International Journal of Technology Assessment in Health Care最新文献

The use of Artificial Intelligence (AI) in Health Technology Assessment (HTA) activities presents an opportunity to enhance the efficiency, accuracy, and speed of HTA processes worldwide. However, the adoption of AI tools in HTA comes with diverse challenges and concerns that must be carefully managed to ensure their responsible, ethical, and effective deployment. The 2025 Health Technology Assessment international Global Policy Forum (GPF) informed GPF members of the integration of AI into HTA activities, with a particular focus on the use of Generative AI (GenAI). With the overarching goal of illuminating and inspiring tangible outputs and actionable recommendations, the event brought together a diverse range of interest holders to explore the opportunities and challenges of AI in HTA. This article summarizes the key discussions and themes that informed the GPF outcomes, including trust, human agency, and risk-based approaches, culminating in a proposed set of priority next steps for the HTA community regarding the integration of GenAI. It also highlights insights into the current state of digital transformation within HTA organizations and the life sciences industry, providing insights into where the field stands and where it is heading.

Introduction: Economic evaluation supports public funding decisions about the use of health technologies within the Portuguese National Health System (NHS). The methods guide for economic evaluation in Portugal serves both companies preparing economic evaluation submissions and the independent commission appraising the evidence submitted.

Methods: This article presents the revised methods guide for economic evaluation in Portugal. The revisions reflect advances in economic evaluation, updates to regulatory policies, and responses to the evolving economic context. The paper highlights the most significant changes to the guidance, comparing the new Portuguese guidelines to those from the United Kingdom and Canada. The discussion is framed around key comments received during public consultation.

Results: The updated guidelines recommend cost-effectiveness analyses based on quality-adjusted life years and advocate for long-term modelling, a 4 percent discount rate, and a focus on NHS costs. New features include guidance on the identification and management of uncertainty within a dynamic appraisal process with regular contract negotiations (which can trigger reappraisals). The guide also covers how cost-effectiveness models, typically centrally developed, should be adapted to the Portuguese context. It highlights the key role of structured expert elicitation to address uncertainties in evidence, including those related to model adaptation.

Conclusions: The revision was developed through stakeholder consultations and aligns with international best practices, offering more explicit and transparent methods to support health resource allocation decisions.

Objectives: This study aims to explore the perspectives on disinvestment of low-value care and interventions in Malaysia's healthcare system, with a focus on establishing the criteria for assessing disinvestment candidates, identifying potential barriers, and proposing strategies to improve the acceptance and effective implementation of disinvestment.

Methods: Between March and May 2023, we conducted online, semistructured interviews with seventeen Malaysian healthcare stakeholders with different professional roles at various levels of governance and decision making. Participants were recruited through a mix of purposive and snowballing sampling. Interviews were transcribed verbatim and analyzed using inductive thematic approach in Atlas.ti.

Results: We identified four major themes: disinvestment as a catalyst for efficient resource allocation; disinvestment as a justifiable way of cutting budgets; challenges and barriers in implementation; and strategies for value-based assessment and effective implementation. Stakeholders viewed disinvestment both optimistically and skeptically in terms of its implementation but were unanimous in including equity as a key component in decision making. Practical challenges and uncertainty among healthcare professionals emerged as significant barriers to implementing disinvestment initiatives in Malaysia.

Conclusions: Malaysian stakeholders viewed disinvestment as both an opportunity to improve resource allocation and a source of concern due to potential negative consequences and system readiness. This study identified strategies to support value-based assessment and implementation, underscoring the need for accountability and collaboration. Although current disinvestment efforts in Malaysia remain limited and undocumented, the thematic framework developed offers transferable insights and a structured lens for assessing readiness. These stakeholder-derived themes can guide other countries in designing transparent, equitable, and context-sensitive disinvestment processes.

Introduction: Patient involvement in health technology assessment (HTA) is nascent globally especially in Asia. The aim was to assess patient awareness, involvement, and learning needs of HTA, particularly in Asia.

Method: An online survey assessed HTA awareness, involvement, and learning needs among patients and caregivers across 33 countries from October 2021 to July 2022.

Results: The survey of 170 participants (127 Asians, 43 non-Asians) revealed that 52.3 percent (89 of 170) were unaware of HTA, only 14.1 percent (24 of 170) engaged in HTA, and only 9.3 percent (15 of 161) had received training. The Asian group exhibited significantly lower HTA awareness (mean score 24.6 vs. 30.4, p < 0.05) and had lower participation rates in HTA discussions (10.2 percent, 13 of 127) compared to the non-Asian group (25.6 percent, 11 of 43) (p < 0.05). Among participants without prior HTA training, 68.5 percent (100 of 146) expressed a learning need.

Conclusion: Patient awareness and involvement in HTA were low globally, particularly in Asia. There was a strong patient learning need for HTA globally.

