TBD: The use of health technology assessment to reduce health inequalities in health systems
Parexel International Spain
Health inequality are differences in health statuses/outcomes between people. Health inequity occurs due to unjust factors. Many global efforts aim to reduce health inequality/inequity. This study aimed to review the role of health technology assessment in reducing health inequalities/inequities
A targeted review was conducted to identify the main health technology assessments methodology frameworks used in high- and middle-income countries to assess health technologies. The HTA frameworks were reviewed to identify equity/equality criteria used during the assessment process.
In this research, we identified the HTA assessment frameworks of high-income and middle-income countries (HICs/MICs) to assess whether considerations of health equality/equity are included as core principles of their methodology. We found that HTA agencies in HICs are advancing towards equality/equity goals. For example, in England, the HTA appraisal framework by the National Institute for Health and Care Excellence (NICE) considers issues relating to health inequalities as a component of its HTA evaluation. In the US, the Institute for Clinical and Economic Review (ICER) announced an initiative to evaluate potential methodological changes to advance health equity goals. The findings of this initiative will be used to update ICER’s value assessment framework. Beyond the traditional HTA agency, payers in the US are adopting initiatives to improve health equity. The Centers of Medicare & Medicaid Services’ (CMS) Enhancing Oncology Model is an example of such initiative. Moreover, in China, the national HTA considers equity as a criterion to prioritize the technologies that undergo annual HTA assessment.
While this research shows that HTA agencies are moving towards equality-based policies, the extent to which the existing methodology frameworks and efforts of HTA agencies translate into equality in healthcare for patients remains uncertain. More research is needed to evaluate the impact of these policies on direct healthcare outcomes for patients. Inequality indexes should be considered in the HTA evaluations as a tangible way to measure this impact.