Equity in HTA: what doesn’t get measured, gets marginalised

Richard Andrew Cookson; Andrew Mirelman

doi:10.1186/s13584-017-0162-3

Equity in HTA: what doesn’t get measured, gets marginalised

Richard Andrew Cookson, Andrew Mirelman

Centre for Health Economics

Research output: Contribution to journal › Comment/debate

Abstract

When making recommendations about the public funding of new health
technologies, policy makers typically pay close attention to quantitative
evidence about the comparative effectiveness, cost effectiveness and budget
impact of those technologies – what we might call “efficiency” criteria. Less
attention is paid, however, to quantitative evidence about who gains and who
loses from these public expenditure decisions, and whether those who gain are
better or worse off than the rest of the population in terms of their health –
what we might call “equity” criteria. Two studies recently published in this
journal by Shmueli and colleagues suggest that this efficiency-oriented
imbalance in the use of quantitative evidence may have unfortunate
consequences – as the old adage goes: “what gets measured, gets done”. The first study, by Shmueli, Golan, Paolucci and Mentzakis, found that health
policy makers in Israel think equity considerations are just as important as
efficiency considerations – at least when it comes to making hypothetical
technology funding decisions in a survey. By contrast, the second study – by
Shmueli alone – found that efficiency rules the roost when it comes to making
real decisions about health technology funding in Israel. Both studies have
limitations and potential biases, and more research is needed using qualitative
methods and more nuanced survey designs to determine precisely which kinds
of equity consideration decision makers think are most important and why
these considerations do not appear to be given much weight in decision
making. However, the basic overall finding from the two studies seems
plausible and important. It suggests that health technology funding bodies
need to pay closer attention to equity considerations, and to start making
equity a quantitative endpoint of health technology assessment using the
methods of equity-informative economic evaluation that are now available.

Original language	English
Article number	JHPR-D-17-00053.0
Journal	Israel Journal of Health Policy Research
Volume	6
Issue number	38
DOIs	https://doi.org/10.1186/s13584-017-0162-3
Publication status	Published - 10 Jul 2017

Bibliographical note

Keywords

Equity
health technology assessment
health economics
economic evaluation
priority setting

Access to Document

10.1186/s13584-017-0162-3

Cookson_et_al-2017-Israel_Journal_of_Health_Policy_Research
© The Author(s). 2017
Final published version, 355 KBLicence: CC BY

Cite this

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title = "Equity in HTA: what doesn{\textquoteright}t get measured, gets marginalised",

abstract = "When making recommendations about the public funding of new healthtechnologies, policy makers typically pay close attention to quantitativeevidence about the comparative effectiveness, cost effectiveness and budgetimpact of those technologies – what we might call “efficiency” criteria. Lessattention is paid, however, to quantitative evidence about who gains and wholoses from these public expenditure decisions, and whether those who gain arebetter or worse off than the rest of the population in terms of their health –what we might call “equity” criteria. Two studies recently published in thisjournal by Shmueli and colleagues suggest that this efficiency-orientedimbalance in the use of quantitative evidence may have unfortunateconsequences – as the old adage goes: “what gets measured, gets done”. The first study, by Shmueli, Golan, Paolucci and Mentzakis, found that healthpolicy makers in Israel think equity considerations are just as important asefficiency considerations – at least when it comes to making hypotheticaltechnology funding decisions in a survey. By contrast, the second study – byShmueli alone – found that efficiency rules the roost when it comes to makingreal decisions about health technology funding in Israel. Both studies havelimitations and potential biases, and more research is needed using qualitativemethods and more nuanced survey designs to determine precisely which kindsof equity consideration decision makers think are most important and whythese considerations do not appear to be given much weight in decisionmaking. However, the basic overall finding from the two studies seemsplausible and important. It suggests that health technology funding bodiesneed to pay closer attention to equity considerations, and to start makingequity a quantitative endpoint of health technology assessment using themethods of equity-informative economic evaluation that are now available.",

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