Comparative Effectiveness Health Care Around the World International Health Care Systems

Adding the patient perspective to health technology assessment

Health technology assessments (HTAs) aim to measure the cost effectiveness of a given treatment or set of treatments for a specific patient populations.  Often, these assessments are conducted from the point of view of the payer–either a national health system or the individual insurer perspective.  This payer focused perspective can often focus largely on treatment costs rather than healthcare benefits that matter to patients.  However, patient preferences vary from person to person.  Thus, a question remains: how can HTAs integrate the patient perspective into their assessment process.

Finland may provide one instructive case.  A paper by Kleme et al. (2014) describes the approach taken by the Finnish Medicines Agency (Fimea).

Their study claimed that:

…patient interviews provide researchers and assessment groups with patients’ views, not merely regarding clinical effectiveness and safety of pharmaceuticals but also concerning clinical treatment pathways and medicines information as part of pharmacotherapy. In the long term, the information received from patients affects the quality of medicines information if it concerns experiences of everyday use of the pharmaceutical products.

Fimea involves patients participate at the HTA process in a variety of stages.

  • Individual patients suggesting topics for the HTA to consider
  • Patient representative on HTA board selections topics among those suggested by patients and others
  • Patient advocacy groups provide comments on the HTA assessment plan
  • Patient advocacy groups provide comments on the draft assessment report
  • Patient representative on HTA board helps to appraise the therapeutic and economic value

In an assessment of insulin glargine, Fimea supplemented their standard approach with focus group interviews of patients with type 1 or type 2 diabetes.  The article concludes that “qualitative interviews (focus group discussions or individual interviews) seem to be suitable methods for integrating the patient perspective into health technology assessments of pharmaceuticals.”

I commend Fimea for their approach to integrate the patient perspective–the individuals who ultimately matter most for treatment recommendations–into the HTA process.



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