title: Revealing and acknowledging value judgments in health technology assessment.
abstract: BACKGROUND
  Although value issues are increasingly addressed in health technology assessment (HTA) reports, HTA is still seen as a scientific endeavor and sometimes contrasted with value judgments, which are considered arbitrary and unscientific. This article aims at illustrating how numerous value judgments are at play in the HTA process, and why it is important to acknowledge and address value judgments.
  
  
  METHODS
  A panel of experts involved in HTA, including ethicists, scrutinized the HTA process with regard to implicit value judgments. It was analyzed whether these value judgments undermine the accountability of HTA results. The final results were obtained after several rounds of deliberation.
  
  
  RESULTS
  Value judgments are identified before the assessment when identifying and selecting health technologies to assess, and as part of assessment. They are at play in the processes of deciding on how to select, frame, present, summarize or synthesize information in systematic reviews. Also, in economic analysis, value judgments are ubiquitous. Addressing the ethical, legal, and social issues of a given health technology involves moral, legal, and social value judgments by definition. So do the appraisal and the decision-making process.
  
  
  CONCLUSIONS
  HTA by and large is a process of value judgments. However, the preponderance of value judgments does not render HTA biased or flawed. On the contrary they are basic elements of the HTA process. Acknowledging and explicitly addressing value judgments may improve the accountability of HTA.
authors: University College of Gjøvik and University of Oslo,bjoern.hofmann@hig.no.
authors: Bjørn
authors: B
authors: Hofmann
authors: Hasselt University and Belgian Health Care Knowledge Centre (KCE).
authors: Irina
authors: I
authors: Cleemput
authors: Canadian Agency for Drugs and Technologies in Health.
authors: Kenneth
authors: K
authors: Bond
authors: University Hospital/University of Zürich.
authors: Tanja
authors: T
authors: Krones
authors: Institute for Quality and Efficiency in Healthcare (IQWiG).
authors: Sigrid
authors: S
authors: Droste
authors: Institute of Bioethics,"Agostino Gemelli" School of Medicine,Universita Cattolica del Sacro Cuore.
authors: Dario
authors: D
authors: Sacchini
authors: Ecorys Netherlands.
authors: Wija
authors: W
authors: Oortwijn
mesh_terms: D003657:Decision Making / Q000941:ethics*; D006801:Humans; D007600:Judgment; D013673:Technology Assessment, Biomedical / Q000941:ethics*
keywords: Norms