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Reflections on the evolution of health technology assessment in Europe

Published online by Cambridge University Press:  05 January 2012

Corinna Sorenson  and
Kalipso Chalkidou
Corinna Sorenson*
Affiliation:
Research Fellow in Health Policy, London School of Economics, London, UK
Kalipso Chalkidou
Affiliation:
Director, NICE International and Visiting Faculty, Berman Institute of Bioethics, Johns Hopkins University, USA
*
*Correspondence to: Corinna Sorenson, London School of Economics, LSE Health, Cowdray House, Houghton Street, London WC2A 2AE, UK. Email: [email protected]
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Abstract

Health technology assessment (HTA) has assumed an increasing role in health systems in recent years, with many countries establishing agencies or programmes to evaluate health technology and other interventions to inform policy decisions and clinical practice. This paper reflects upon its development and evolution in Europe over the last decade, with a focus on England, France, Germany and Sweden. In particular, we explore how HTA has evolved over time as well as its impact on policy and practice. While countries share many of the same objectives, there are differences in the way HTA agencies and programmes are organised, operate, and influence decision making. Despite these differences, all systems are faced with opportunities and challenges related to stakeholder involvement and acceptance, the suitability and transparency of assessment requirements and methods, balancing evidence and values in decision making, and demonstrating impact.

Type
Articles
Information
Health Economics, Policy and Law , Volume 7 , Issue 1 , 05 January 2012 , pp. 25 - 45
Copyright
Copyright © Cambridge University Press 2012

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References

Appleby, J., Devlin, N., Parkin, D., Buxton, M.Chalkidou, K. (2009), ‘Searching for cost-effectiveness thresholds in the NHS’, Health Policy, 91(3): 239–245.Google Scholar
Abelson, J., Giacomini, M., Lehoux, P.Gauvin, F. (2007), ‘Bringing “the public” into health technology assessment and coverage policy decisions: from principle to practice’, Health Policy, 82(1): 37–50.Google Scholar
Anell, A.Persson, U. (2005), ‘Reimbursement and clinical guidance for pharmaceuticals in Sweden: do health economic evaluations support decision making?’, European Journal of Health Economics, 6(3): 274–279.CrossRefGoogle ScholarPubMed
Audit Commission (2005), Managing the Financial Implications of NICE Guidance, London: Audit Commission.Google Scholar
Bending, M.W., Hutton, J., McGrath, C. (2010), ‘Comparative-effectiveness versus cost-effectiveness: A comparison of the French and Scottish approaches to Single Technology Appraisal’, ISPOR 15th Annual International Meeting, May 15–19th Atlanta, GA.Google Scholar
Brickwood, D. (2004), Implementation of NICE Guidance: an ABHI Perspective, London: Department of Health.Google Scholar
Bundesgesundheitsministerium (2008), Stellungnahme zur Methodik der Kosten-Nutzen-Bewertung von Arzneimitteln, http://www.bmg.bund.de/cln_169/nn_1168258/SharedDocs/Standardartikel/DE/AZ/K/Glossar-Kosten-Nutez-Berwertung/Stellungnahme.html. Bonn: Bundesgesundheitsministerium.Google Scholar
Caniard, E. (2002), Les recommandations de bonnes pratiqués: un outil de dialogue, de responsabilité et de diffusion de l'innovation, Saint-Denis: Haute Autorité de Santé.Google Scholar
Chalkidou, K. (2009), Comparative Effectiveness Review within the U.K.'s National Institute for Health and Clinical Excellence, New York: The Commonwealth Fund.Google ScholarPubMed
