International Journal of Technology Assessment in Health Care


Methodology of constructive technology assessment in health care

Kirsten F. L. Doumaa1, Kim Karsenberga1, Marjan J. M. Hummela2, Jolien M. Bueno-de-Mesquitaa3 and Wim H. van Hartena4

a1 The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital

a2 University of Twente

a3 The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital

a4 University of Twente and The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital


Objectives: Technologies in health care are evolving quickly, with new findings in the area of biotechnological and genetic research being published regularly. A health technology assessment (HTA) is often used to answer the question of whether the new technology should be implemented into clinical practice. International evidence confirms that the results of HTA research sometimes have limited impact on practical implementation and on coverage decisions; the study design is commonly based on the paradigm of stability of both the technology and the environment, which is often not the case. Constructive technology assessment (CTA) was first described in the 1980s. In addition to the traditional HTA elements, this approach also takes into account the technology dynamics by emphasizing sociodynamic processes. With a CTA approach, comprehensive assessment can be combined with an intentional influence in a favorable direction to improve quality.

Methods: In this study, the methodological aspects mainly concerning the diagnostic use of CTA are explained. The methodology will be illustrated using the controlled introduction of a new technology, called microarray analysis, into the clinical practice of breast cancer treatment as a case study. Attention is paid to the operationalization of the phases of development and implementation and the research methods most appropriate for CTA.

Conclusions: In addition to HTA, CTA can be used as a complementary approach, especially in technologies that are introduced in an early stage of development in a controlled way.


The RASTER team members are Sabine Linn, Marc van de Vijver, Laura van't Veer, Harm van Tinteren, Frits van Dam, and Emiel Rutgers. This study was made possible with a grant of the Dutch Health Care Insurance Board (CVZ).