Health Technology Assessment (HTA)

Health expenditure in most developed countries is experiencing dramatic growth. On average in OECD countries, this expenditure rose from 6.9% of GDP to 9% since 1990 alone. This long-term trend looks likely to accelerate as an effect of ageing populations. Yet, public resistance to cutting health care spending is traditionally strong.

In this context, Health Technology Assessment (HTA), the systematic appraisal of the costs and benefits of a medical treatment, is presented as an objective and scientific way to address this dilemma. Independent professional institutions, so their proponents argue, can systematically and objectively assess which medicines should be financed by the public purse, and not less importantly which medicines can be rejected on the basis of high costs and low benefits to the patients. In this way, it is argued, exuberant spending can be eliminated without affecting public health outcomes.

However, the adoption of HTA throughout the developed world raises some important but often overlooked questions. To what extent are HTA systems an objective and scientific tool, and to what extent just another political construct aimed at the systematic rationing of medicines? Is there really a "Gold Standard" in HTA that is being applied by all countries, or is this concept interpreted and applied differently in different countries, based on various political and institutional considerations? Why has the phenomenon escaped vigorous public attention? Is HTA compatible with the goals of patient choice and therapeutic autonomy? And finally how does its use affect the future development of new and innovative healthcare technologies?

The Stockholm Network’s research programme on HTA attempts to address these and other questions.