Traditional HTAs keep diverse patients out of the conversation

Concerns about the cost of health care have led to calls for the use of health technology assessments or HTAs by the federal government. This would allow government agencies to make important decisions about patient access to health care based on their determination of the value of new tests and treatments. In this series, we explore some of the key short-comings of traditional HTA, particularly how it:

• Ignore differences in diverse populations
• Limit access to beneficial treatment options  
• Reinforce – rather than reduce – health disparities

As we work toward a more value-driven health care system, health technology assessments offer one tool that can be used by patients, physicians and health insurance companies to support these efforts. Yet it’s critical value assessments are more than just a simple budgetary exercise, especially in light of the recently passed Inflation Reduction Act that gives CMS unprecedented new power to make judgments about the relative clinical value of new treatments. That’s why PhRMA supports researchers and organizations developing HTA methods that account for patient differences and consider outcomes that matter to all patients.  

Traditional health technology assessments, or HTAs, often do not adequately represent diverse patient groups or their preferences and experiences. According to one study, only about half of the evidence used to measure quality-adjusted life years, or QALYs, for cost-effectiveness analysis included information on race and less than 15% included information on ethnicity, disability or employment status. 

While some research organizations like the Patient-Centered Outcomes Research Institute have made strides toward these issues, many leading HTA organizations, such as the Institute for Clinical and Economic Review (ICER), employ methods that fail to include the perspectives of patients from diverse backgrounds, races or ethnicities in their research in a systematic and meaningful way. That’s not right.

Patient groups have repeatedly called for steps to incorporate diverse perspectives and values into their assessments.

• Responding to ICER’s stakeholder engagement list for evaluation of Sickle Cell Disease (SCD) treatments, SickCells stated that ICER’s "current list of stakeholders is incomplete and missing key [community-based organizations]and professional societies that contribute to the landscape of SCD.”
• Any plan to improve the health care system needs to capture all patients’ values. While ICER has signaled it may change course, it remains to be seen whether it will do so in a meaningful way. If we want to move toward a more equitable health care system, one group should never be the final arbiter of a treatment’s value and whether it should be available to patients. 

Learn more at phrma.org/policy-issues/value-assessment.