Basics of Health Technology Assessment

  • Daria OReillyEmail author
  • Kaitryn Campbell
  • Ron Goeree
Part of the Methods in Molecular Biology™ book series (MIMB, volume 473)


This chapter begins with a brief introduction to health technology assessment (HTA). HTA is concerned with the systematic evaluation of the consequences of the adoption and use of new health technologies and improving the evidence on existing technologies. The objective of mainstream HTA is to support evidence-based decision and policy making that encourage the uptake of efficient and effective health care technologies. This chapter provides a basic framework for conducting an HTA, as well as some fundamental concepts and challenges in assessing health technologies. A case study of the assessment of drug-eluting stents in Ontario is presented to illustrate the HTA process. Whether HTA is beneficial (supporting timely access to needed technologies) or detrimental depends on three critical issues: when the assessment is performed, how it is performed, and how the findings are used.

Key words

Health technology assessment health care technology economic evaluation evidence-based decision making health policy 


  1. 1.
    1. Goodman, C. S., Snider, G., Flynn, K. (1996). Health Care Technology Assessment in VA. Management Decision and Research Center, Health Services Research and Development Service, Boston, Washington, DC.Google Scholar
  2. 2.
    2. Health Canada. (2006). Access to Therapeutic Products. Health Canada, Ottawa.Google Scholar
  3. 3.
    3. Canadian Agency for Drugs and Technologies in Health. (2007). Medical device regulation in Canada: A primer. Health Technology Update no. 5. Canadian Agency for Drugs and Technologies in Health, Ottawa.Google Scholar
  4. 4.
    4. Coburn, D. (2007). Managing decision making under uncertainty: Perspectives from a central administrator, in OECD Health Project. Health Technologies and Decision Making. Organization for Economic Co-Operation and Development, Paris, pp. 119–130.Google Scholar
  5. 5.
    5. Banta, D. (2003). The development of health technology assessment. Health Policy 63, 121–132.PubMedCrossRefGoogle Scholar
  6. 6.
    6. Poulsen, P. B. (1999). Economic evaluation and the diffusion of health technology, in Health Technology Assessment and Diffusion of Health Technology. Odense University Press, Odense, Denmark, pp. 183–220.Google Scholar
  7. 7.
    7. Jonsson, E., Banta, H. D., Henshall, C., Sampietro-Colom, L., European Collaboration for Health Technology Assessment/Assessment of Health Interventions. (2002). Summary report of the ECHTA/ECAHI project. Int J Technol Assess Health Care 18, 218–237.PubMedGoogle Scholar
  8. 8.
    8. Franklin, C. (1993). Basic concepts and fundamental issues in technology assessment. Intensive Care Med 19, 117–121.PubMedCrossRefGoogle Scholar
  9. 9.
    Canadian Agency for Drugs and Technologies in Health. (2006). Further information can be obtained from CADTH at
  10. 10.
    10. Goodman, C. S. (2004). Retrieving evidence for HTA, in HTA 101: Introduction to Health Technology Assessment. Lewin Group, Falls Church, VA.Google Scholar
  11. 11.
    11. Moher, D., Pham, B., Lawson, M. L., Klassen, T. P. (2003). The inclusion of reports of randomised trials published in languages other than English in systematic reviews. Health Technol Assess 7, 1–90.PubMedGoogle Scholar
  12. 12.
    12. Savoie, I., Helmer, D., Green, C. J., Kazanjian, A. (2003). Beyond MEDLINE: Reducing bias through extended systematic review search. Int J Technol Assess Health Care 19, 168–178.PubMedCrossRefGoogle Scholar
  13. 13.
    13. Royle, P., Waugh, N. (2003). Literature searching for clinical and cost-effectiveness studies used in health technology assessment reports carried out for the National Institute for Clinical Excellence appraisal system. Health Technol Assess 7, iii, 9–51.Google Scholar
  14. 14.
    Searching for studies. (2008) In (Higgins, J. P. T., Green, S., eds.) Cochrane Handbook for Systematic Reviews of Interventions 5.0.0 (updated February 2008).Google Scholar
  15. 15.
    National Library of Medicine. (2007) Databases, bibliographic, in MeSH Browser (2008 MeSH). National Library of Medicine, Bethesda, MD.Google Scholar
