Health Technology Assessment

Dr Jorge Reynolds Photo: PAHO/WHO

An assessment report gives information about how the technology can be adapted to current available technologies and the added value of the reviewed technology to the current technologies. This final assessment contains evidence-based conclusions with the outcomes of the use of the technology supporting the decision-making process of health policymakers. Health technologies include pharmaceuticals, equipment and machines, as well as procedures and physical techniques for health prevention and promotion.

Key facts

In September 2012, the Member States were pioneers when they adopted the first resolution on health technology assessment (HTA) and the incorporation of health technologies into health systems.
A resolution was adopted an innovative policy paper that proposes linking HTA with the decision-making processes involved in incorporating these technologies into health systems.
The Region was mapped to determine the status of HTA. The responses from the countries indicate that the Region has 76 institutions that carry out some type of HTA-related activity: 49% of them are governmental and 34% are academic institutions.

Fact sheet

Health Technology Assessment (HTA) is the systematic evaluation of properties, effects, and/or impacts of health care technology. It should include medical, social, ethical, and economic dimensions, and its main purpose is to inform decision-making in the health area. These assessments look at benefits and efficacy, clinical and technical safety, and cost-effectiveness. Informed decision-making comprises issues surrounding coverage and reimbursement, pricing decisions, clinical guidelines and protocols, and lastly, medical device regulation. The main purpose of HTA is to inform a policy decision making in health care, and thus improve the uptake of cost-effective new technologies and prevent the uptake of technologies that are of doubtful value for the health system.

HTA is used to define which benefits to include while carrying out evidence-based assessments. New technologies are usually costlier than older ones and contribute to rising health expenditures. In this context, the HTA process ensures that new technology is not added until it is proven to be effective. Meanwhile, older technology is not removed from the health package until it is shown to be ineffective or not cost-effective. HTA is also concerned with quality, and the role of new technologies to improve health outcomes. PAHO supports HTA activities that emphasize health outcomes that can be measured against a benchmark.

PAHO Response

Given the growing interest for health technologies, PAHO has launched several initiatives in HTA with member countries to promote and strengthen health technology assessment in the Americas. PAHO's role is important for the development and implementation of HTA in the Americas, and to support the promotion of evidence-based decision-making processes, which contribute to the incorporation of cost-effective technologies.

In 2012 member states adopted the resolution "Health Technology Assessment and incorporation into Health Systems" (CSP28.R9). The resolution proposes linking HTA with the decision-making processes involved in incorporating these technologies into health systems. Since the approval of CSP28.R9, there have been clear advances in the institutionalization of HTA in the Region, both at regional and national levels. Despite the major progress, the implementation of HTA remains at a low level in some countries. PAHO encourages the establishment of an institutional framework for HTA-based decision-making. This framework would establish linkages between HTA and decision-makers, encouraging institutional responsibility and creating linkages between the use of technologies and evaluative data to feed into the decision-making process.

To support the development of HTA in member countries, the Medicines and Health Technologies Unit is involved in many activities, such as:

Human resources development: establishing a regional strategy to assess different regional needs. Promotion of regional meetings, workshops, and training through online courses, and webinars.
Dissemination of information: identifying existing opportunities and disseminating findings amongst stakeholders and decision-makers, through the Regional Platform on Access and Innovation for Health Technologies (PRAIS).
Rational use of health technologies: developing and implementing clinical guidelines to evaluate the use of health technologies in health services.
Promotion of network collaboration: promotion of regional cooperation among member countries, strengthening the HTA Regional Network through the Regional Network of Health Technology Assessments for the Americas (RedETSA).

RedETsa - Webinar

Virtual Campus for Public Health

PAHO's current work on HTA

In 2011, PAHO and the member countries launched a Regional Network of Health Technology Assessments for the Americas (RedETSA). RedETSA is comprised of representatives from the ministries of health, regulatory agencies, HTA agencies, PAHO/WHO collaborating centers, and non-profit educational and research institutions dedicated to promote HTA to inform decision-making. The network aims to promote and strengthen HTA through regional exchanges of information to support decision-making on regulation, use and replacement of technologies, improvements in the quality of care and rational use of technologies, and contribute to the sustainability and equity in access to health systems. Over the years, RedETSA has been playing a key role in the development of HTA in the Region. Currently, RedETSA is represented by 14 countries and 28 institutions.

RedETSA's main objectives include:

Identify the status of HTA in the Region, at national, sub-Regional, and Regional levels, and the priorities in order to facilitate cooperation among countries and institutions through networking.
Facilitate access to information through the RedETSA'S Community of Practice on the Platform on Access and Innovation for Health Technologies (PRAIS*).
Strengthen human resources, including assessment teams and decision-makers, in the use of HTA.
Promote best practices in HTA.
Promote technical cooperation among institutions (national, sub-regional, and global).
Reducing information asymmetries and improving the processes of decision-making
Stimulate the consolidation of local HTA networks and their synergy with RedETSA

PRAIS: The Regional Platform on Access and Innovation for Health Technologies is composed of a series of virtual tools designed to support and promote technological innovation, access, rational use, regulation and governance of health technologies from a public health perspective. PAHO expects the platform to facilitate the development of linkages between stakeholders for innovation in health systems that extend beyond institutional, country and sector boundaries.

