Expanding health technology assessment towards broader value: Ireland as a case study

• Published in: International journal of technology assessment in health care Vol. 39; no. 1; p. e26
• Main Authors: Kinchin, Irina, Walshe, Valerie, Normand, Charles, Coast, Joanna, Elliott, Rachel, Kroll, Thilo, Kinghorn, Philip, Thompson, Alexander, Viney, Rosalie, Currow, David, O’Mahony, James F.
• Format: Journal Article
• Language: English
• Published: New York, USA Cambridge University Press 02.05.2023
• Subjects: Biomedical Technology; Commentary; Cost analysis; Decisions; Delivery of Health Care; Evaluation; Health care; Health care policy; Health services; Health technology assessment; Humans; Intervention; Ireland; Pharmaceuticals; Pharmacoeconomics; Public health; Public services; Quality of life; Reimbursement; Resource Allocation; Social values; Technology assessment; Technology Assessment, Biomedical; Ireland; Health technology assessment (HTA); resource allocation; benefits beyond health; wellbeing; outcome measurement; social value
• ISSN: 0266-4623; 1471-6348
• DOI: 10.1017/S0266462323000235

Healthcare innovations often represent important improvements in population welfare, but at what cost, and to whom? Health technology assessment (HTA) is a multidisciplinary process to inform resource allocation. HTA is conventionally anchored on health maximization as the only relevant output of health services. If we accept the proposition that health technologies can generate value outside the healthcare system, resource allocation decisions could be suboptimal from a societal perspective. Incorporating “broader value” in HTA as derived from social values and patient experience could provide a richer evaluative space for informing resource allocation decisions. This article considers how HTA is practiced and what its current context implies for adopting “broader value” to evaluating health technologies. Methodological challenges are highlighted, as is a future research agenda. Ireland serves as an example of a healthcare system that both has an explicit role for HTA and is evolving under a current program of reform to offer universal, single-tier access to public services. There are various ways in which HTA processes could move beyond health, including considering the processes of care delivery and/or expanding the evaluative space to some broader concept of well-being. Methods to facilitate the latter exist, but their adaptation to HTA is still emerging. We recommend a multi-stakeholder working group to develop and advance an international agenda for HTA that captures welfare/benefit beyond health.