Chalkidou, K., Lord, J., Fisher, A.Littlejohns, P. (2008), ‘Evidence-based decision making: when should we wait for more information?’, Health Affairs, 27: 1642–1623.CrossRefGoogle ScholarPubMed
Chalkidou, K., Tunis, S., Lopert, R., Rochaix, L., Sawicki, P. T., Nasser, M.Xerri, B. (2009), ‘Comparative effectiveness research and evidence-based health policy: experience from four countries’, Milbank Quarterly, 87(2): 339–367.Google Scholar
Chevreul, K.Durand-Zaleski, I. (2009), ‘HTA in coverage and reimbursement decisions in France: toward a new paradigm?’, Euro Observer, 11(1): 5–6.Google Scholar
Chisholm, A., Briggs, K.Askham, J. (2009), Not NICE: can PCTs Engage Patients and the Public in Commissioning New Health Technologies?, Oxford: Picker Institute Europe.Google Scholar
Claxton, K. (2009), ‘Innovation Review – The Value of Innovation’, Presentation at Kennedy Workshop on NICE's Approach to Valuing Innovation, London, May 19.Google Scholar
Cookson, R., McDaid, D.Maynard, A. (2001), ‘Wrong SIGN, NICE mess: Is national guidance distorting allocation of resources’, British Medical Journal, 323: 743–745.CrossRefGoogle ScholarPubMed
Culyer, A. J.Lomas, J. (2006), ‘Deliberative process and evidence-informed decision-making in health care: Do they work and how might be now’, Evidence & Policy, 2(3): 357–371.Google Scholar
Department of Health (2009), Update of NICE Approved Cancer Drugs 2007/2008, London: Department of Health.Google Scholar
Department of Health (2010), Equity and Excellence: Liberating the NHS, London: The Stationary Office Limited.Google Scholar
Devlin, N.Parkin, D. (2004), ‘Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? A binary choice analysis’, Health Economics, 13: 437–452.CrossRefGoogle ScholarPubMed
Devlin, N., Parkin, D.Gold, M. (2003), ‘WHO evaluates NICE’, British Medical Journal, 327: 1061–1062.Google Scholar
Drummond, M. (2009), ‘More haste, less speed? The emerging practice of HTA in the United Kingdom’, Euro Observer, 11(1): 9–10.Google Scholar
Drummond, M. F., Schwartz, J. S., Jonsson, B., Luce, B. R., Neumann, P. J., Siebert, U.Sullivan, S. D. (2008), ‘Key principles for the improved conduct of health technology assessments for resource allocation decisions’, International Journal of Technology Assessment in Health Care, 24: 244–258.Google Scholar
Gerhardus, A. (2006), ‘The role of HTA in German health care. Do we need impact objectives?’, Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 49(3): 233–240.CrossRefGoogle ScholarPubMed
Goddard, M., Hauk, K., Preker, A.Smith, P. (2006), ‘Priority-setting in health: a political economy perspective’, Health Economics, Policy and Law, 1: 79–90.Google Scholar
Goodman, C. (2004), HTA 101: Introduction to Health Technology Assessment, Bethesda, MA: National Library of Medicine, National Information Center on Health Services Research and Health Care Technology.Google Scholar
Haycox, A. (2008), ‘Does NICE blight exist, and if so, why?’, Pharmacoeconomics, 26(12): 987–989.Google Scholar
Hitchen, L. (2008), ‘NICE recommendations have had little effect on multiple sclerosis services five years on’, British Medical Journal, 337: a734.CrossRefGoogle Scholar
Hughes, B. (2008), ‘Payers’ growing influence on R&D decision making’, Nature Reviews Drug Discovery, 7: 876–878.Google Scholar
Hutton, J., McGrath, C., Frybourg, J., Tremblay, M., Bramley-Harker, E.Henshall, C. (2006), ‘Framework for describing and classifying decision-making systems using technology assessment to determine the reimbursement of health technologies (fourth hurdle systems)’, International Journal of Technology Assessment in Health Care, 22: 10–18.Google Scholar
