Bridging the Perceived Disconnect between Health Technology Assessment and Delivery Systems

Grieve, E. , Hesselgreaves, H., Wu, O. and Briggs, A. (2021) Bridging the Perceived Disconnect between Health Technology Assessment and Delivery Systems. 2021 World Congress on Health Economics, 12-15 Jul 2021.

Abstract

There has often been a perceived disconnect between the delivery system and Health Technology Assessment (HTA), with the uneven implementation of recommendations. Even in well-resourced health systems, cost-effective interventions do not always (rarely) get implemented optimally with recurrent themes around organisational processes, clinician engagement and financing being key barriers. Whilst high-income countries (HIC) may have led the way, lower- and middle- income countries (LMIC) are increasingly beginning to develop HTA processes to assist in their healthcare decision-making. Optimisation of health technology utilisation is health technology - and system-specific, and HTA may be made more impactful by greater consideration of organisational and contextual issues. Providing evidence about the expected impact of a technology on health system structure, processes and resources might be valuable to inform the construct and recommendations of an HTA or develop an implementation plan. Yet, this aspect of HTA is often found to be lacking. We undertook a realist synthesis to produce tested and data-driven theory that considers individual, interpersonal, institutional and systemslevel components and their interactions on the mechanisms by which HTA can be optimised. Drawing on our programme theory, we consider practical implications to achieve greater interconnectedness between HTA and health systems, in LMIC in particular. Firstly, rather than maintaining an emphasis on user-focused HTA ie where a synthesis of clinical evidence and economic evaluation of available technologies are the mainstay, we consider the application of developer-focused HTA where system constraints are addressed whilst the technology is still under development. Secondly, although health products have been its more significant focus to-date, HTA could develop to increase its focus on technologies applied to healthcare ie regulatory and policy measures for managing and organising healthcare systems - as well as extending its application to non-healthcare sectors. We consider such a refocus towards meso/macro HTA given the interdependency of HTA and health systems - and wider sectors - for optimising its impact on health outcomes. The global expansion of HTA, its variable implementation, the lack of quantified evidence on health outcomes, along with an increasing investment in these processes at the systems level in LMIC has generated greater interest from policy makers about the value and impact of HTA. HTA should seek to harness mechanisms to improve implementation of findings - as it is only when decisions result in practice change, can better health be achieved. In HICs, there has been perhaps an element of taking for granted that a fully functioning system will adapt accordingly to ensure implementation of recommendations. In an era of investment and expansion, in particular, for LMICs, we hope this research offers a forward-looking model as a reference for their own implementation of HTA.

• Item Type: Conference or Workshop Item
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Hesselgreaves, Dr Hannah and Wu, Professor Olivia and Grieve, Dr Eleanor and Briggs, Professor Andrew
• Authors: Grieve, E., Hesselgreaves, H., Wu, O., and Briggs, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment