International Journal of Technology Assessment in Health Care

General Essays

Methods, procedures, and contextual characteristics of health technology assessment and health policy decision making: Comparison of health technology assessment agencies in Germany, United Kingdom, France, and Sweden

Ruth Schwarzera1 and Uwe Sieberta2

a1 UMIT–University of Health Sciences, Medical Informatics and Technology

a2 UMIT–University of Health Sciences, Medical Informatics and Technology; Harvard School of Public Health; and Harvard Medical School

Abstract

Objectives: The objectives of this study were (i) to develop a systematic framework for describing and comparing different features of health technology assessment (HTA) agencies, (ii) to identify and describe similarities and differences between the agencies, and (iii) to draw conclusions both for producers and users of HTA in research, policy, and practice.

Methods: We performed a systematic literature search, added information from HTA agencies, and developed a conceptual framework comprising eight main domains: organization, scope, processes, methods, dissemination, decision, implementation, and impact. We grouped relevant items of these domains in an evidence table and chose five HTA agencies to test our framework: DAHTA@DIMDI, HAS, IQWiG, NICE, and SBU. Item and domain similarity was assessed using the percentage of identical characteristics in pairwise comparisons across agencies. Results were interpreted across agencies by demonstrating similarities and differences.

Results: Based on 306 included documents, we identified 90 characteristics of eight main domains appropriate for our framework. After applying the framework to the five agencies, we were able to show 40 percent similarities in “dissemination,” 38 percent in “scope,” 35 percent in “organization,” 29 percent in “methods,” 26 percent in “processes,” 23 percent in “impact,” 19 percent in “decision,” and 17 percent in “implementation.”

Conclusion: We found considerably more differences than similarities of HTA features across agencies and countries. Our framework and comparison provides insights and clarification into the need for harmonization. Our findings could serve as descriptive database facilitating communication between producers and users.

Footnotes

The authors are grateful to all persons who provided information on the HTA agencies German Agency for HTA at The German Institute for Medical Documentation and Information (DAHTA@DIMDI), The Institute for Quality and Efficiency in Health Care (IQWiG), La Haute Autorité de Santé (HAS), The Swedish Council on Technology Assessment in Health Care (SBU), and The International Network of Agencies for Health Technology Assessment (INAHTA). However, the findings and conclusions in this publication are exclusively those of the authors. The authors also want to thank Dr. Mark J.C. Nuijten (Erasmus University Rotterdam, the Netherlands) and Don Husereau, B.Sc.Pharm., MSc. (CADTH – Canadian Agency for Drugs and Technologies in Health, Canada) for their helpful comments. This work was supported by the ONCOTYROL Center of Personalized Cancer Medicine and the Program on Health Technology Assessment at the Department of Public Health, Medical Informatics and Health Technology Assessment, UMIT. Oncotyrol is a COMET Center funded by the Austrian Research Promotion Agency (FFG), the Tiroler Zukunftsstiftung, and the Styrian Business Promotion Agency (SFG).