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EXPLORING VALUES OF HEALTH TECHNOLOGY ASSESSMENT AGENCIES USING REFLECTIVE MULTICRITERIA AND RARE DISEASE CASE

Published online by Cambridge University Press:  11 October 2017

Mireille M. Goetghebeur ,
Monika Wagner ,
Dima Samaha ,
William O'Neil ,
Danielle Badgley ,
Hector Castro-Jaramillo ,
Payam Abrishami ,
Antonio Sarria-Santamera ,
Irina Cleemput  and
Michele Tringali
Mireille M. Goetghebeur
Affiliation:
LASER School of Public Health, University of Montrealmm.goetghebeur@umontreal.ca
Monika Wagner
Affiliation:
LASER
Dima Samaha
Affiliation:
LASER
William O'Neil
Affiliation:
LASER
Danielle Badgley
Affiliation:
LASER
Hector Castro-Jaramillo
Affiliation:
Ministry of Health, Colombia
Payam Abrishami
Affiliation:
National Health Care Institute ZINL
Antonio Sarria-Santamera
Affiliation:
Agencia de Evaluación de Tecnologias Sanitarias (AETS) of Instituto de Salud Carlos III, Faculty of Medicine, University of Alcalá
Irina Cleemput
Affiliation:
Belgian Health Care Knowledge Centre (KCE)
Michele Tringali
Affiliation:
Lombardia Health Directorate
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Abstract

Objectives: Tackling ethical dilemmas faced by reimbursement decision makers requires deeper understanding of values on which health technology assessment (HTA) agencies are founded and how trade-offs are made. This was explored in this study including the case of rare disease.

Methods: Representatives from eight HTA explored values on which institutions are founded using a narrative approach and reflective multicriteria (developed from EVIDEM, criteria derived from ethical imperatives of health care). Trade-offs between criteria and the impact of incorporating defined priorities (including for rare diseases) were explored through a quantitative values elicitation exercise.

Results: Participants reported a diversity of substantive and procedural values with a common emphasis on scientific excellence, stakeholder involvement, independence, and transparency. Examining the ethical imperatives behind EVIDEM criteria was found to be useful to further explore substantive values. Most criteria were deemed to reflect institutions’ values, while 70 percent of the criteria were reported by at least half of participants to be considered formally by their institutions. The quantitative values elicitation highlighted the difficulty to balance imperatives of “alleviating or preventing patient suffering,” “serving the whole population equitably,” “upholding healthcare system sustainability,” and “making decisions informed by evidence and context” but may help share the ethical reasoning behind decisions. Incorporating “Priorities” (including for rare diseases) helped reveal trade-offs from other criteria and their underlying ethical imperatives.

Conclusions: Reflective multicriteria are useful to explore substantive values of HTAs, reflect how these values and their ethical underpinnings can be operationalized into criteria, and explore the ethical reasoning at the heart of the healthcare debate.

Keywords

HTAValuesEthicsReflective MulticriteriaRare disease
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 33 , Issue 4: Mini-Theme: Stories of HTA Impact , 2017 , pp. 504 - 520
Copyright
Copyright © Cambridge University Press 2017 

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