title: CHANGING HEALTH TECHNOLOGY ASSESSMENT PARADIGMS?
abstract: OBJECTIVE
  Health technology assessment (HTA) has to innovate to best support changing health system environments and to help provide access to valuable innovation under fiscal constraint.
  
  
  METHODS
  Issues associated with changing HTA paradigms were identified through scoping and explored through deliberation at a meeting of industry and HTA leaders.
  
  
  RESULTS
  Five broad areas of change (engagement, scientific dialogue, research prioritization, adaptive approaches, and real world data) were identified. The meeting focused on two themes derived from these: re-thinking scientific dialogue and multi-stakeholder engagement, and re-thinking value, affordability, and access. Earlier and ongoing engagement to steer the innovation process and help achieve appropriate use across the technology lifecycle was perceived as important but would be resource intensive and would require priority setting. Patients need to be involved throughout, and particularly at the early stages. Further discussion is needed on the type of body best suited to convening the dialogue required. There was agreement that HTA must continue to assess value, but views differed on the role that HTA should play in assessing affordability and on appropriate responses to challenges around affordability. Enhanced horizon scanning could play an important role in preparing for significant future investments.
  
  
  CONCLUSIONS
  Early and ongoing multi-stakeholder engagement and revisiting approaches to valuing innovation are required. Questions remain as to the most appropriate role for HTA bodies. Changing HTA paradigms extend HTA's traditional remit of being responsive to decision-makers demands to being more proactive and considering whole system value.
authors: Institute of Health Economics,School of Epidemiology,Public Health and Preventive Medicine,University of Ottawa,University for Health Sciences,Medical Informatics and Technologydhusereau@ihe.ca.
authors: Don
authors: D
authors: Husereau
authors: Health Economics Research Group,Brunel University London.
authors: Chris
authors: C
authors: Henshall
authors: Hospital Clinic.
authors: Laura
authors: L
authors: Sampietro-Colom
authors: Wessex Institute Enterprise and Partnerships,University of Southampton.
authors: Sarah
authors: S
authors: Thomas
mesh_terms: D003365:Costs and Cost Analysis; D006297:Health Services Accessibility; D006801:Humans; D010358:Patient Participation; D012106:Research / Q000458:organization & administration*; D012107:Research Design; D012108:Research Personnel / Q000458:organization & administration; D013673:Technology Assessment, Biomedical / Q000458:organization & administration*
keywords: Financial management; Health technology assessment; Patient participation; Stakeholder engagement; Value-based purchasing