title: Barriers and facilitators influencing ethical evaluation in health technology assessment.
abstract: OBJECTIVE
  The objective of this study was to explore barriers and facilitators influencing the integration of ethical considerations in health technology assessment (HTA).
  
  
  METHODS
  The study consisted of two complementary approaches: (a) a systematic review of the literature; and (b) an eighteen-item online survey that was distributed to fifty-six HTA agencies affiliated with the International Network of Agencies for Health Technology Assessment.
  
  
  RESULTS
  The review identified twenty-six relevant articles. The most often cited barriers in the literature were: scarcity, heterogeneity and complexity of ethical analysis methods; challenges in translating ethical analysis results into knowledge that is useful for decision makers; and lack of organizational support in terms of required expertise, time and financial resources. The most frequently cited facilitators included: usage of value-based appraisal methods, stakeholder and public engagement, enhancement of practice guidelines, ethical expertise, and educational interventions. Representatives of twenty-six (46.5 percent) agencies from nineteen countries completed the survey. A median of 10 percent (interquartile range, 5 percent to 50 percent) of the HTA products produced by the agencies was reported to include an assessment of ethical aspects. The most commonly perceived barriers were: limited ethical knowledge and expertise, insufficient time and resources, and difficulties in finding ethical evidence or using ethical guidelines. Educational interventions, demand by policy makers, and involvement of ethicists in HTA were the most commonly perceived facilitators.
  
  
  CONCLUSIONS
  Our results emphasize the importance of simplification of ethics methodology and development of good practice guidelines in HTA, as well as capacity building for engaging HTA practitioners in ethical analyses.
authors.affiliation: Programs for Assessment of Technology in Health (PATH) Research Institute,St. Joseph's Healthcare,Hamilton;Department of Clinical Epidemiology & Biostatistics,McMaster Universityassasin@mcmaster.ca.
authors.forename: Nazila
authors.initials: N
authors.lastname: Assasi
authors.affiliation: Department of Clinical Epidemiology & Biostatistics,McMaster University;Centre for Health Economics and Policy Analysis,McMaster University.
authors.forename: Lisa
authors.initials: L
authors.lastname: Schwartz
authors.affiliation: Programs for Assessment of Technology in Health (PATH) Research Institute,St. Joseph's Healthcare,Hamilton;Department of Clinical Epidemiology & Biostatistics,McMaster University.
authors.forename: Jean-Eric
authors.initials: JE
authors.lastname: Tarride
authors.affiliation: Programs for Assessment of Technology in Health (PATH) Research Institute,St. Joseph's Healthcare,Hamilton;Department of Clinical Epidemiology & Biostatistics,McMaster University.
authors.forename: Daria
authors.initials: D
authors.lastname: O'Reilly
authors.affiliation: Programs for Assessment of Technology in Health (PATH) Research Institute,St. Joseph's Healthcare,Hamilton;Department of Clinical Epidemiology & Biostatistics,McMaster University.
authors.forename: Ron
authors.initials: R
authors.lastname: Goeree
mesh_terms: D003657:Decision Making; D026689:Ethical Analysis; D006801:Humans; D009014:Morals; D013673:Technology Assessment, Biomedical / Q000941:ethics* / Q000458:organization & administration*
keywords: Barriers; Ethical analysis; Facilitators; Health technology assessment; Survey