IQWiG (2008), General Methods, http://www.iqwig.de/download/IQWiG_General_methods_V-3-0.pdf, Cologne: IQWiG.Google Scholar
IQWiG (2010a), http://www.iqwig.de/institute-for-quality-and-efficiency-in-health.2.en.html, Cologne: IQWiG.Google Scholar
IQWiG (2010b), IQWiG in Dialogue, http://www.iqwig.de/iqwig-in-dialogue.908.en.html, Cologne: IQWiG.Google Scholar
Jacob, R.McGregor, M. (1997), ‘Assessing the impact of health technology assessment’, International Journal of Technology Assessment in Health Care, 13(1): 68–80.Google Scholar
Johnson, F. R. (2009), ‘Moving the QALY forward or just stuck in traffic?’, Value in Health, 12: S38–S39.CrossRefGoogle ScholarPubMed
Kanavos, P., Nicod, E., Van den Aardweg, S.Pomedli, S. (2010), ‘The impact of health technology assessments: an international comparison’, Euro Observer, 12(4): 1–6.Google Scholar
Kennedy, I. (2009), Appraising the Value of Innovation and Other Benefits: a Short Study for NICE, London: NICE.Google Scholar
Milewa, T. (2006), ‘Health technology adoption and the politics of governance in the UK’, Social Science and Medicine, 63: 3102–3112.CrossRefGoogle ScholarPubMed
Milewa, T.Barry, C. (2005), ‘Health policy and the politics of evidence’, Social Policy and Administration, 39(3): 498–412.Google Scholar
Nasser, M.Sawicki, P. (2009), Institute for Quality and Efficiency in Health Care: Germany, New York: The Commonwealth Fund.Google Scholar
National Cancer Director (2006), Usage of Cancer Drugs Approved by NICE, London: Department of Health.Google Scholar
National Health Authority (2007), Service to the Community (SERC): How to Take into Account other Dimensions Other than Medical in Practice?, Paris: National Health Authority.Google Scholar
National Institute for Health and Clinical Excellence (NICE) (2006a), NICE Implementation Uptake Report: Drugs for Obesity, http://www.nice.org.uk/page.aspx?o=390757, London: NICE.Google Scholar
NICE (2006b), NICE Implementation Uptake Report: Cox II Selective Inhibitors, http://www.nice.org.uk/page.aspx?o=390760, London: NICEGoogle Scholar
NICE (2008a), Guide to the Methods of Technology Appraisal, London: NICE.Google Scholar
NICE (2008b), Social Value Judgments: Principles for the Development of NICE Guidance, 2nd edn, London: NICE.Google Scholar
NICE (2009), Net Cost Estimate, Implementation Programme, London: NICE.Google Scholar
Oberlander, J., Marmor, T.Jacobs, L. (1994), ‘Rationing medical care: Rhetoric and reality in the Oregon health plan’, Canadian Medical Association Journal, 164(1): 1583–1587.Google Scholar
Office of Technology Assessment (1996), The OTA legacy, Washington, DC: Government Printing Office, http://www.princeton.edu/~ota/Google Scholar
Oliver, A.Sorenson, C. (2009), ‘The limitations and challenges to the economic evaluation of health technologies’, in J. Costa-Font, C. Courbage and A. McGuire (eds), The Economics of New Health Technologies: Incentives, Organization, and Financing, Oxford: Oxford University Press.Google Scholar
Oliver, A., Mossialos, E.Robinson, R. (2004), ‘Health technology assessment and its influence on health-care priority setting’, International Journal of Technology Assessment in Health Care, 20(1): 1–10.Google Scholar
Olson, M. (1965), The Logic of Collective Action, Cambridge: Harvard University Press.Google Scholar
Owen-Smith, A., Coast, J.Donovan, J. (2010), ‘The usefulness of NICE guidance in practice: different perspectives of managers, clinicians, and patients’, International Journal of Technology Assessment in Health Care, 26(3): 317–322.Google Scholar
