HEALTH ECONOMIC OR TECHNOLOGY ASSESSMENTS

As physicians, patients, advocates, health plans, drug manufacturers, and policymakers search for tangible solutions to address increasing healthcare costs and access issues in the United States, Institute for Clinical and Economic Research (ICER) drug reviews and other health economic assessments (HEAs) and value discussions have become commonplace today.  For purposes of this website page and Lupus and Allied Diseases Association's Elevating the Patient Voice in Health Economic Assessments Initiative, HEAs represent Health Technology Assessments (HTAs) and Value Assessments (for example ICER Drug Reviews). 

Definition

The definition of health technology assessment (HTA) is provided below, with important clarifying information provided in 4 accompanying notes:

HTA is a multidisciplinary process that uses explicit methods to determine the value of a health technology at different points in its lifecycle. The purpose is to inform decision making in order to promote an equitable, efficient, and high-quality health system.

Note 1: A health technology is an intervention developed to prevent, diagnose, or treat medical conditions; promote health; provide rehabilitation; or organize healthcare delivery. The intervention can be a test, device, medicine, vaccine, procedure, program, or system. 
(Definition from the HTA Glossary: http://htaglossary.net/health1technology).

Note 2: The process is formal, systematic, and transparent, and it uses state-of-the-art methods to consider the best available evidence.

Note 3: The dimensions of value for a health technology may be assessed by examining the intended and unintended consequences of using a health technology compared with existing alternatives. These dimensions often include clinical effectiveness; safety, costs, and economic implications; ethical, social, cultural and legal issues; and organizational and environmental aspects, as well as wider implications for the patient, relatives, caregivers, and the population. The overall value may vary depending on the perspective taken, the stakeholders involved,
and the decision context.

Note 4: HTA can be applied at different points in the lifecycle of a health technology

References

HTA Glossary. Definition of health technology assessment. https://htaglossary.net/health1technology1assessment. Accessed May 26, 2020.

O’Rourke B, Oortwijn W, Schuller T. The new definition of health technology assessment: a milestone in international collaboration. Int J Technol Assess Health Care. 2020:1–4.

LADA's Elevating the Patient Voice in Health Economic Assessments Initiative

LADA actively engaged and participated in a HEA through ICER for Lupus Nephritis (LN) therapies over an 8-month period during 2020-2021.  By drawing on our own unique experiences in using the patient and caregiver voice to drive the review to assess the drugs’ worth based on what people living with lupus and lupus nephritis and their caregivers value most in a treatment, we were able to effectively contribute to the assessment.  The involvement of LADA and other lupus community participants and advocacy stakeholders ensured that the patient and caregiver viewpoints were properly accrued and accounted for in the lupus nephritis drug evaluation.  In this case, the process yielded a positive assessment of both drugs being appraised, which has not been the usual outcome of these reviews.  We would like to note that although the review was positive, it has not resulted in the lupus community gaining access to both treatments.
 

As a takeaway from this experience, LADA sought to better understand the collective patient advocacy experience in HEAs in order to demystify the process and encourage and prepare other patient advocacy organizations in different disease states to strategically engage and empower their own communities to effectively participate.  LADA developed and conducted a survey between February and April 2022 to gauge the knowledge and experience of U.S. based patient advocacy organizations concerning HEAs and to inform the degree and structure of potential educational resources needed to better prepare groups to participate.