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 as the practical application of organized knowledge and skills to address a health problem and improve the quality of life. Medical technologies have various forms: medicines, medical aids, dietetic foods, vaccines, medical devices, but also procedures or 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.
An example of the difference between assessment and appraisal:
A research question may arise as to whether the state should purchase another piece of innovative and costly medical technology, such as the da Vinci robotic operating system.
Summarizes information about the device, its clinical, organizational, social or ethical benefits, costs, and its use in Slovakia and abroad.
The assessor would also find out how many similar devices are used by other countries, for what purpose and in what facilities; whether countries have issued recommendations for their number and use, at what prices they have procured them, and the like.
The assessor then produces an extensive analysis with shorter, clear and concise information in a few sentences – a recommendation, on whether or not to buy another piece of the da Vinci robotic system and why.
Based on the summary text of the assessment and other inputs, the appraisal committee can issue a recommendation to the minister whether or not to purchase a new system in Slovakia.
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.