EUnetHTA: Practical Tools for Health Technology Assessment in Europe

This significant article, authored by Finn Børlum Kristensen, Kristian Lampe, Deborah L. Chase, Sun Hae Lee-Robin, Claudia Wild, Montse Moharra, Marcial Velasco Garrido, Camilla Palmhøj Nielsen, John-Arne Røttingen, Susanna Allgurin Neikter, and Marie Louise Bistrup, was published in the International Journal of Technology Assessment in Health Care, Volume 25, Supplement 2, in 2009. The publication highlights the collective efforts of the authors, representing the European network for Health Technology Assessment (EUnetHTA).

Core Objective and Context of EUnetHTA: The primary objective of the article is to provide a comprehensive overview of the practical methods and tools developed and pilot-tested by EUnetHTA to support transnational Health Technology Assessment (HTA) across Europe. EUnetHTA was established between 2006 and 2008 in direct response to an expressed need from European Union (EU) Member States and the European Commission to create a sustainable network for HTA in Europe. The project involved a substantial collaboration, engaging a total of sixty-four Partner organizations. During its three-year span, the EUnetHTA Project meticulously examined the entire HTA process and its linkages to policy, addressing critical challenges for enhancing transnational collaboration, such as reporting standards and information sharing. The project was strategically designed to be practical, focusing on the development of useful tools to provide reliable, timely, transparent, and transferable information on the effects of health technologies, aiding decision-making in Member States and the EU.

Key Practical Tools and Methodologies Developed: The article details the objectives, diverse methods (including literature reviews, surveys, Delphi and consensus methods, workshops, and pilot tests), and practical results of six streams of HTA-related work within EUnetHTA. These tools are described as providing high-quality information and robust methodological frameworks that facilitate HTA documentation and information sharing both within and across national and regional health systems.

