4. How do qualitative and quantitative methods fit into HTA processes?
Quantitative
Focused on numerical data and statistical analysis
Quantitative research answers key questions such as:
- How many people are affected by a disease
- What the economic burden of a disease is
- Who might benefit from a medicine, and how often it would be used once access is provided
- What is the value of that benefit
These aspects are crucial for HTA and reimbursement decisions—but often benefit from qualitative insights to provide a more complete picture.
Quantitative methods
Quantitative methods—such as meta-analysis, network meta-analysis, and modelling—are widely used for synthesis, while critical appraisal tools help assess the quality of evidence.
Qualitative
Focused on exploring perspectives, experiences, and meanings
Qualitative research can make a meaningful contribution to health technology assessment (HTA), particularly in areas that quantitative methods alone cannot fully address. This includes:
- Explaining variation in intervention effects
- Exploring aspects of implementation
- Capturing the needs, preferences, and experiences of patients
In particular, qualitative evidence can provide valuable insights into how patients perceive treatment options, what outcomes matter most to them, and how interventions affect their quality of life. Such evidence helps decision-makers and developers better incorporate the patient voice into medicine development, evaluation, and reimbursement decisions.
It also contributes to broader societal questions, such as:
- Should we value care for the very sick or the very old more than others?
- How should we value technologies that reduce interactions with doctors and caregivers?
- Are there reasons that help explain sub-optimal use of medicines in practice?
Qualitative Evidence Synthesis (QES)
To integrate qualitative research into decision-making processes, qualitative evidence synthesis (QES) methods—also known as qualitative systematic review, qualitative meta-synthesis, or qualitative research synthesis—have been developed.
QES methods:
- Allow for systematic, rigorous reviews of primary qualitative studies
- Explore dimensions beyond "what works," such as acceptability, feasibility, and contextual factors
- Complement traditional reviews of quantitative evidence (e.g., RCTs), particularly by addressing the “why” and “how” behind an intervention’s success or failure
Importantly, qualitative research cannot be synthesised using the same methods as quantitative research. Instead, QES relies on its own methodological frameworks, now numbering over 30 distinct approaches, tailored to the nature and aims of qualitative inquiry.[1]
These methodologies are increasingly used not only in health care, but also in social care and related sectors. (See Further Reading for more in-depth guidance.)
- Identify diseases that are priorities for patients
- Assess unmet needs for new treatments
- Define outcomes that matter to patients
- Select appropriate PROMs and HRQoL tools
Reimbursement & Decision-Making
- Clarify the need for an existing medicine
- Explore limitations of current alternatives
- Capture societal values to guide decision-making
Implementation & Impact
- Evaluate reasons for suboptimal adherence
- Understand how to improve patient experiences
- Identify additional contextual factors relevant for adoption and access
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[1] Flemming, K and Noyes, J. Qualitative Evidence Synthesis: Where Are We at? International Journal of Qualitative Methods, Volume 20: 1–13, 2021, DOI: 10.1177/1609406921993276, journals.sagepub.com/home/ijq