  16. 16.
    16. Jadad, A. R., Moher, D., Klassen, T. P. (1998). Guides for reading and interpreting systematic reviews, II: How did the authors find the studies and assess their quality? Arch Pediatr Adolesc Med 152, 812–817.PubMedGoogle Scholar
  17. 17.
    A Dictionary of Epidemiology, 4th ed. (2001) Oxford University Press, New York.Google Scholar
  18. 18.
    18. McAuley, L., Pham, B., Tugwell, P., Moher, D. (2000). Does the inclusion of grey literature influence estimates of intervention effectiveness reported in meta-analyses? Lancet 356, 1228–1231.PubMedCrossRefGoogle Scholar
  19. 19.
    Chan, L., Collins, S., Dennett, L., Varney, J. (2007). Health Technology Assessment on the Net: A Guide to Internet Sources of Information, 9th ed. Institute of Health Economics and Alberta Heritage Foundation for Medical Research, Edmonton, Canada. Google Scholar
  20. 20.
    20. Library and Archives Canada. (2005). Theses Canada portal. Library and Archives Canada, Ottawa.Google Scholar
  21. 21.
    21. Jizba, R. (2000). Measuring search effectiveness, in Creighton University Health Sciences Library and Learning Resources Center. Creighton University, Omaha, NE.Google Scholar
  22. 22.
    22. Keitz, S. (2006). Overview of EBM and anatomy of a question, in EBM curriculum at Duke. Duke University Medical Center Library, Durham, NC.Google Scholar
  23. 23.
    23. Sackett, D. L., Haynes, R. B. (1997). Evidence-Based Medicine: How to Practice and Teach EBM. Churchill Livingstone, New York.Google Scholar
  24. 24.
    24. Moher, D., Cook, D. J., Eastwood, S., Olkin, I., Rennie, D., Stroup, D. F. (1999). Improving the quality of reports of meta-analyses of randomised controlled trials: The QUOROM [Quality of Reporting of Meta-Analyses.] statement. Lancet 354, 1896–1900.PubMedCrossRefGoogle Scholar
  25. 25.
    25. Heitman, E. (1998). Ethical issues in technology assessment. Conceptual categories and procedural considerations. Int J Technol Assess Health Care 14, 544–566.PubMedCrossRefGoogle Scholar
  26. 26.
    26. McIsaac, M. L., Goeree, R., Brophy, J. M. (2007). Primary data collection in health technology assessment. Int J Technol Assess Health Care 23, 24–29.PubMedCrossRefGoogle Scholar
  27. 27.
    27. Goeree, R., Levin, L. (2006). Building bridges between academic research and policy formulation: The PRUFE framework—an integral part of Ontario's evidence-based HTPA process. Pharmacoeconomics 24, 1143–1156.PubMedCrossRefGoogle Scholar
  28. 28.
    28. Lilford, R. J., Richardson, A., Stevens, A., Fitzpatrick, R., Edwards, S., Rock, F., Hutton, J. L. (2001). Issues in methodological research: Perspectives from researchers and commissioners. Health Technol Assess 5, 1–57.PubMedGoogle Scholar
  29. 29.
    29. Health Technology Assessment Task Group. (2004). Health Technology Strategy 1.0: Final Report. Health Canada, Ottawa.Google Scholar
  30. 30.
    30. The Evidence-Based Medicine Working Group. (2002). User's Guides to the Medical Literature, 5th ed. American Medical Association Press, Chicago.Google Scholar
  31. 31.
    31. Eisenberg, J. M. (1989). Clinical economics. A guide to the economic analysis of clinical practices. JAMA 262, 2879–2886.PubMedCrossRefGoogle Scholar
  32. 32.
    32. Detsky, A. S., Naglie, I. G. (1990). A clinician's guide to cost-effectiveness analysis. Ann Intern Med 113, 147–154.PubMedGoogle Scholar
  33. 33.
    33. Drummond, M., O'Brien, B., Stoddart, G., Torrance, G. (1987). Basic types of economic evaluation, in Methods for the Eonomic Evaluation of Health Care Programmes. Oxford University Press, Oxford, pp. 6–26.Google Scholar
  34. 34.
    34. Drummond, M., et al. (2005). Methods for the Economic Evaluation of Health Care Programmes, 3rd ed. Oxford University Press, Oxford.Google Scholar
  35. 35.
    35. Poulsen, P. B. (2001). The economy, in (Kristensen, F. B., Horder, M., Poulsen, P. B., eds.) Health Technology Assessment Handbook. Danish Institute for Health Technology Assessment, Copenhagen, pp. 96–121.Google Scholar
  36. 36.
    36. Mehrez, A., Gafni, A. (1989). Quality-adjusted life years, utility theory, and healthy-years equivalents. Med Decis Making 9, 142–149.PubMedCrossRefGoogle Scholar
