Conceptualising, measuring and valuing the impact of Health Technology Assessment

Grieve, Eleanor (2020) Conceptualising, measuring and valuing the impact of Health Technology Assessment. PhD thesis, University of Glasgow.

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Abstract

How do we assess the impact of Health Technology Assessment (HTA)? Whilst high-income countries (HIC) may have led the way, lower-income countries are increasingly beginning to develop HTA processes to assist in their healthcare decision-making. Understanding how we might quantify the costs and benefits of investing in HTA is important to policy makers and donors. Very few studies have, however, estimated the benefits of the process of HTA in terms of its value to the health system. The global expansion of HTA, its variable implementation, the lack of quantified evidence on health outcomes, along with an increasing investment in these processes at the systems level in low- and middle-income countries (LMIC) has generated greater interest from policy makers about the value and return on investment (ROI) of HTA. A lack of longer-term impact assessment (IA) may undermine its importance and value.

To fill this research gap, we have developed a methodological framework to estimate the ROI in HTA using net health benefits (NHB) as our measure of value. This is the difference between QALYs gained by an intervention and QALYs that could have been gained if the money required to deliver it had been spent on other interventions. We use a mixed-methods approach to quantify the value of HTA and to produce explanatory programme theory on the mechanisms by which HTA impact can be optimised. It is also important to consider opportunity costs when establishing HTA processes but which are often overlooked. The aim is to convey the concepts of potential and realised population NHB, and what we can attribute to the HTA process. Central to understanding this is the ‘value of implementation’ (VOImp). Theory-driven approaches will be used to generate and test contextual explanations for gaps between expected and actual gains in population health.

We envisage the use of this research will encourage accountability of spending decisions and help to optimise the impact of HTA in an era of investment and expansion, in particular, for LMICs, through better understanding of HTA’s role in delivering health outcomes and value for money at the system level. This research will offer a forward-looking model that LMICs can point to as a reference for their own implementation.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: HTA, Health Technology Assessment, impact.
Subjects: H Social Sciences > H Social Sciences (General)
R Medicine > R Medicine (General)
Colleges/Schools: College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
Supervisor's Name: Briggs, Professor Andrew and Wu, Professor Olivia and Hesselgreaves, Professor Hannah
Date of Award: 2020
Depositing User: Ms Eleanor Grieve
Unique ID: glathesis:2020-81864
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 15 Dec 2020 09:29
Last Modified: 15 Dec 2020 10:34
URI: http://theses.gla.ac.uk/id/eprint/81864

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