Henshall Chris, Schuller Tara
University of York.
Int J Technol Assess Health Care. 2013 Oct;29(4):353-9. doi: 10.1017/S0266462313000378. Epub 2013 Jul 11.
Identifying treatments that offer value and value for money is becoming increasingly important, with interest in how health technology assessment (HTA) and decision makers can take appropriate account of what is of value to patients and to society, and in the relationship between innovation and assessments of value.
This study summarizes points from an Health Technology Assessment International (HTAi) Policy Forum discussion, drawing on presentations, discussions among attendees, and background papers.
Various perspectives on value were considered; most place patient health at the core of value. Wider elements of value comprise other benefits for: patients; caregivers; the health and social care systems; and society. Most decision-making systems seek to take account of similar elements of value, although they are assessed and combined in different ways. Judgment in decisions remains important and cannot be replaced by mathematical approaches. There was discussion of the value of innovation and of the effects of value assessments on innovation. Discussion also included moving toward "progressive health system decision making," an ongoing process whereby evidence-based decisions on use would be made at various stages in the technology lifecycle. Five actions are identified: (i) development of a general framework for the definition and assessment of value; development by HTA/coverage bodies and regulators of (ii) disease-specific guidance and (iii) further joint scientific advice for industry on demonstrating value; (iv) development of a framework for progressive licensing, usage, and reimbursement; and (v) promoting work to better adapt HTA, coverage, and procurement approaches to medical devices.
确定具有价值和性价比的治疗方法变得越来越重要，人们关注卫生技术评估（HTA）以及决策者如何能够适当地考虑对患者和社会具有价值的因素，以及创新与价值评估之间的关系。
本研究总结了国际卫生技术评估（HTAi）政策论坛讨论的要点，参考了演讲内容、与会者之间的讨论以及背景文件。
考虑了关于价值的各种观点；大多数观点将患者健康置于价值的核心。价值的更广泛要素包括对患者、护理人员、卫生和社会护理系统以及社会的其他益处。大多数决策系统试图考虑类似的价值要素，尽管它们的评估和组合方式不同。决策中的判断仍然很重要，不能被数学方法所取代。讨论了创新的价值以及价值评估对创新的影响。讨论还包括朝着“渐进式卫生系统决策”迈进，这是一个持续的过程，在此过程中，将在技术生命周期的各个阶段基于证据做出关于使用的决策。确定了五项行动：（i）制定价值定义和评估的总体框架；HTA/覆盖机构和监管机构制定（ii）针对特定疾病的指南以及（iii）就证明价值向行业提供进一步的联合科学建议；（iv）制定渐进式许可、使用和报销框架；以及（v）推动开展工作，以使HTA、覆盖和采购方法更好地适应医疗设备。
