Expanded HTA, Legitimacy and Independence; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy”

Document Type: Commentary

Author

Cardiff School of Law and Politics, Cardiff University, Wales, UK

Abstract

This brief commentary seeks to develop the analysis of Daniels, Porteny and Urrutia of the implications of expansion of the scope of health technology assessment (HTA) beyond issues of safety, efficacy, and cost-effectiveness. Drawing in particular on experience in the United Kingdom, it suggests that such expansion can be understood not only as a response to the problem of insufficiency of evidence, but also to that of legitimacy. However, as expansion of HTA also renders it more visibly political in character, it is plausible that its legitimacy may be undermined, rather than enhanced by, independence from the policy process.

Keywords

Main Subjects


  1. Daniels N, Porteny T, Urrutia J [correction of Urritia J]. Expanded HTA: enhancing fairness and legitimacy [published correction appears in Int J Health Policy Manag. 2016;5(5):347]. Int J Health Policy Manag.2016;5(1):1–3. doi:10.15171/ijhpm.2015.187
  2. Wild C, Jonas S. Health Policy Decisions between Rationing and Rationalisation – exemplified by Erythropoietin in Tumor Anemia. Gesundheitswesen. 2001;63(4):221-225.
  3. Daniels N. Accountability for Reasonableness in Private and Public Health Insurance. In: Coulter A, Ham C. eds. The Global Challenge of Health Care Rationing. Buckingham: Open University Press; 2000:89-106.
  4. Rawlins M. Pharmacopolitics and Deliberative Democracy. Clin Med. 2005;5(5):471-475. doi:10.7861/clinmedicine.5-5-471
  5. Shah K, Cookson R, Culyer A, Littlejohns P. NICE's Social Value Judgements about Equity in Health and Health Care. York: Centre for Health Economics; 2011.
  6. Rawlins M, Barnett D, Stevens  A. Pharmacoeconomics: NICE's approach to decision-making. Br J Clin Pharmacol. 2010;70(3):346-349. doi:10.1111/j.1365-2125.2009.03589.x
  7. Rawlins M, Culyer J. National Institute for Clinical Excellence and its value judgements. BMJ. 2004;329(7459):224-227. doi:10.1136/bmj.329.7459.224
  8. National Institute for Health and Care Excellence (NICE). Social Value Judgements: principles for the development of NICE guidance. London: NICE; 2005.
  9. McMillan J, Sheehan M, Austin D, Howell J. Ethics and opportunity costs: have NICE grasped the ethics of priority-setting? J Med Ethics. 2006;32(3):127-128. doi:10.1136/jme.2005.014860
  10. Syrett K. Deconstructing Deliberation in the Appraisal of Medical Technologies: NICEly does it? Modern Law Review. 2006;69(6):869-894. doi:10.1111/j.1468-2230.2006.00615.x
  11. Health and Social Care Act 2012. http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted.
  12. Syrett K. NICE work? Rationing, review and the ‘legitimacy problem’ in the new NHS. Med Law Rev. 2002;10(1):1-27. doi:10.1093/medlaw/10.1.1
  13. Culyer A, McCabe C, Briggs A, et al . Searching for a threshold, not setting one: the role of the National Institute for Health and Clinical Excellence. J Health Serv Res Policy. 2007;12(1):56-58. doi:10.1258/135581907779497567
  14. Claxton K, Martin S, Soares M, et al. Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold. Health Technol Assess. 2015;19(14):1-542. doi:10.3310/hta19140
  15. Research says approval of new drugs by NICE is "doing more harm than  good." University of York. Website. https://www.york.ac.uk/news-and-events/news/2015/research/nice-drugs-research/. Accessed March 6, 2016
  16. Council Cs. Departing from the Threshold. London: NICE; 2008.
  17. Klein R. Puzzling Out Priorities. BMJ. 1998;317(7164):959-960. doi:10.1136/bmj.317.7164.959
  18. Battista R, Hodge, M. The development of health care technology assessment: an international perspective. Int J Technol Assess Health Care. 1995;11(2):287-300. doi:10.1017/s0266462300006905
  19. Rezi-Kato T. User Perspectives in Health Technology Assessment: the case of HPV vaccination in Ireland and the Netherlands. In: Horstman K, Dow, E., Penders, B., ed. Governance of Health Care Innovation: Excursions into Politics, Science and Citizenship. Raleigh: Lulu Academic; 2011:109-126.
  20. Majone G. The regulatory state and its legitimacy problems. West Eur Polit. 1999;22(1):1-24. doi:10.1080/01402389908425284
  21. Rodwin M. The politics of evidence-based medicine. J Health Polit Policy Law. 2001;26(2):439-446. doi:10.1215/03616878-26-2-439