Health technology assessment: A matter of facts and values

The unique task and contribution of health technology assessment (HTA) is to help identify those health technologies and their uses that are most likely to preserve and restore a population’s health in a way that is consonant with its values, including, for example, equity and access to high-quality care (1). Such a task is challenging for at least two reasons. First, because of the vast and constantly evolving number and diversity of health technologies and their applications. Second, because of the usual wide variety of competing views within communities and their stakeholders regarding what strategies are likely to be conducive to the goal of preserving and restoring population health. Although perhaps tempting, it would be a grave mistake to hold that the controversies that result from such competing views can be resolved by taking recourse to the facts only. For such controversies are usually fueled by different notions of health and disease and different specifications of values such as equity and individual and collective responsibility for health. For this reason, they cannot be resolved in a satisfactory way without also addressing those normative issues and their interplay with empirical analysis.*

Interestingly, the need to also address normative issues in such cases has long been acknowledged in the field of policy sciences (2). HTA, as a specific type of policy analysis (3), can benefit substantially from incorporating these insights and associated methodologies in its practice. This, in fact, was the objective of the recently completed values in doing assessments of healthcare technologies (VALIDATE project, financially supported by the Erasmus+ program of the European Union). This was a 3-year strategic partnerships project (2018–21) in which HTA organizations and academic institutes have collaborated in developing educational and training materials for the next generation of HTA practitioners. The project consisted of the development of an E-learning course and associated handbook, focusing on the type of knowledge and skills that those who have an interest in HTA need to develop in order to further enhance HTA’s scientific rigor and policy relevance. In addition, a consensus statement was developed, articulating the consortium’s position on the role of empirical analysis and normative inquiry in HTA. Master’s students, PhD students, and researchers working on projects related to HTA and/or the evaluation of health technologies and policy who wished to broaden and deepen their knowledge and skills in this area were eligible for enrollment in the VALIDATE E-learning course. Students who had successfully completed the E-learning course were offered the opportunity of conducting an internship at an academic institute or HTA organization in order to apply their newly acquired knowledge and skills to a specific subject. The E-learning course has been accredited by the international society for HTA (HTAi). All deliverables of the project are freely available from the project’s Web site, www.validatehta.eu.

In this journal, two related papers that derived from the VALIDATE project have been published. One paper (4) briefly explains the VALIDATE approach to HTA and how it differs from current HTA practice. Using a concrete example, it shows how the relevance of empirical evidence is contingent upon a specific interpretive frame that comprises normative commitments. In addition, it argues that incorporating specific insights and methods from policy sciences offers a concrete way for achieving two important objectives: (i) conducting a scoping exercise as an integral part of HTA, and (ii) involving stakeholders in a more structural and constructive way than the currently is usually the case. The second paper (5) reports the experiences and lessons that were obtained with the VALIDATE teaching program and training materials: how did students experience the E-learning course, and how did it help them in conducting an internship that lived up to the aspirations, as expressed in the course and associated handbook? The paper shows that, overall, ratings of the teaching materials were high, but that students found it challenging to maintain and employ the critical perspective learned in VALIDATE and to justify their choices to the staff of host organizations. The paper closes by discussing how the associated approaches to scoping and stakeholder involvement could be incorporated more structurally in HTA, taking into account the various constraints that HTA organizations are facing. Whether such challenges can be met will, to a large extent, determine the rate with which the proposed approach can be adopted by the HTA community.

With the new definition of HTA (1) the path for integrating empirical analysis and normative inquiry in HTA has been laid out. The evaluation of the E-learning course by the students and the reflections from supervisors at HTA organizations demonstrate the added value of VALIDATE for HTA. The evaluation, the continuous interest of Master’s students at our universities, as well as positive feedback given by HTA experts during the HTAi Annual Meeting 2021 pre-conference workshop on VALIDATE that we organized, encouraged us in continuing to train the next HTA generation. Ultimately, it is never too late to learn.