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

Abstract

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 dissemi- nation, 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 emerg- ing markets and update the results of this survey to specifically address additional aspects of research methods in HTA.