve transparency, the methods and data used, and how the HTA was
influenced, must be clearly reported. 
 Conflicts of interest of individuals involved in the process must be documented.
• Unbiased - 
• Systematic
• Evidence Based
• Comprehensive
The HTA Process

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 Health Technology
Assessment Process
Processes and methods
There is great variation in the scope,
selection of methods and level of detail
in the practice of HTA. In a condensed
form, an HTA can be characterized by
three phases:
Assessment: collation and critical review
of scientific evidence
Appraisal: review of the assessment with
consideration of all other (policy) factors
by a committee to make a
recommendation
Decision-making: implementation of the
recommendation.
Figure 1 shows a general (simplified) HTA process. It highlights the goal of the HTA process: communicating
Each of these three phases comprises information from health research (science) to decision-making and, ultimately, to the population.
various structures and functions. Not all
HTA programs conduct all of these steps,
in fact ‘decision making’ is rarely, if ever,
in the remit of an HTA body.
• HTA bodies must decide what information is important for decision makers to have about a technology and how they
will gather that information.
Decisions that an HTA body makes about its processes and methods influence the assessments, and are in turn
influenced by the organization and remit of the HTA body itself.

• HTA bodies have to determine what knowledge regarding the consequences and impacts of using a health technology
are important for decision-makers and to what extent their assessment should be individualized (to a single
technology).

For example, while understanding the clinical effectiveness of a health technology is generally considered important for
decision-makers, some health technologies may have ethical issues associated with their use while others do not. An HTA
body must choose if it will apply one standard process to all health technologies, or if it will allow for specific processes for
the assessment of each technology individually, based on the relevant information required. In this case, should ethical
information be gathered for all technologies under evaluation, or should there be a separate process that provides that
information where necessary?
Most HTA involves some form of the following basic steps:

• Identify assessment topics

• Specify the assessment problems or questions
• Retrieve available relevant evidence
• Generate or collect new evidence (as appropriate)
• Appraise/interpret quality of the evidence
• Integrate/synthesize evidence
• Formulate findings and recommendations
• Disseminate findings and recommendations
• Monitor impact

Not all HTA bodies conduct all of these steps, and they are not necessarily
conducted in a linear manner.

Reference: https://toolbox.eupati.eu/resources/health-technology-assessment-process-fundamentals/

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 • The Philippine HTA Process Guide is an
• The Philippine HTA Process Guide is a annex of the Administrative Order with the
reference document detailing the title “The New Implementing Guidelines
general steps employed by the HTA
Unit of the Department of Health in on Health Technology Assessment to
conducting health technology Guide Funding Allocation and Coverage
assessments. Decisions in support of Universal Health
• It aims to provide structure,
Care”. 
transparency and clarity in the The Philippine HTA Process Guide can be
processes followed by the HTA accessed in this link:  
committee and its subcommittees http://bit.ly/HTAPGPhilippines.
when undertaking a health
technology appraisal.
• It also aims to ensure that the HTAC
and the HTA Unit are properly guided
in the effective discharge of their
functions and responsibilities. At the
same time, it serves as a guide for
the stakeholders in terms of the roles
and participation in the processes.
What is
Pharmacoeconomics?

• Pharmacoeconomics can be regarded as a
branch of health economics which deals with
identifying, measuring, and comparing the
costs and consequences of pharmaceutical
products and services.
•  It helps in forming an economic relationship
which combines the drug research, its
production and distribution, storage, pricing,
and further use by the people. 
Some of the concepts involved in
pharmacoeconomic analysis include cost
minimization, cost effectiveness, cost benefit,
and cost utility analysis.
• Pharmacoeconomics can be of tremendous help in decision-making
when evaluating the affordability of and access to the right
medication to the right patient at the right time when comparing two
drugs in the same therapeutic class of drugs.
•  This helps in establishing accountability that the claims by a
manufacturer regarding a drug are justified. 
• Proper application of pharmacoeconomics, will allow the pharmacy
practitioners and administrators to make better and more informed
decisions regarding products and services they provide.
• Reference/s:
• https://www.nlm.nih.gov/nichsr/hta101/ta10104.html
• https://eunethta.eu/wp-content/uploads/2018/01/Training_SF2014_key_principles_of_hta.pdf
• http://bit.ly/HTAPGPhilippines.]

• https://www.slideshare.net/siddharthadutta8/pharmacoeconomics-80695080
        THANK YOU :)

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