Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-26T03:08:28.391Z Has data issue: false hasContentIssue false
  • English
  • Français

ETHICS IN HEALTH TECHNOLOGY ASSESSMENT: A SYSTEMATIC REVIEW

Part of: Special Collection - Methods

Published online by Cambridge University Press:  09 October 2018

Christian A. Bellemare ,
Pierre Dagenais Open the ORCID record for Pierre Dagenais [Opens in a new window] ,
Suzanne K.-Bédard ,
Jean-Pierre Béland ,
Louise Bernier ,
Charles-Étienne Daniel ,
Hubert Gagnon ,
Georges-Auguste Legault ,
Monelle Parent  and
Johane Patenaude
Christian A. Bellemare
Affiliation:
Centre intégré universitaire de santé et services sociaux (CIUSSS) de l'Estrie – Centre hospitalier de l'université de Sherbrooke (CHUS) Institut interdisciplinaire d'innovation technologique (3IT) de l'Université de Sherbrooke
Pierre Dagenais
Affiliation:
Centre intégré universitaire de santé et services sociaux (CIUSSS) de l'Estrie – Centre hospitalier de l'université de Sherbrooke (CHUS), Faculté de médecine et des sciences de la santé de l'Université de Sherbrooke Institut interdisciplinaire d'innovation technologique (3IT) de l'Université de Sherbrooke, CHUS Hô[email protected]
Suzanne K.-Bédard
Affiliation:
Centre intégré universitaire de santé et services sociaux (CIUSSS) de l'Estrie – Centre hospitalier de l'université de Sherbrooke (CHUS) Institut interdisciplinaire d'innovation technologique (3IT) de l'Université de Sherbrooke
Jean-Pierre Béland
Affiliation:
Unité d'enseignement en éthique Département des sciences humaines, Université du Québec à Chicoutimi (UQAC) Institut interdisciplinaire d'innovation technologique (3IT) de l'Université de Sherbrooke
Louise Bernier
Affiliation:
Faculté de droit, Université de Sherbrooke
Charles-Étienne Daniel
Affiliation:
Faculté de droit, Université de Sherbrooke Institut interdisciplinaire d'innovation technologique (3IT) de l'Université de Sherbrooke
Hubert Gagnon
Affiliation:
Institut interdisciplinaire d'innovation technologique (3IT) de l'Université de Sherbrooke
Georges-Auguste Legault
Affiliation:
Faculté de droit, Université de Sherbrooke AND Institut interdisciplinaire d'innovation technologique (3IT) de l'Université de Sherbrooke
Monelle Parent
Affiliation:
Institut interdisciplinaire d'innovation technologique (3IT) de l'Université de Sherbrooke
Johane Patenaude
Affiliation:
Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke Institut interdisciplinaire d'innovation technologique (3IT) de l'Université de Sherbrooke
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Integration of ethics into health technology assessment (HTA) remains challenging for HTA practitioners. We conducted a systematic review on social and methodological issues related to ethical analysis in HTA. We examined: (1) reasons for integrating ethics (social needs); (2) obstacles to ethical integration; (3) concepts and processes deployed in ethical evaluation (more specifically value judgments) and critical analyses of formal experimentations of ethical evaluation in HTA.

Methods:

Search criteria included “ethic,” “technology assessment,” and “HTA”. The literature search was done in Medline/Ovid, SCOPUS, CINAHL, PsycINFO, and the international HTA Database. Screening of citations, full-text screening, and data extraction were performed by two subgroups of two independent reviewers. Data extracted from articles were grouped into categories using a general inductive method.

Results:

A list of 1,646 citations remained after the removal of duplicates. Of these, 132 were fully reviewed, yielding 67 eligible articles for analysis. The social need most often reported was to inform policy decision making. The absence of shared standard models for ethical analysis was the obstacle to integration most often mentioned. Fairness and Equity and values embedded in Principlism were the values most often mentioned in relation to ethical evaluation.

Conclusions:

Compared with the scientific experimental paradigm, there are no settled proceedings for ethics in HTA nor consensus on the role of ethical theory and ethical expertise hindering its integration. Our findings enable us to hypothesize that there exists interdependence between the three issues studied in this work and that value judgments could be their linking concept.

