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Patient participation in Health Technology Assessment (HTA)
[edit]HTA forms part of Evidence Based Medicine (EBM) as one of EBM's three different forms of evaluation (the other two being Randomized_controlled_trials (RCT) and Quality of Life (QoL)). [1] EBM is the predominant paradigm in the developed world today; but it is at odds with a newer trend toward personalized medicine (PM). [2]
First of all, there is a question of desirability: "Do patients want to participate in HTA?". Secondly, one must consider that HTA covers more than technology in the stricter sense. Instead it covers practically "any intervention", as the WHO defines health technology broadly as consisting of: "the application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve quality of lives." [3]
Therefore, after 20-odd years in which this trend toward HTA has played out, a look at the more controversial side of it appears appropriate.
Sociologist Andrew Webster puts a new twist on the problem when he complains "HTA is a technology itself that needs assessment." [4] Webster continues with his "critique of HTA from within Science and Technology Studies (STS)" getting to the patient perspective eventually; he sees the problem in "a failure to recognise that evaluation is a contested terrain involving different sorts of evidence related to different sorts of context (such as the experimental derived from clinical trials, evidential, derived from existing clinical practice, and experiential, based on patients' experiences of an intervention".[5]
Likewise Kelly et al. offer their perspective in an open access article, starting with historical background and gradually getting to the patient perspective.[6] They recall how "In the UK, the HTA programme was specifically set up to counterbalance the commercial biases of the relevant industries and many HTA assessments are done on orphan drugs, diseases or procedures, or ones that offer no profit to industry (citing Raftery and Powell on their page 4).[7] Especially relevant is the paper's section 3 headed "The importance of patient values in clinical decision-making".
The coverage of historical background by Kelly at al., page 5, contrasts the public good with the interest of the individual patient thus (with their original citations shown here in brackets): "From the moment Archie Cochrane linked questions of clinical effectiveness to cost effectiveness [17] and cost utility analysis was chosen as the basis for assessing value for money, EBM and HTA have been framed within the utilitarian philosophical tradition. Utilitarianism is premised on the view that actions are good insofar as they maximize benefit for the greatest number [51]. This is not necessarily congruent with what is in the best interest of an individual patient [34]."
A more optimistic perspective is to be found in such innovations as
- Food_and_Drug_Administration#Critical_Path_Initiative and
- Adaptive Biomedical Innovation [8]
which strive to accomplish some of the goals as HTA earlier in the process of decision-making.
External links
[edit]The European Patients' Academy (EUPATI) offers currently three pages of links to videos and articles on HTA (details on EUPATI's funding), [9] https://www.eupati.eu/tag/health-technology-assessment-hta/
In 2017 an entire book was published on patient involvement in HTA, warning of an ominous trend in HTA to which more patient involvement might be an effective antidote. [10] The book itself is not open access, but the main editor also published a paper on the topic six years before the larger collection. [11]
One chapter of the book in particular, i.e. Chapter 3 by Hansen and Street, describes problems with integrating patient involvement into HTA, seeing challenges in terminology, in sorting out the confusion caused by conflicting goals, and in the management of change; then it proposes solutions. [12]
References
- ^ Webster, Andrew: Evaluation, governance and moves to a socially robust assessment of health technology, Working Paper 34, York, 2006, page 12,
- ^ de Leon, Jose (2012). "Evidence-Based Medicine versus Personalized Medicine: Are They Enemies? (non-final, open-access version of article)". Journal of Clinical Psychopharmacology: 153–164. doi:10.1097/JCP.0b013e3182491383.
{{cite journal}}: Cite has empty unknown parameter:|1=(help) - ^ http://www.who.int/health-technology-assessment/about/healthtechnology/en/
- ^ Webster, Andrew (2004). "Health technology assessment: A sociological commentary on reflexive innovation". International journal of technology assessment in health care: 65. doi:10.1017/S0266462304000790.
{{cite journal}}: Cite has empty unknown parameter:|1=(help) - ^ Webster, Andrew: Evaluation, governance and moves to a socially robust assessment of health technology, Working Paper 34, York, 2006, page 8,
- ^ Kelly, Michael P.; Heath, Kelly Iona; Howick, Jeremy; Greenhalgh, Trisha (2015). "The importance of values in evidence-based medicine". BMC Medical Ethics: 16:69.
{{cite journal}}: Cite has empty unknown parameters:|1=,|2=, and|3=(help) (Open Access) - ^ Raftery, J; Powell, J (2013). "Health technology assessment in the UK". Lancet.
{{cite journal}}: Cite has empty unknown parameter:|1=(help) - ^ Hirsch, G; Trusheim, M; Cobbs, E (2013). "Adaptive Biomedical Innovation: Evolving Our Global System to Sustainably and Safely Bring New Medicines to Patients in Need, pp. 685-698". Clinical Pharmacology & Therapeutics.
{{cite journal}}: Cite has empty unknown parameters:|1=and|2=(help) - ^ Originally an EU project, EUPATI started receiving new funding in February 2017 under the direction of EPF, an umbrella organisation with two-thirds public and one-third private funding that works with patients’ groups. EUPATI
- ^ Facey, Karen; Ploug Hansen, Helle; Single, Ann, eds. (2017). Patient Involvement in Health Technology Assessment. Adis, Singapore. doi:10.1007/978-981-10-4068-9.
- ^ Facey, Karen (2011). "Patient involvement in HTA: What added value?".
{{cite journal}}: Cite has empty unknown parameter:|1=(help); Cite journal requires|journal=(help) (Open Access) - ^ Hansen, HP; Street, J. (2017). "3 Reflections on Terms, Goals and Organisation.". In Facey, Karen; Ploug Hansen, Helle; Single, Ann (eds.). Patient Involvement in Health Technology Assessment. Adis, Singapore.