title: Do ethical considerations influence any in HTA reports? A review of reports.
abstract: BACKGROUND
  Dealing with ethical considerations is a major component of Health Technology Assessment (HTA) definitions.
  
  
  OBJECTIVE
  Present study aimed to explore and describe the manner of ethical analyses in HTA reports and the effects it had on HTA-related decision making around the world.
  
  
  METHODS
  By considering the contextual milieu of reports and searching for ethical themes and subjects in HTA full reports, a descriptive analysis of HTA reports' contents and related processes was conducted. The review focused on all English HTA reports issued in a year. All ethical aspects, criteria, approaches, and also decision- making related ethical issues were described and summarized in retrieved reports. The inclusion of ethical aspects in final decision-making criteria of HTA reports was also considered.
  
  
  RESULTS
  Eighty-nine HTA reports issued in one year were included in this review and analyzed for ethical considerations. There was no trace of any ethical issues in 60.7% of retrieved HTA reports. Dimensions of equity in resource distribution, stakeholder engagement, social values, essence and nature of technology, and ethical issues about the method of assessment for decision making, and physician-patient relationship were raised and discussed in 38.2%, 3.4%, 3.4%, 3.4%, 34.8% and 3.4% of reports respectively. Those issues were also included in 44.1, 5.9, 2.9, 2.9, 0 and 2.9% of final reports, respectively. In overall, only in 16 cases (17.9%) of all 89 reports, ethical issues were included in HTA decision-making orientations.
  
  
  CONCLUSIONS
  This review shows that ethical issues are occasionally raised and discussed in HTA reports. More importantly, the inclusion of ethical concerns as a decision criterion in HTAs is few and insufficient.
authors: MSc, School of Public Health, Tehran University of Medical Sciences, Tehran, & Primary Health Care and Public Health deputy, Mazandaran University of Medical Sciences, Sari, Iran. arf_shams@yahoo.com.
authors: Alireza
authors: A
authors: Shams Moattar
authors: MD, Associate Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. fasghari@tums.ac.ir.
authors: Fariba
authors: F
authors: Asghari
authors: DVM, MSc, PhD, Professor, School of Public Health and Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran. rezamajd@tums.ac.ir.
authors: Reza
authors: R
authors: Majdzadeh
keywords: Decision process; Ethical analysis; Ethical considerations; Health Technology Assessment