3. The role of HTA in health system decision making: Weighing value and opportunities
Health resources are limited, and spending can't keep increasing indefinitely. When funds are scarce, using resources for one healthcare intervention means they can't be used elsewhere. The ‘opportunity cost’ refers to the health benefits (e.g., life years saved) that could have been achieved if the money was spent on the next best alternative intervention [1] or healthcare program.
Health Technology Assessment (HTA) provides decision-makers with crucial information when deciding which medicines or services should be funded within a health system's limited resources. HTA helps evaluate the value of these decisions, which refers to what society is willing to pay and the trade offs that might need to be considered. For example, raising taxes to pay for new medicines can have serious consequences for those with little money.
HTA processes typically focus on the added value (additional health benefits) of new interventions. For new interventions HTA also assesses the economic impact (costs) to ensure consistent evaluations. This helps avoid skewed results due to different assumptions or methods in the research. 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 managing health systems aim to
- Protect income
- Ensure adequacy and equitable access to care (equity) 🔗Access the definition of Health equity by WHO)
- Safeguard consumer choice,
- Maintain appropriate autonomy for care providers.
Besides considering opportunity costs within the health system, governments must also balance health spending with other societal needs, such as education and justice. Public preference tends to favour fairness (equity) in distributing health and wealth across the population rather than just maximizing health benefits from limited resources.
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[1] Available at: The use of citizens' juries in health policy decision-making: A systematic review - ScienceDirect