Keywords

EthicsHealth technology assessmentSocial needsValue judgmentsValues
Type
Method
Information
International Journal of Technology Assessment in Health Care , Volume 34 , Issue 5 , 2018 , pp. 447 - 457
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

The authors thank the information scientists Mykola Krupko and Francis Lacasse. The authors thank Mrs. Rina Kampeas and Louise Corbeil for editorial work on the manuscript. This work was supported by the Canadian Institutes of Health Research (J.P., grant number 142187). We the authors below attest that (1) each author contributed to the conception and design or analysis and interpretation of data and the writing of the study; (2) each has approved the version being submitted; and (3) the content has not been published nor is being considered for publication elsewhere.

References

REFERENCES

1.ten Have, H. Ethical perspectives on health technology assessment. Int J Technol Assess Health Care. 2004;20:71-76.Google Scholar
2.Reuzel, R, Oortwijn, W, Decker, M, et al. Ethics and HTA: Some lessons and challenges for the future. Poiesis Prax. 2004;2:247-256.Google Scholar
3.Hofmann, BM. Why ethics should be part of health technology assessment. Int J Technol Assess Health Care. 2008;24:423-429.Google Scholar
4.Hofmann, B. Toward a procedure for integrating moral issues in health technology assessment. Int J Technol Assess Health Care. 2005;21:312-318.Google Scholar
5.DeJean, D, Giacomini, M, Schwartz, L, Miller, FA. Ethics in Canadian health technology assessment: A descriptive review. Int J Technol Assess Health Care. 2009;25:463-469.Google Scholar
6.Lavis, J, Wilson, M, Grimshaw, J, et al. Towards optimally packaged and relevance assessed health technology assessments. Hamilton, Ontario: The Canadian Agency for Drugs and Therapeutics in Healthcare; 2007.Google Scholar
7.Burls, A, Caron, L, Cleret de Langavant, G, et al. Tackling ethical issues in health technology assessment: A proposed framework. Int J Technol Assess Health Care. 2011;27:230-237.Google Scholar
8.Assasi, N, Schwartz, L, Tarride, JE, O'Reilly, D, Goeree, R. Barriers and facilitators influencing ethical evaluation in health technology assessment. Int J Technol Assess Health Care. 2015;31:113-123.Google Scholar
9.Hofmann, B. Why not integrate ethics in HTA: Identification and assessment of the reasons. GMS Health Technol Assess. 2014;10:Doc04.Google Scholar
10.Assasi, N, Schwartz, L, Tarride, JE, Campbell, K, Goeree, R. Methodological guidance documents for evaluation of ethical considerations in health technology assessment: A systematic review. Expert Rev Pharmacoecon Outcomes Res. 2014;14:203-220.Google Scholar
11.Garrido, MV, Amaro, JAB, Cichietti, A, et al. Health technology assessment in Europe - Overview of the producers. In: Health technology assessment and health policy-making in Europe. Copenhagen, Denmark; 2008.Google Scholar
12.Saarni, SI, Hofmann, B, Lampe, K, et al. Ethical analysis to improve decision-making on health technologies. Bull World Health Organ. 2008;86:617-623.Google Scholar
13.International Network of Agencies for Health Technology Assessment. Results of the survey on Ethical Issues among INAHTA organizations. Edmonton, Canada: INAHTA: 2003.Google Scholar
14.Arellano, LE, Willett, JM, Borry, P. International survey on attitudes toward ethics in health technology assessment: An exploratory study. Int J Technol Assess Health Care. 2011;27:50-54.Google Scholar
15.Duthie, K, Bond, K. Improving ethics analysis in health technology assessment. Int J Technol Assess Health Care. 2011;27:64-70.Google Scholar
16.European Network for Health Technology Assessment (EUnetHTA). HTA Core Model® online, 2.1 ed. Helsinki: National Institute for Health and Welfare. 2014.Google Scholar
17.Froschl, B, Brunner-Ziegler, S, Eisenmann, A, et al. Methodenhandbuch fur HTA Version 1,2010. [Methods manual for Health Technology Assessment, Version 1.2010]. Vienna: Gesundheit Osterreich GmbH (GOG); 2011.Google Scholar
18.Kristensen, F, Sigmund, H. Health technology assessment handbook. Copenhagen: Danish Centre for Health technology Assessment, National Board of Health; 2007.Google Scholar
