EUnetHTA Adaptation Glossary (beta)

The success of HTA is its impact on decision-making processes. Thus the concept of HTA was developed to suit the demand for policy making by apply the context specific analysis for brokering science into policy.

Whether the HTA process meets the demand from policy makers is an important question, and there is a tension between the need for rigorous and high quality assessments on the one hand, and relevant and timely outputs to feed into decision-making processes on the other hand.

International collaboration might enable more HTA-reports to be in time with policy making processes.

The Norwegian Knowledge Centre has paid little attention to the issue of equity in our work in general and in the use of external HTA reports and reviews in particular. Our responsibility for an international conference on the issue of equity in 2006 [3] has, however, raised our awareness of this issue. The conference also led to a publication that serves as background for advice from the WHO Advisory Committee on Health Research [4]. Here, the authors give recommendations of how issues of equity should be addressed in the development of systematic reviews and guidelines.

Efficacy refers to the trial setting, and thus any HTA need to consider whether the results obtained in clinical trials can be generalized outside to clinical practice. In some instances “real world” studies are conducted to evaluate real world effectiveness, such studies are however often registry based and thus not of a design comparable to study designs most often included to analyse efficacy.

Context applies to the local setting in which the output of the HTA-process should apply, and may be viewed as the brokering of science into decision-making processes. In this process issues to consider are the facilitators or restrictions for applying the HTA-conclusions into the local setting. These issues are financial restrictions/facilitators, organisational issues such as hospital structure, education, speciality services, legal issues such as patients access to treatment.

In health technology assessment ”conflict of interest” relates to two issues:

- conflict of interest in published studies (authors, sponsors) and
- conflict of interest of the people involved in the HTA.

The issue of conflict of interest in published studies may interfere with the objectivity of the study. All studies should declare conflict of interest from all authors, and how the study was sponsored.

How does the issue of conflict in publications apply to HTA?

The HTA core model describes how HTAs are produced. Therefore, it can be described as either the method for producing an HTA or the content of an HTA. The core model can also be viewed as the product resulting from an HTA.

The Norwegian Knowledge Centre does not currently have a structured approach to assessing the applicability of external HTA reports or reviews, although issues tied to applicability and transferability are dealt with frequently. In practice, our approach when evaluating these documents resembles processes described by other institutions, including the New Zealand Guideline Group (NZGG) [1].