Health system and equity perspectives in health technology assessment.

Economic evaluation is a useful and increasingly popular tool that helps policy makers and health practitioners in the assessment of new technology and health interventions. It is expected that careful assessment of the costs and benefits of all technology choices will guide one's decision in selecting the best mixture of cost-effective options, thus promoting allocative efficiency and increasing value for money within the limited resources available. The use of economic evaluation is also seen as a key step towards evidence-based medicine and evidence-based policy-making. Nevertheless, value for money and allocative efficiency may not be the only or the most important issue to be considered in technology adoption. There are a number of factors that should be evaluated in addition to economic efficiency These include safety, efficacy, and effectiveness of the technology or policy of interest. In addition, it is important to assess other external factors that could be impacted by the use of such technology or policy. This article presents two important areas of health technology assessment, in addition to economic evaluation, that must be considered as a part of any health technology assessment exercise. They are (1) health system feasibility and impact analysis, and (2) equity and fairness assessment.