19.Droste, S, Gerhardus, A, Kollek, R. Methoden zur Erfassung ethischer Aspekte und gesellschaftlicher Wertvorstellungen in Kurz-HTA-Berichten: Eine internationale Bestandsaufnahme. Köln: Deutschen Agentur für Health Technology Assessment des Deutschen Instituts für Medizinische Dokumentation.Google Scholar
20.Hofmann, B. Etikk i vurdering av helsetiltak. Utvikling av en metode for å synliggjøre etiske utfordringer ved vurdering av helsetiltak. Rapport nr 26-2008. Oslo: Nasjonalt kunnskapssenter for helsetjenesten (NOKC); 2008.Google Scholar
21.Assasi, N, Tarride, J-E, O'Reilly, D, Schwartz, L. Steps toward improving ethical evaluation in health technology assessment: A proposed framework. BMC Med Ethics. 2016;17:1-16.Google Scholar
22.Hofmann, B, Oortwijn, W, Bakke Lysdahl, K, Schwartz, L. Integrating ethics in health technology assessment: Many ways to Rome. Int J Technol Assess Health Care. 2015;31:131-137.Google Scholar
23.Lehoux, P, Williams-Jones, B. Mapping the integration of social and ethical issues in health technology assessment. Int J Technol Assess Health Care. 2007;23:9-16.Google Scholar
24.Saarni, SI, Braunack-Mayer, A, Hofmann, B, van der Wilt, GJ. Different methods for ethical analysis in health technology assessment: An empirical study. Int J Technol Assess Health Care. 2011;27:305-312.Google Scholar
25.Potter, BK, Avard, D, Graham, ID, et al. Guidance for considering ethical, legal, and social issues in health technology assessment: Application to genetic screening. Int J Technol Assess Health Care. 2008;24:412-422.Google Scholar
26.Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, Grp, P. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement (Reprinted from Annals of Internal Medicine). PLoS Med. 2009;89:873-880.Google Scholar
27.Thomas, DR. A general inductive approach for analyzing qualitative evaluation data. Am J Eval. 2006;27:237-246.Google Scholar
28.Pedersen, VH, Dagenais, P, Lehoux, P. Multi-source synthesis of data to inform health policy. Int J Technol Assess Health Care. 2011;27:238-246.Google Scholar
29.Goetghebeur, MM, Wagner, M, Khoury, H, Rindress, D, Gregoire, JP, Deal, C. Combining multicriteria decision analysis, ethics and health technology assessment: Applying the EVIDEM decision-making framework to growth hormone for Turner syndrome patients. Cost Eff Resour Alloc. 2010;8:4.Google Scholar
30.Sacchini, D, Refolo, P, Virdis, A, et al. Electronic Medical Diary (EMD): Ethical analysis in a HTA process. In: 5th Conference of the Italian Chapter of the Association for Information Systems, ItAIS 2008. Paris: Physica-Verlag; 2010:313-320.Google Scholar
31.European network for Health Technology Assessement. Health technology assessment (HTA) [Internet]. [cited August 17, 2017]. www.eunethta.eu/wp-content/uploads/2018/01/The-HTA-Core-Model_Guiding-principles-on-use_20151218.pdf (accessed August 27, 2018).Google Scholar
32.Daniels, N, Porteny, T, Urrutia, J. Expanded HTA: Enhancing fairness and legitimacy. Int J Health Policy Manag. 2016;5:1-3.Google Scholar
33.Daniels, N, van der Wilt, GJ. Health technology assessment, deliberative process, and ethically contested issues. Int J Technol Assess Health Care. 2016;32:10-15.Google Scholar
34.Refolo, P, Sacchini, D, Brereton, L, et al. Why is it so difficult to integrate ethics in Health Technology Assessment (HTA)? The epistemological viewpoint. Eur Rev Med Pharmacol Sci. 2016;20:4202-4208.Google Scholar
Supplementary material: File

Bellemare et al. supplementary material

Bellemare et al. supplementary material 1

Download Bellemare et al. supplementary material(File)
File 29.7 KB
Supplementary material: Image

Bellemare et al. supplementary material

Bellemare et al. supplementary material 2

Download Bellemare et al. supplementary material(Image)
Image 530 KB
Supplementary material: File

Bellemare et al. supplementary material

Bellemare et al. supplementary material 3

Download Bellemare et al. supplementary material(File)
File 27.2 KB
Supplementary material: File

Bellemare et al. supplementary material

Bellemare et al. supplementary material 4

Download Bellemare et al. supplementary material(File)
File 22.8 KB