This chapter describes how patients and the social perspective can be included in health technology assessments (HTA). Utilising an HTA is a common procedure for defining and describing the value of a health technology for health policy decision-making. The HTA reports are produced on medical interventions to map the value of a health technology for various stakeholders and serve as a basis for information. The evidence from the HTA report should enable health policy decision makers to decide whether or not a health technology should be approved and/or reimbursed.
The integration of the patient and social perspective into the evaluation process of health technologies is highly relevant in the health policy context. It provides an important contribution to understanding what the value of an intervention is for users. At the European level, the HTA Core Model®, which was developed by the European Network for HTA (EUnetHTA), offers a framework for orientation on how to elaborate the domain.
The aim of integrating patients and social aspects into the HTA report is to understand the needs, values and preferences of the users of a medical intervention better. The domain provides information on important facets of the value of a health technology for users, including moral values and information needs. Relevant outcomes are particularly the motivation in favour or against the intervention under investigation, access to, experience with and expectations of the intervention or to better understand possible unmet needs.
Nevertheless, the current state of the research is that although the inclusion of the patient perspective is considered an important issue by HTA agencies worldwide, there is a lack of implementation. The integration of patients is currently still rare and insufficiently systematic. Moreover, in most cases, there is no evaluation of the additional benefit of including patients or the patient perspective.
There are various ways to include the patient and social perspective in the HTA process. They can be included by either secondary data analysis or collecting primary data. The evidence can be qualitative or quantitative. A systematic elaboration of the patients and social aspects domain requires more resources in the production, but there are good reasons to elaborate the patient perspective and social aspects comprehensively. As an example of an HTA report with a focus on patients and social aspects, we describe the HTA commissioned by a German HTA agency on integrative mistletoe therapy for patients with breast cancer in addition to standard therapy.
In this project, it was already foreseeable before the start of the HTA project that there might be only a few randomised controlled trials on the effectiveness of mistletoe therapy in patients with breast cancer. If the evidence on effectiveness as a basis is unclear, it is difficult to make a recommendation. Nevertheless, mistletoe extracts are in demand. In order to understand better why this is the case, the patients and social aspects domain has also been systematically elaborated in this HTA report.
Although it is not possible to estimate what influence the results on patients and social aspects will have on health policy decisions, it is evident that the elaboration has provided valuable indications as to the value of mistletoe therapy for users.
© W. Kohlhammer GmbH, Stuttgart.