  37. 37.
    37. Canadian Agency for Drugs and Technologies in Health. (2006). Guidelines for the Economic Evaluation of Health Technologies: Canada, 3rd ed. Canadian Agency for Drugs and Technologies in Health, Ottawa.Google Scholar
  38. 38.
    38. Drummond, M., Weatherly, H. (2000). Implementing the findings of health technology assessments. If the CAT got out of the bag, can the TAIL wag the dog? Int J Technol Assess Health Care 16, 1–12.PubMedCrossRefGoogle Scholar
  39. 39.
    39. George, C. J., Baim, D. S., Brinker, J. A., Fischman, D. L., Goldberg, S., Holubkov, R., Kennard, E. D., Veltri, L., Detre, K. M. (1998). One-year follow-up of the Stent Restenosis (STRESS I) Study. Am J Cardiol 81, 860–865.PubMedCrossRefGoogle Scholar
  40. 40.
    40. Macaya, C., Serruys, P. W., Ruygrok, P., Suryapranata, H., Mast, G., Klugmann, S., Urban, P., den Heijer, P., Koch, K., Simon, R., Morice, M. C., Crean, P., Bonnier, H., Wijns, W., Danchin, N., Bourdonnec, C., Morel, M. A., Benestent Study Group 13. (1996). Continued benefit of coronary stenting versus balloon angioplasty: One-year clinical follow-up of Benestent trial. J Am Coll Cardiol 27, 255–261.PubMedCrossRefGoogle Scholar
  41. 41.
    41. Stone, G. W., Ellis, S. G., Cox, D. A., Hermiller, J., O'Shaughnessy, C., Mann, J. T., Turco, M., Caputo, R., Bergin, P., Greenberg, J., Popma, J. J., Russell, M. E., TAXUS-IV, I. (2004). One-year clinical results with the slow-release, polymer-based, paclitaxel-eluting TAXUS stent: The TAXUS-IV trial 14. Circulation 109, 1942–1947.PubMedCrossRefGoogle Scholar
  42. 42.
    42. Medical Advisory Secretariat. (2003). Review of drug-eluting coronary stents (internal document). Ontario Ministry of Health and Long-Term Care, Toronto.Google Scholar
  43. 43.
    43. Bowen, J., Hopkins, R., He, Y., Blackhouse, G., Lazzam, C., Tu, J., Cohen, E., Tarride, J. E., Goeree, R. (2005). Systematic Review and Cost-Effectiveness Analysis of Drug Eluting Stents Compared to Bare Metal Stents for Percutaneous Coronary Interventions in Ontario. Program for Assessment of Technology in Health, Hamilton, Canada.Google Scholar
  44. 44.
    44. Ontario Health Technology Advisory Committee. (2005). OHTAC Recommendation: Drug Eluting Stents (DES). Medical Advisory Secretariat Ministry of Health and Long-Term Care, Toronto.Google Scholar
  45. 45.
    Pan American Health Organization. (1998). Developing Health Technology Assessment in Latin America and the Caribbean. World Health Organization.Google Scholar
  46. 46.
    46. Sculpher, M., Drummond, M., Buxton, M. (1997). The iterative use of economic evaluation as part of the process of health technology assessment. J Health Serv Res Policy 2, 26–30.PubMedGoogle Scholar
  47. 47.
    47. Mowatt, G., Bower, D. J., Brebner, J. A., Cairns, J. A., Grant, A. M., McKee, L. (1998). When is the “right” time to initiate an assessment of a health technology? Int J Technol Assess Health Care 14, 372–386.PubMedCrossRefGoogle Scholar
  48. 48.
    48. Buxton, M. (1987). Problems in the economic appraisal of new health technology: The evaluation of heart transplants in the UK, in (Drummond, M., ed.) Economic Appraisal of Health Technology in the European Community. Oxford Medical Publications, Oxford, pp. 103–118.Google Scholar
  49. 49.
    49. Eisenberg, J. M. (1999). Ten lessons for evidence-based technology assessment. JAMA 282, 1865–1869.PubMedCrossRefGoogle Scholar
  50. 50.
    50. Stevens, A., Milne, R., Burls, A. (2003). Health technology assessment: History and demand. J Public Health Med 25, 98–101.PubMedCrossRefGoogle Scholar
  51. 51.
    51. Drummond, M., O'Brien, B., Stoddart, G., and Torrance, G. (1997). Critical assessment of economic evaluation, in Methods for the Economic Evaluation of Health Care Programmes. Oxford University Press, Oxford, pp. 27–51.Google Scholar

Copyright information

© Humana Press, a part of Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Program for Assessment of Technology in Health (PATH) Research InstituteHamiltonCanada
  2. 2.Research Librarian, Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada

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