RedETSA's Community of Practice (CoP) is an instrument that enables exchange of knowledge and information related to HTA among RedETSA's members. The CoP allows members to share reports, documents, and presentations, and also have information about events, webinars, meetings, and workshops promoted by the Medicines and Health Technologies Unit. Moreover, the Community has a discussion group where members discuss about a relevant topics related to HTA.

Advance HTA is a project funded by the European Commission and led by a team of the London School of Economics in partnership with thirteen participating institutions. PAHO is working jointly with the Escuela Andaluza de Salud Publica to identify the use and capacity for HTA in emerging settings (Eastern Europe and the Region of the Americas). Advance-HTA aims to broaden the spectrum, complement and address areas of methodological debate in the application, use and implementation of HTA across settings. The study aims to improve HTA methods, which can be taken further by competent authorities nationally while supplementing the work of supra-national bodies towards a common understanding of choices in health care decision-making.

Given the nascent stage of HTA in the Region of the Americas, the core research objectives include:

To identify the use of and capacity for HTA in emerging settings (Eastern Europe, Region of the Americas) including decision-making bodies, other stakeholders (universities, private companies, etc.). This includes the identification of HTA mechanisms and techniques that apply in different emerging countries/regions.
To understand the decision-making process for the incorporation of health technologies to health systems in developing countries.
To enable and facilitate an effective exchange of economic evaluations and evidence, reducing duplication of effort, between countries in Eastern Europe/Latin America and EU countries that have strong HTA tradition.
To develop and disseminate an adaptable Toolbox for emerging countries to improve the process of decision-making, highlighting best practices, concrete examples, and innovative approaches.

Advance HTA hopes to extend the implementation and capacity building of HTA to emerging markets. This will involve bringing together the wider stakeholder community in the debate around decision-making and resource allocation. Several capacity-building activities and workshops are planned around this project in the Region of the Americas. Please visit Advance_HTA - Rethinking the future of Health Technology Assessment for more information.

University of Ottawa, Bruyère Research Institute, Centre for Global Health

PAHO/WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity
Country: Canada
Date of designation: 04/Sep/2007
Last redesignation: 21/Oct/2015
Terms of Reference:
Support PAHO/WHO in strengthening the HTA Network of the Americas (RedETSA), with a special focus in the incorporation of Caribbean countries to the Network.
Assist PAHO/WHO in the application of the Equity-oriented toolkit for HTA.
Support PAHO/WHO in the development and implementation of clinical practice guidelines.
At PAHO/WHO's request, develop and support the implementation of knowledge translation strategies.

Universidade Federal de Santa Catarina (UFSC)

PAHO/WHO Collaborating Centre for Healthcare Technology Management
Country: Brazil
Date of designation: 29/Jan/2010
Last redesignation: 29/Jan/2014
Terms of Reference:
Support for technical assistance and joint work with PAHO/WHO to implement Health Technology Management methodologies and assessment for medical equipment in Latin American and Caribbean countries.
Training and Teaching in Health Technology Management regarding appropriate use, decision-making tools and clinical engineering for Latin American and Caribbean countries.
Contribute with PAHO/WHO to the development of manuals and dissemination of Health Technology Management Programs.

Centro Nacional de Excelencia Tecnológica en Salud (CENETEC)

PAHO/WHO Collaborating Centre in Health Technology
Country: México
Date of designation: 18/Feb/2009
Last redesignation: 18/Feb/2013
Terms of Reference:
Participating in the integration and operation of the Health Technology Assessment Network of the Americas to facilitate the exchange of methodologies, information, and capacity support among countries in the region.
Developing and sharing medical equipment management, information, guidelines, national plans, and others for Biomedical, Clinical Engineering, planning and assessing purposes in Latin America, and participating in WHO consultations as an advisor for the work related to WHA60.29.
Exchanging international information relating to the development of clinical guidelines based on evidence for different levels of care, according to epidemiological priorities.
Creating and sharing a strategic plan to develop and to implement e-Health services in different levels of care, including tele-education, health websites, and telemedicine linked to the Electronic Health Record, aligned according to the global e-Health Observatory and EB117 and related resolutions.

Instituto de Efectividad Clínica y Sanitaria (IECS)

PAHO/WHO Collaborating Centre in Health Technology Assessment (HTA)
Country: Argentina
Date of designation: 23/Sep/2013
Terms of Reference:
Support WHO/PAHO in the activities related to the Health Technology Assessment Network of the Americas (RedETSA).
Support WHO/PAHO in Health Technology Assessment (HTA) and clinical effectiveness training.
Support WHO/ PAHO with information on the clinical effectiveness, safety and cost-effectiveness of drugs, medical equipment, clinical procedures and other health technologies for reference.