Health Technology Assessment and Ethics Health

A trend or a useful tool? HTA (Health Technology Assessment) was born in the 70s as a tool to support decision makers in the health sector and has been quickly developing since, also with the creation of specialized international agencies (e.g. Health Technology Assessment International – HTAi; International Network of Assessment Agencies of health technologies - INAHTA). What is HTA? It is the “systematic evaluation of the properties and effects of a health technology, which addresses the direct and expected effects of this technology, as well as its indirect and unintended consequences, and aims primarily to inform decision-makers on health technologies”. The approach is interdisciplinary, because HTA summarizes information on medical, social, economic and ethical issues, and methods of evaluation can be different. Since of its born, ethics has been considered a key element in HTA, even if there is still not an agreement on “why” and “how” ethics should be integrated in HTA. This difficulty is not new and it mainly due to the narrowing of HTA to economic analysis. In 2004, ten Have has listed some potential reasons of this situation: a) Existing approaches for ethical inquiry are not suitable for HTA; b) Technologies are often considered by HTA producers as being value-free; c) The only questions perceived as relevant in an HTA are technical and economical ones; d) Value issues may be acknowledged to be present at all levels in HTA, but ethics is not needed to address these issues; e) It is practically difficult to integrate ethical considerations in HTA; f) HTA experts are not trained to make ethical assessments and there is too little expertise on ethics and HTA; g. Limited resources available to conduct ethical analyses.