title: Value Assessment Frameworks for HTA Agencies: The Organization of Evidence-Informed Deliberative Processes.
abstract: Priority setting in health care has been long recognized as an intrinsically complex and value-laden process. Yet, health technology assessment agencies (HTAs) presently employ value assessment frameworks that are ill fitted to capture the range and diversity of stakeholder values and thereby risk compromising the legitimacy of their recommendations. We propose "evidence-informed deliberative processes" as an alternative framework with the aim to enhance this legitimacy. This framework integrates two increasingly popular and complementary frameworks for priority setting: multicriteria decision analysis and accountability for reasonableness. Evidence-informed deliberative processes are, on one hand, based on early, continued stakeholder deliberation to learn about the importance of relevant social values. On the other hand, they are based on rational decision-making through evidence-informed evaluation of the identified values. The framework has important implications for how HTA agencies should ideally organize their processes. First, HTA agencies should take the responsibility of organizing stakeholder involvement. Second, agencies are advised to integrate their assessment and appraisal phases, allowing for the timely collection of evidence on values that are considered relevant. Third, HTA agencies should subject their decision-making criteria to public scrutiny. Fourth, agencies are advised to use a checklist of potentially relevant criteria and to provide argumentation for how each criterion affected the recommendation. Fifth, HTA agencies must publish their argumentation and install options for appeal. The framework should not be considered a blueprint for HTA agencies but rather an aspirational goal-agencies can take incremental steps toward achieving this goal.
authors.affiliation: Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: rob.baltussen@radboudumc.nl.
authors.forename: Rob
authors.initials: R
authors.lastname: Baltussen
authors.affiliation: Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Maarten Paul Maria
authors.initials: MPM
authors.lastname: Jansen
authors.affiliation: Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Leon
authors.initials: L
authors.lastname: Bijlmakers
authors.affiliation: Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Janneke
authors.initials: J
authors.lastname: Grutters
authors.affiliation: Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Anouck
authors.initials: A
authors.lastname: Kluytmans
authors.affiliation: Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Rob P
authors.initials: RP
authors.lastname: Reuzel
authors.affiliation: Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Marcia
authors.initials: M
authors.lastname: Tummers
authors.affiliation: Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Gert Jan van
authors.initials: GJV
authors.lastname: der Wilt
mesh_terms: D003661:Decision Support Techniques; D003695:Delivery of Health Care; D019317:Evidence-Based Medicine; D013673:Technology Assessment, Biomedical / Q000379:methods*; D062505:Value-Based Purchasing
keywords: Evidence-informed deliberative processes; HTA agency; Health Technology Assessment; Value Assessment Framework