1. The HTA Core Model and Handbook for Transnational HTA:
   • Purpose: To develop and test a generic framework enabling international collaboration for producing and sharing HTA results in a common, structured format, addressing the variability in HTA report structures across agencies.
   • Development: Ten international teams constructed the HTA Core Model, which divides HTA information into standardized assessment elements. It incorporates nine domains: Health problem and current use; Description and technical characteristics; Safety; Effectiveness; Costs and economic evaluation; Ethical; Organizational; Social; and Legal aspects, building upon the earlier EUR-ASSESS Project.
   • Structure: The model comprises 133 assessment elements for medical/surgical interventions and 153 for diagnostic technologies, with a significant portion (121 and 143, respectively) designated as core elements. Each element contains a generic issue to be translated into practical research questions.
   • Results & Impact: The elementary structure proved useful in pilot HTAs. It is envisioned as a platform for genuine transnational HTA collaboration, allowing for work distribution and maximum utilization of a common pool of structured HTA information for national reports. Importantly, Core HTAs do not contain recommendations on technology use, which are typically found in HTA reports targeted at specific national or regional settings. A detailed HTA Core Model Handbook provides guidance on its use.
   • Next Steps: The current electronic version requires further refinement to identify overlapping issues and more widespread, carefully monitored pilot application within the EUnetHTA Collaboration.
2. HTA Adaptation Toolkit for New Contexts:
   • Purpose: To reduce time, costs, and duplication by facilitating the adaptation of existing HTA reports to new settings.
   • Development: Through several rounds of input from twenty-eight European HTA agencies and scholarly institutions, including literature searches, a survey, two Delphi rounds, and two rounds of quality assurance testing, a toolkit was developed. A glossary of HTA adaptation terms was also created to reduce misunderstandings.
   • Results: The toolkit consists of checklists and resources designed to identify and clarify the relevance, reliability, and transferability of data and information from existing reports. Most respondents to a survey had experience adapting reports and believed it was useful, strongly supporting the toolkit’s development.
   • Next Steps: Future plans include Web-based implementation and further field testing within the EUnetHTA Collaboration.
3. Newsletter for Informing Decision-Makers about Emerging Technologies:
   • Purpose: To disseminate information gathered from horizon scanning activities to a wider, non-specialized European audience, including policymakers, beyond regional or national boundaries.
   • Methodology: The EuroScan database served as the primary source for identifying potentially relevant technologies. A panel of HTA experts prioritized technologies based on their potential impact.
   • Results: From July to December 2007, 104 technologies were identified, and 12 were selected for description in a pilot newsletter. Feedback was largely positive regarding relevance and readability, but readers requested more information on cost-effectiveness and questioned timeliness.
   • Conclusion: While feasible, an EU-only newsletter based solely on EuroScan information was deemed potentially duplicative of EuroScan’s own planned efforts. EUnetHTA suggested exploring alternative future collaborative actions, such as providing a core set of early awareness information or an on-demand electronic information system.
4. Interactive Web-based Tool for Evidence Generation of New Technology (AEG):
   • Purpose: To address the lack of structured collaboration among HTA agencies in generating additional evidence for promising health technologies, particularly in the context of Access with Evidence Generation (AEG) policies.
   • Methodology: A review of AEG mechanisms in twenty-three countries (including 20 European countries, the US, Canada, and Australia) was conducted through literature reviews, partner surveys, and expert consultation. Collaboration modalities were discussed at a workshop.
   • Results: There is growing interest in implementing AEG policies at the coverage decision stage. This led to the creation of a Web-based toolkit to facilitate structured information sharing, including standardized forms for requesting and posting information, and an online database (http://eiffel.eunethta.has-sante.fr/).
   • Impact: This tool aims to help managers and policymakers make robust decisions on the timely adoption of promising health technologies by gathering a critical mass of high-quality data quickly. Its full operationalization depends on active engagement and information supply from EUnetHTA Partners.
5. Handbook on HTA Capacity Building:
   • Purpose: To support Member States with limited HTA institutionalization by defining minimum components for HTA organizations and providing tools for information support. This responds to the rapid growth of HTA agencies and increasing interest in establishing them.
   • Methodology: Activities included reviewing existing HTA organizations’ websites, conducting a worldwide survey on HTA institutionalization, a survey on information units, a workshop, and a survey on HTA educational programs (sent to INAHTA members and Cochrane Centers).
   • Results: These efforts culminated in the production of a Handbook on HTA Capacity Building. The survey on educational programs identified ten MSc programs (five in HTA, five HTA-related) and eleven postgraduate HTA-related courses.
   • Key Insights: Emphasizes that establishing a new agency requires not only funding but also trained, multidisciplinary staff. Success also depends on the quality and relevance of HTA reports, efficient dissemination systems, and the political will to integrate HTA into decision-making.
6. Book on HTA and Health Policy Making in Europe:
   • Purpose: To review the relationship between HTA and policy making, with a special focus on Europe, and to promote HTA as valuable policy input. This addresses the often unrealized potential of HTA’s impact on health system decision-making.
   • Methodology: Following a workshop with healthcare policy makers and managers, a group of HTA researchers produced a book. The chapters integrated systematic literature reviews, document analyses, expert knowledge, and practical experiences from European HTA agencies.
   • Results: Published in cooperation with the European Observatory on Health Systems and Policies, the book identifies factors that might enhance or hinder HTA’s contribution to policy making. It explores research utilization models, the generalities of HTA and policy making, options for locating HTA institutions, and a hierarchical model for HTA impact evaluation. It also provides insights on barriers and facilitators in using HTA evidence and proposes strategies to improve knowledge transfer.
   • Conclusion: The study offered a multidisciplinary perspective, highlighting the integration of HTA with other quality improvement efforts and its interrelation with health services research. It concluded that while the field is gaining theoretical and empirical ground, it remains immature, necessitating more multidisciplinary research into the HTA-health policy relationship.

Overall Achievements and Future Outlook: The EUnetHTA Project successfully met its objectives, delivering tangible results and engaging a large network of organizations and individuals. The article concludes that these tools, along with a sustainable network, establish an operational and functional basis for European collaboration in HTA. The strategic goals include reducing unnecessary duplication of HTA activities, promoting good practices, facilitating local adaptation of HTA information, and improving the connection between health policy and HTA. While the concrete models and tools require further piloting and adjustment, the necessary structures are now in place within the EUnetHTA Collaboration. Future phases of collaboration will carefully consider the division of work among organizations based on their competencies and needs.

Reference: Kristensen, F. B., Lampe, K., Chase, D. L., Lee-Robin, S. H., Wild, C., Moharra, M., Velasco Garrido, M., Nielsen, C. P., Røttingen, J.-A., Allgurin Neikter, S., & Bistrup, M. L. (2009). Practical tools and methods for health technology assessment in Europe: Structures, methodologies, and tools developed by the European network for Health Technology Assessment, EUnetHTA. International Journal of Technology Assessment in Health Care, 25(Suppl. 2), 1–8. https://doi.org/10.1017/S0266462309990626