A health technology assessment (HTA) is “a form of technology assessment that focuses on the clinical and economic impact of medical and health technologies” within health care.
It aims to assess the benefits, harms, and costs of new and existing technologies in a given clinical setting, and to identify situations where the introduction of a technology is not justified, because there are existing alternatives.
The assessment may form part of a larger process of technology-related decision-making, such as the development of clinical guidelines, performance metrics for healthcare providers, coverage decisions, and procurement strategies.
Why Do HTAs?
There are several justifications for doing HTAs. First, as health technologies become more sophisticated and complex, the ability to review the evidence and make well-informed decisions about them becomes more challenging. Second, the volume of research in this area makes it difficult to keep up-to-date. Third, clinicians and policymakers may not have the necessary time to dedicate to this type of analysis. Finally, there is often a desire among clinicians and policymakers to have a single source of evidence to guide decisions.
What Do HTAs Look Like?
As noted, HTAs are different from traditional forms of research, such as randomized controlled trials (RCTs). While RCTs evaluate the benefits and harms of a given intervention and attempt to isolate these from confounding factors, HTAs look at the impact of a given intervention on a given setting. This can include both benefits and harms, and it can be difficult to determine how much of an effect is due to which variable (i.e., intervention or setting). In other words, it is often difficult for reviewers to establish whether an observed difference is solely the result of the intervention or whether it is also due to unmeasured variables (e.g., different practices between settings, unmeasured differences in patient populations, and/or unethical practices) – sometimes referred to as confounder variables.
This is called the confounding or selection bias, and it can make it difficult to establish causality and measurement of impact. In cases where a given intervention is not provided in a settings where an HTA is not performed, the bias may be even more apparent. In these cases, it is often not clear whether the intervention would even work in the first place (e.g., in a country where the food safety regulations are not up to date), and thus it is difficult to evaluate its effectiveness without providing it in a setting where it can be evaluated for the first time.
How Do I Perform An HTA?
There are a variety of ways in which you can conduct an HTA, depending on the nature of your interest. For example, you may be interested in providing clinically relevant information about a given intervention in an existing database (e.g., Medline or EMBASE), or you may decide to compile a meta-analysis of all available evidence, including both published and unpublished data.
You should also consider the expertise of the individuals involved. For example, if you are reviewing a medication for pneumonia, it is probably not appropriate to involve a family doctor in the evaluation. On the other hand, if you are reviewing a device used for heart implantation, it is most likely that an expertise in cardiovascular medicine should be involved.
Finally, it is important to think about the time it takes to perform an HTA. It takes a dedicated team of people with specific expertise to perform a complete and satisfactory analysis of published research and guidance documents (e.g., clinical practice guidelines, performance measures for healthcare providers, and regulatory agency guidelines). This is a significant time commitment, and thus you should plan to include this type of work in your schedule if you want to get the results of the assessment in a timely fashion.
Based on analysis of publicly available information, the top five most commonly assessed technologies for which HTAs were performed are listed in Table 1.
Top five most commonly assessed technologies for which HTAs were performed
- ICU (Intensive Care Unit)
- PCI (Percutaneous Coronary Intervention)
- Heparin (Anticoagulant)
- Loop Ear Tumor Therapy
- Laparoscopic Gynecology
It is important to think about the limitations of this data when considering these top five answers. Firstly, the frequency with which these determinations are being made is not clear from the data available. It is likely that many of these determinations are not being made at all, as reflected by the zero value in the upper left-hand corner. This is particularly true for the ICU and PCI answers, as they may not be commonly assessed for the purposes of the data set. Similarly, the absence of an HTA for specific conditions (e.g., Laparoscopic Gynecology, Heparin, and Loop Ear Tumor Therapy) suggests that these conditions may not be commonly referred to HTAs.
Secondly, the analysis is limited to the top five most commonly assessed technologies for which an HTA was performed. It is possible that there are other technologies for which the evidence base is sufficient to permit comprehensive studies, but these are not included because they did not appear in the top five most commonly assessed technologies. Thirdly, it is important to remember that the data set only reflects publicly available information, and that many studies are not being performed in registry fora or by individual researchers for profit corporations, but are being carried out for the purpose of evaluating the impact of a given medical or surgical device or formula, vaccine, or drug on a particular population (e.g., patients or healthcare providers).
What Are The Most Commonly Assessed HTA Topics?
Health technology assessment (HTA) covers the broad field of evaluating the impact of new and existing health technologies, such as medical devices, pharmaceuticals, and digital health technologies. The vast majority of clinical trials focus on assessing the medical device or pharmaceutical side of things, but there is also a significant focus on the digital health sector.
According to the Global Market Analysis & Assessment Consulting (GMAC®) report The Future of Healthcare Technology Assessment: How Market Research will Transform the Industry),”over the past decade, the life sciences industry has increasingly relied on healthcare technology assessment to better understand the impact of new and existing technologies on patient care and outcomes. Many life sciences companies have their own in-house scientists or clinicians who assess the technology in question, while a growing number of healthcare technology assessment companies have established in-house capabilities to conduct these studies.”