International survey of methods used in health technology assessment (HTA): does practice meet the principles proposed for good research?

Jennifer M Stephens,¹ Bonnie Handke,² Jalpa A Doshi³
On behalf of the HTA Principles Working Group, part of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) HTA Special Interest Group (SIG)

¹Pharmerit International, Bethesda, MD, USA; ²Medtronic Neuromodulation, Minneapolis, MN, USA; ³Center for Evidence-Based Practice and Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

Objective: To describe research methods used internationally in health technology assessment (HTA) and health-care reimbursement policies; compare the survey findings on research methods and processes to published HTA principles; and discuss important issues/trends reported by HTA bodies related to current research methods and applications of the HTA process.
Methods: Representatives from HTA bodies worldwide were recruited to complete an online survey consisting of 47 items within four topics: (1) organizational information and process, (2) primary HTA methodologies and importance of attributes, (3) HTA application and dissemination, and (4) quality of HTA, including key issues. Results were presented as a comparison of current HTA practices and research methods to published HTA principles.
Results: The survey was completed by 30 respondents representing 16 countries in five major regions, Australia (n = 3), Canada (n = 2), Europe (n = 17), Latin America (n = 2), and the United States (n = 6). The most common methodologies used were systematic review, meta-analysis, and economic modeling. The most common attributes evaluated were effectiveness (more commonly than efficacy), cost-effectiveness, safety, and quality of life. The attributes assessed, relative importance of the attributes, and conformance with HTA principles varied by region/country. Key issues and trends facing HTA bodies included standardizing methods for economic evaluations and grading of evidence, lack of evidence, and data availability for emerging technologies.
Conclusion: This is the first international survey to specifically assess the state of HTA research methods. Future efforts should expand the respondent sample to include more emerging markets and update the results of this survey to specifically address additional aspects of research methods in HTA.

Keywords: survey, technology assessment, payers, research methods, reimbursement