Despite all the efforts and the available methodological guidance, performing HTAs remains a resource-intensive task where relevant human, capital and data requirements need to be addressed. In light of these requirements, it is perhaps not surprising that lack of resources is one of the key challenges that HTA agencies typically face.

Sourcing resources
Two surveys illuminate how the problem of having the right resources is seen in the HTA practitioners’ eyes. In the survey conducted by Cheung et al. (2018) involving European policy makers and HTA researchers, a lack of qualified human resources, particularly in the field of health economics, is a recognised barrier together with the need of improving this specialist knowledge among policy makers. In another survey with global health practitioners (Teerawattananon et al., 2021), the lack of data and technical skills were among the top reasons for not using HTAs, with these reasons more frequently quoted by practitioners working in lower middle- and low-income countries.

It’s all about building capacity and sharing knowledge
Investment in capacity building and knowledge-sharing appears key in overcoming the lack of HTA resources. To tackle the lack of technical skills, Teerawattananon et al. (2021) suggest capacity building and academic research as potential solutions, recognising that HTA training and networking opportunities have increased in recent years in low- and middle-income countries (see Wilkinson et al., 2016 and The International Network of Agencies for Health Technology Assessment as some examples). However, lack of continuous investment could make it difficult to maintain the required technical skills or even retaining staff with those skills once they are formed.

On the lack of data, an example of how improvements can be made to overcome this barrier comes from India. In recent years, strides have been made to ensure the availability of high-quality data on healthcare costs for a range of conditions to inform the development of HTAs. These efforts have culminated in the creation of a freely accessible National Health System Cost Database for India, and the development of the large scale ‘Cost of Health Services in India (CHSI)’ study (Chahuan et al., 2022). As recognised by Drummond et al. (2022), the development of local databases is key in the success of HTA activities, particularly for data which may not be easily transferable across different countries or jurisdictions (e.g. unit costs, health state utility values and epidemiological data) or where ‘standard of care’ or ‘usual care’ (which is the typical comparator in cost-effectiveness analyses) tend to differ from country to country.

Author of this blogpost:
Dr Valerio Benedetto, UCLan and MIDAS Theme

What’s next
In the next blog, Professor Andy Clegg will explore decision-making using HTAs.

Some references:
• Chauhan, A.S., Guinness, L., Bahuguna, P., Singh, M.P., Aggarwal, V., Rajsekhar, K., Tripathi, S. and Prinja, S., 2022. Cost of hospital services in India: a multi-site study to inform provider payment rates and Health Technology Assessment. BMC health services research, 22(1), pp.1-12.
• Cheung, K. L., Evers, S. M. A. A., De Vries, H., Lévy, P., Pokhrel, S., Jones, T., … & Hiligsmann, M. (2018). Most important barriers and facilitators of HTA usage in decision-making in Europe. Expert review of pharmacoeconomics & outcomes research, 18(3), 297-304.
• Drummond, M.F., Augustovski, F., Bhattacharyya, D., Campbell, J., Chaiyakanapruk, N., Chen, Y., Galindo-Suarez, R.M., Guerino, J., Mejía, A., Mujoomdar, M. and Ollendorf, D., 2022. Challenges of health technology assessment in pluralistic healthcare systems: an ISPOR Council Report. Value in Health, 25(8), pp.1257-1267.
• Teerawattananon, Y., Painter, C., Dabak, S., Ottersen, T., Gopinathan, U., Chola, L., Chalkidou, K. and Culyer, A.J., 2021. Avoiding health technology assessment: a global survey of reasons for not using health technology assessment in decision making. Cost Effectiveness and Resource Allocation, 19(1), pp.1-8.
• Wilkinson, T., Sculpher, M.J., Claxton, K., Revill, P., Briggs, A., Cairns, J.A., Teerawattananon, Y., Asfaw, E., Lopert, R., Culyer, A.J. and Walker, D.G., 2016. The international decision support initiative reference case for economic evaluation: an aid to thought. Value in health, 19(8), pp.921-928.