3. The role of HTA in health system decision making: Weighing value and opportunities

The role of HTA in health system decision making: Weighing value and opportunities


Spending on health cannot increase infinitely; there are always various constraints on the supply of health services. When resources are scarce relative to needs because of a limited budget, the use of resources in one way prevents their use in other ways. The health benefits (e.g. life years saved) that could have been achieved had the money been spent on the next best alternative intervention [1] or healthcare programme is the ‘opportunity cost’ of investing in a given healthcare intervention.

HTA information is important for the decision-makers when choosing which medicines or other services will be paid for (or reimbursed) by a health system, and which cannot be paid for with limited resources, because of the existing constraints.

HTA attempts to give decision-makers some notion of the value of their decisions. Value is technically defined as what consumers individually would be willing to pay or to give up for an additional ‘good’ or service. When making political decisions for entire health systems, value is expressed in terms of populations, rather than individuals. It must recognize that what is gained and what is lost can occur in different parts of the health system or outside of the health system. For example, raising taxes to pay for new medicines can have serious consequences for those with little money.

As a starting point, most HTA processes consider the ´added value´ (additional health benefits) as the main element for their recommendations. Some HTA processes, and particularly those considering coverage for new medicines, also examine the economic impact (costs) of decisions to pay for new medicines. Many health systems have developed guidance for economic evaluation to ensure estimates of costs and effects from paying for new medicines are derived in a clear and consistent manner. This avoids a situation where an evaluation of one medicine looks more attractive than another, simply because the researcher used different underlying assumptions and approaches.

Governments in charge of health systems are also often attempting to:

  • Protect income.
  • Provide adequacy and equity in access.
  • Protect freedom of choice for consumers.
  • Ensure appropriate autonomy for care providers.

In addition to opportunity costs within a health system, governments must equally consider questions of how much money should be spent on health and how this may affect opportunities for societal benefit from other government programmes, like justice and educationIt has been shown repeatedly that fairness in the distribution of health and wealth across the population (equity) is more important to the public than maximising health from limited resources (efficiency).

[1] http://www.sciencedirect.com/science/article/pii/S027795361400166X?eid=10911&displayformat=dictionary