Patel, P., Roberts, S., Sparrowhawk, K., Ng Haing, J. (2010), ‘Evaluating comparative effectiveness research for oncology in the US: An analysis based on lessons from health technology assessment in Europe’, ISPOR 15th Annual International Meeting, May 15–19th, Atlanta, GA.Google Scholar
Perleth, M., Gibis, B.Gohlen, B. (2009), ‘A short history of health technology assessment in Germany’, International Journal of Technology Assessment in Health Care, 25(S1): 112–119.Google Scholar
Persson, U.Hjelmgren, J. (2003), ‘Health services need knowledge of how the public values health’, Lakartidningen, 100(43): 3436–3437.Google ScholarPubMed
Raftery, J. (2010a), ‘Should NICE's threshold range for cost per QALY be raised? No’, British Medical Journal, 338: b185.Google Scholar
Raftery, J. (2010b), ‘Multiple sclerosis risk sharing scheme: a costly failure’, British Medical Journal, 340: c1672.Google Scholar
Rawlins, M.Culyer, A. (2004), ‘National Institute for Clinical Excellence and its value judgements’, British Medical Journal, 329: 224.CrossRefGoogle Scholar
Rochaix, R.Xerri, B. (2009), National Authority for Health: France, New York: The Commonwealth Fund.Google Scholar
Schlozman, K. L.Tierney, J. T. (1986), Organized Interests and American Democracy, New York: Harper and Row.Google Scholar
Schmidt, H.Kreis, J. (2009), ‘Lessons from abroad’, Hastings Center Report, 39(6): 20–22.CrossRefGoogle ScholarPubMed
Sheldon, T. A., Cullum, N., Dawson, P., Lankshear, A., Lawson, K., Watt, I., West, P., Wright, D.Wright, J. (2004), ‘What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients’ notes, and interviews’, British Medical Journal, 329: 999.CrossRefGoogle ScholarPubMed
Sorenson, C., Tarricone, R., Siebert, M.Drummond, M. (2011), ‘Applying health economics for policy decision making: do devices differ from drugs?’, Europace, 13, Supplement 2: ii54–ii58.Google Scholar
Sorenson, C., Drummond, M.Kanavos, P. (2008a), Ensuring Value for Money in Health Care: the Role of Health Technology Assessment in the European Union, Copenhagen: European Observatory on Health Systems and Policies.Google Scholar
Sorenson, C., Drummond, M., Kanavos, P.McGuire, A. (2008b), National Institute for Health and Clinical Excellence (NICE): How Does It Work and What Are the Implications for the US?, Reston, VA: National Pharmaceutical Council.Google Scholar
Straus, S. E. (2004), ‘What has evidence based medicine does for us?’, British Medical Journal, 329: 987–988.CrossRefGoogle ScholarPubMed
Swedish Dental and Pharmaceutical Benefits Agency (2010), Developing the Pricing System for Pharmaceuticals Could Save Billions, http://www.tlv.se/in-english/news/developing-the-pricing-system-for-pharmaceuticals-could-save-billions/ [13 April 2011]Google Scholar
Syrett, K. (2003), ‘A technocratic fix to the “legitimacy problem”? The Blair government and health care rationing in the United Kingdom’, Journal of Health Politics, Policy and Law, 28(4): 715–746.CrossRefGoogle Scholar
Towse, A. (2009), ‘Should NICE's threshold range for cost per QALY be raised? Yes’, British Medical Journal, 338: b181.CrossRefGoogle ScholarPubMed
Velasco-Garrido, M.Busse, R. (2005), Health Technology Assessment: an Introduction on Objectives, Role of Evidence, and Structure in Europe, Brussels: European Observatory on Health Systems and Policies.Google Scholar
Velasco-Garrido, M., Kristensen, F. B., Nielsen, C. P.Busse, R. (2008), Health Technology Assessment and Health Policy-making in Europe: Current Status, Challenges and Potential, Copenhagen: European Observatory on Health Systems and Policies.Google Scholar
Williams, I.Bryan, S. (2007), ‘Understanding the limited impact of economic evaluation in health care resource allocation: a conceptual framework’, Health Policy, 80: 135–143.CrossRefGoogle ScholarPubMed