Threats to the value of Health Technology Assessment: Qualitative evidence from Canada and Poland.

Autor: Wranik WD; School of Public Administration, Faculty of Management, Dalhousie University, 6100 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada; Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Canada; Decision Analysis Support Unit, SGH Warsaw School of Economics, ul. Madalińskiego 6/8, 02-513 Warszawa, Poland. Electronic address: dwl@dal.ca., Zielińska DA; Decision Analysis Support Unit, SGH Warsaw School of Economics, ul. Madalińskiego 6/8, 02-513 Warszawa, Poland; Institute of Sociology, University of Warsaw, ul. Karowa 18, 00-324 Warszawa, Poland. Electronic address: d.zielinska@is.uw.edu.pl., Gambold L; Department of Sociology and Social Anthropology, Dalhousie University, 6135 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada; Jean Monnet European Union Centre for Excellence, Dalhousie University, 6299 South Street, Halifax, Nova Scotia, B3H 4R2, Canada. Electronic address: liesl.gambold@dal.ca., Sevgur S; Department of Sociology and Social Anthropology, Dalhousie University, 6135 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada. Electronic address: serperi.sevgur@dal.ca.
Jazyk: angličtina
Zdroj: Health policy (Amsterdam, Netherlands) [Health Policy] 2019 Feb; Vol. 123 (2), pp. 191-202. Date of Electronic Publication: 2018 Dec 07.
DOI: 10.1016/j.healthpol.2018.12.001
Abstrakt: Background: Health Technology Assessment is used to support the process of drug appraisal and reimbursement decisions in a variety of health systems. Examples can be found in mature Western countries, such as Canada, and in emerging economies of Central and Eastern Europe, such as Poland. The value of HTA in the process is influenced by the evidence used and the stakeholders involved.
Methods: Qualitative interviews with 29 members of two appraisal committees were held in Canada and Poland between July 2017 and March 2018. An a priori thematic framework was applied and supplemented with emergent themes.
Results: We report on the results of a core emergent theme - threats identified by respondents to the value of HTA in the formulary process. We classified these into internal threats that arise due to undue influence on the individuals involved in appraisal, and external threats that arise due to undue influence on the production of evidence.
Discussion: Findings align with previous evidence regarding political and corporate pressures on the process, and a perception of declining quality of evidence. We contribute to the discussion by highlighting the importance of motivation of experts involved in the appraisal process.
Conclusions: The recognition of internal and external threats lays the groundwork for a discussion of policies used to mitigate them. We offer suggestions about potential policy responses.
(Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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