What is HTA

HTA is the abbreviation of the English term "health technology assessment".

What is technology and what is meant by assessment?

The concept of health technology is defined by the  World Health Organization ako praktické uplatnenie organizovaných vedomostí a zručností na riešenie zdravotného problému a zlepšenie kvality života. Zdravotnícke technológie majú rôzne formy: lieky, zdravotnícke pomôcky, dietetické potraviny, očkovacie látky, prístroje, ale aj postupy či software.

In this context, to assess a health technology means to gather all the scientific studies and knowledge about the given technology. Subsequently, it means to interconnect the knowledge, interpret it (using the principles of evidence-based medicine), and determine the technology´s clinical benefit. Then, it means to include all the other essential aspects, such as organizational, social/patient aspects, legal or ethical aspects. And last but not least, calculate the magnitude of clinical benefit in proportion to the costs incurred.

To assess does not mean to appraise

The meaning of the word assessment is discussed above. To appraise, however, means to consider the information resulting from the assessment and to issue a decision.

Assessment is a purely professional activity with a well-defined methodology, which factually and soberly evaluates the current state of things and the degree to which the technology meets the respective regulations, or under what circumstances it would meet them. The assessment forms the basis of the appraisal.

Appraisal is more of a political act. It is a process the decision will come from. It may even deviate from the conclusions of the institution's HTA assessment, but that needs to be adequately justified. Some European HTA institutions combine both assessment and appraisal in a single institution. However, there is a prevalence of those that separate them for the sake of political independence.

Príklad rozdielu medzi hodnotením a posúdením:

Môže prísť výskumná otázka, či má štát zakúpiť ďalší kus inovatívnej, a zároveň nákladnej zdravotníckej technológie, napr. robotizovaný operačný systém da Vinci.

Assessment:

Zosumarizovanie informácií o danom prístroji, jeho klinickom, organizačnom, sociálnom či etickom prínose, nákladoch, a jeho používaní na Slovensku a v zahraničí.

Hodnotiteľ by zistil, koľko podobných prístrojov používajú iné krajiny, za akým účelom a v akých zariadeniach; či krajiny vydali odporúčania pre ich počet a použitie, za aké ceny ich obstarávali a podobne.

Hodnotiteľ vypracuje rozsiahlu analýzu s kratšou, jasnou a výstižnou informáciou v niekoľkých vetách – odporúčaním, či ďalší kus robotizovaného systému da Vinci kúpiť alebo nie a prečo.

Appraisal:

Posudzovateľ (osoba alebo komisia) na základe sumarizačného textu z hodnotenia a iných vstupov vie prijať rozhodnutie, či má Slovensko zakúpiť nový systém alebo nie.

Why is the HTA body an independent institution?

The health technologies industry naturally urges for the most positive ratings possible in order to increase sales of its products. Similarly, politicians try to influence the decisions to be in line with the political demand. Such a situation is undesirable and so the HTA body must be immune to such lobbying. The quest for independence is the reason why more and more countries, including those from “developed” Europe, have set up independent HTA agencies. However, there are also countries where the HTA work is carried out by a part of the Ministry of Health or the respective Medicines Agency.

Within the EEA, there are independent HTA institutes in the following countries: Austria, Poland, Germany, the Netherlands, Belgium, France, Italy, Spain, Switzerland, Sweden, Finland, Denmark and Norway.

These countries do not have a separate institution: the Czech Republic, Slovenia, Croatia, Bulgaria, Romania, Cyprus, Portugal and Hungary.