Health technology assessment (HTA) and economic evaluation: efficiency or fairness first.

Area of Science:

• Health Economics
• Health Technology Assessment
• Social Values in Healthcare

Background:

• Economic evaluation in HTA traditionally focuses on efficiency, often measured by utility or quality-adjusted life years (QALYs).
• This efficiency-centric approach can lead to the exclusion of treatments for rare diseases and other groups that the public may wish to prioritize.
• Existing methods for incorporating fairness into economic evaluations are underdeveloped.

Purpose of the Study:

• To review the theory of economic evaluation and its limitations in reflecting social values.
• To present empirical evidence on population preferences regarding healthcare resource allocation.
• To argue for a fairness-focused framework in HTA that prioritizes patients over services.

Main Methods:

• Review of economic evaluation theory and its focus on individual utility and efficiency.
• Presentation of empirical evidence on population values and healthcare priorities.
• Analysis of four studies examining public preferences for resource allocation from a citizen's perspective.

Main Results:

• Economic evaluation theory, by focusing on utility and efficiency, omits crucial social values.
• Population preferences indicate a desire for a fairness-based approach to healthcare resource allocation.
• When adopting a citizen's perspective, individuals favor sharing the health budget to include non-cost-effective services, such as orphan medicinal products (OMPs) and treatments for ultra-rare diseases (URDs).

Conclusions:

• The current methodology of economic evaluation in HTA requires revision to better incorporate social values and fairness.
• A shift towards a patient-centered, fairness-focused framework is needed to align HTA with public preferences.
• Future methods should be developed to ensure equitable access to healthcare, particularly for patients with rare and ultra-rare diseases.