Health Technology Assessment (HTA) informs resource allocation and policy decisions, particularly to achieve Universal Health Coverage (UHC). Recognizing the increasing demand for evidence-informed decision-making, the HTAsiaLink network was established in 2011 as a regional platform to strengthen individual and institutional capacity in HTA research and facilitate the integration of HTA evidence into policy decisions across the Asia-Pacific.Over the years, HTAsiaLink has expanded to over fifty members from twenty economies. In 2024, a structured strategic planning process was undertaken to ensure its continued growth and strengthen its impact on HTA development and implementation. This process involved a targeted review of strategic plans from international networks, alongside comprehensive member engagement, to develop a data-driven and adaptable plan responsive to the evolving healthcare landscape and member needs. As a result, five strategic priorities, corresponding action items, and success indicators were identified.This commentary outlines the needs and processes involved in developing the network's first-ever strategic plan, emphasizing the critical role of member engagement in shaping its future direction. We believe that this experience offers transferable insights for other HTA networks, particularly those operating in low- and middle-income country contexts, on the collaborative development of strategic plans that are responsive to shared objectives, accommodate varying institutional capacities, and align with regional priorities.

Introduction: Since the introduction of health technology assessment (HTA) in Ukraine, the international technical assistance project "Safe, Affordable, and Effective Medicines for Ukrainians" with financial contributions of the United States Agency for International Development has supported capacity building activities. In 2020, the main HTA stakeholders expressed interest in a comprehensive training program for HTA doers, users, and trainers.

Approach: To inform the design of a training program, the needs of forty HTA doers, users, and potential trainers were assessed using validated surveys. Identified knowledge gaps included comparative effectiveness, health economics, qualitative evidence synthesis, patient and public involvement, and ethical issues. Based on these results a tailored training program consisting of five modules was developed, including an introduction to HTA, as well as a train-the-trainers program.

Results: During January-July 2023, seventy-five persons participated in the training program, while twelve HTA professionals followed the train-the-trainer program. We evaluated participants' self-reported knowledge and skill gains by asking about their confidence level in each learning objective at the beginning and end of each training module. For each module, a learning effect was observed among participants. Furthermore, the majority of trainers felt confident to provide the introductory module on HTA, while for the other modules only one or two trainers felt completely confident to teach the content.

Conclusion: Establishing a training program based on the needs of HTA doers, users, and trainers as developed for Ukraine can serve as inspiration for other countries that wish to attain sustainable HTA capacity.

Objectives: Cost-effectiveness analyses are used to help to inform resource-allocation decision-making in healthcare systems. The manufacturers of new health technologies may choose to employ "early cost-effectiveness analysis" (eCEA) to inform the technology development process in anticipation of a value-based assessment if and when the technology is launched. We aim to provide guidance on how eCEA can effectively inform health technology development processes, presenting novel methodological approaches to address key decision-making questions.

Methods: We present three core health technology development questions that eCEAs can address, as well as recommendations for deriving and presenting insights from eCEA models. A hypothetical treatment for cutaneous squamous cell carcinoma (CSCC) called "dummymab" demonstrates the analytic techniques and presentation formats.

Results: We provide guidance for addressing: 1. What is a health technology's value-based price (VBP) under a range of scenarios? 2. To what extent do different attributes of the technology contribute to its value? 3. Regarding what model parameters is further evidence most valuable? A novel net benefit approach for value driver analysis provides more reliable estimates than traditional 'switch-on' methods by avoiding parameter interaction effects. The manufacturer-perspective value-of-information framework enables evidence prioritization aligned with commercial decision-making while maintaining cost-effectiveness principles.

Conclusions: eCEA can systematically inform technology development through value-based price estimation, value driver identification, and evidence prioritization. Implementing development decision-making based on eCEA insights can foster alignment with value-based principles of HTA-orientated decision-making systems while supporting more efficient resource allocation in technology development.

Objectives: Access to quality healthcare is often limited in rural and underserved areas, leading to higher rates of preventable diseases, avoidable hospitalizations, and mortality. Virtual health clinics, utilizing telehealth and telemedicine technologies, offer a promising solution to bridge these gaps. This scoping review aimed to systematically identify and analyze the benefits, outcomes, and service range of virtual clinics in remote and underserved settings.

Methods: This scoping review was conducted following Arksey and O'Malley's six-stage framework. Relevant literature was searched in PubMed, Web of Science, Scopus, Google, and Google Scholar. Data were extracted using a standardized charting form and thematically analyzed using Braun and Clarke's method with MAXQDA software.

Results: A total of 38 benefits of virtual clinics were identified, primarily related to improved access to health services, reduced costs, and decreased patient travel. In the domain of governance and leadership, enhanced governmental support and optimal resource allocation were reported. For human resources, improved communication and training were emphasized. Moreover, the use of local technologies, remote medication ordering, and digital record-keeping demonstrated a significant impact, particularly in middle- and high-income countries.

Conclusions: Virtual clinics can effectively enhance the quality and accessibility of health services in underserved areas and play an important role in reducing health inequities.