Health Economics & Outcome Research: Open Access

An Empirical Examination of Different Methodologies for Ethical Analysis in Health Technology Assessment

Dabra Watson^{* *}Correspondence: Dabra Watson, Editorial office, Health Economics and Outcome Research, Brussels, Belgium, Email:

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Introduction

Despite progress in developing ethical frameworks for Health Technology Assessment (HTA), there is no clear agreement on the breadth and details of a practical strategy for addressing ethical issues in HTA. The goal of this systematic research was to find existing guidance guides for incorporating ethics into HTA and provide an overview of their methodological features. The study discovered 43 conceptual frameworks or practical recommendations, each with its philosophical approach, structure, and scope. They were created for a variety of objectives across the HTA process, from assisting HTA producers in identifying, appraising, and analyzing ethical data to assisting decision-makers in making value-sensitive decisions. They typically advocated for the use of analytical methodologies that integrated normative reflection with participatory procedures. The context in which technology is being evaluated, the aim of analysis, and the availability of essential resources all appear to influence the approach used to gather and analyze ethical data. In global healthcare settings, the integration of health technology innovation is quickly rising. Theoretically, there are good reasons to include ethics in Health Technology Evaluations (HTA). Technologies and HTAs are never implemented in a vacuum, but rather in the framework of a social and value system. For a variety of reasons, including ethical analysis in HTA can help to account for this and improve its utility. The use of new technologies in health care can have moral ramifications. Technologies bring with them ideas that have the potential to disrupt society's established norms and attitudes. During the assessment process, every HTA necessitates numerous value judgments. Finally, because it usually attempts to improve health care and healthcare decision-making, the entire HTA can be viewed as a value-laden enterprise. These arguments demonstrate that the role of ethics in HTA is not confined to analyzing implementation effects and improving health decision-making. Ethics can also look into the meanings of technology and explain and defend the HTA's normative structure. In practice, however, ethical considerations are still absent from the vast majority of HTAs. One of the underlying rationales for this research is that there is a dearth of understanding of the existing methodologies and, in particular, their relative features. In the field of ethics, there is no shortage of ways. On the contrary, a variety of ways are in use, all of which are warmly supported by their creators and users. However, there is no agreement on which methods are the most effective. There is little evidence that incorporating ethics will improve the effectiveness of HTA outcomes in practice. It would be difficult to develop research that would demonstrate the benefits of including ethics. As a result, it appears that this case for integrating ethics is speculative. It is, however, no more speculative than the first case for using HTA. That is, both HTA and HTA ethics are driven by health policy decisions rather than empirical evidence of efficacy. Another criticism of the efficiency argument is that it assumes a utilitarian view of ethics.

Health Technology Assessment

It lowers ethics to a handmaiden and normative technology. However, just as HTA can't be reduced to a simple decision-making tool for health policy, ethics can't be reduced to a normative instrument for improving HTA efficiency. However, there is a scarcity of studies on the elements that influence technology adoption intentions. On this note, it's become critical to examine and comprehend the complicated aspects that influence practitioners' technology adoption plans. We offer a methodology to empirically explore technology acceptance and its efficacy in pushing universal health coverage, mediated by electronic health technology, based on the Technology Acceptance Model and the Institutional Theory. To empirically test the model, we gathered data from 416 healthcare professionals. The study discovered that perceived ease of use and necessary technical infrastructure all have a substantial positive link with universal health coverage, using the Structural Equation Modeling technique. However, universal health coverage was found to have a negative association with perceived usefulness, management support, and proper practitioner training. The findings also demonstrated that electronic health technology had a favorable link with perceived ease of use, perceived utility, management support, proper practitioner training, and applicable technical infrastructure. Furthermore, electronic health technology was discovered to have a substantial association with universal health coverage as a mediator. The findings' ramifications are examined, and recommendations for future research are then made. Since the 1970s, when HTA was at its peak, it has been suggested that ethics should be a component of the process. Despite repeated promises for more than 30 years, only a small percentage of HTA reports include ethical analysis, and there is little agreement on how to integrate ethics. This begs the question: why is it so critical to incorporate ethics into HTA? The paper examines ten arguments in favor of including ethics in HTA. The arguments' validity is contingent on our definitions of "integration," "ethics," and "HTA." Some of the counterarguments explain why integrating ethics into HTA has taken so long and why there are so many different ethical approaches. Nonetheless, some of the arguments in favor of including ethics in HTA appear to be persuasive. The massive potential of technology raises complicated moral dilemmas in the field of health care. Reflection on these moral dimensions would be part of a comprehensive appraisal of technology. Ethics allows for this kind of moral reflection. Human health technology is a way to make people's lives better. This raises ethical considerations about what constitutes "the good life." Ignoring such considerations could jeopardize the moral foundation of health care: to assist people. Furthermore, HTA is a form of appraisal, and as such, a reflection on values. As a result, there is a strong link between HTA and ethics. As a result, ethics cannot be "integrated" into HTA because ethics is already a fundamental component of HTA. Ethics, on the other hand, can be recognized and reinforced. The need of including ethics in the Health Technology Assessment (HTA) process is becoming more widely recognized. This need stems from the realization that addressing moral and ethical problems in the HTA process will improve transparency and accountability, resulting in better-informed healthcare decisions. As a result, in addition to the outcomes of clinical and economic evaluations in HTA, producers, and decision-makers are becoming increasingly interested in contextual normative issues and value judgments.

Despite its significance, including ethical considerations in HTA is difficult for a variety of reasons. The variety of ethical procedures that HTA practitioners must understand to use them effectively is one of the most significant problems. According to our systematic review of existing guidance documents for ethical analysis in HTA, the methods proposed to address ethical issues differ significantly in terms of philosophical approach, structure, and comprehensiveness, and there is no "one right way" to evaluate ethical considerations around healthcare technologies. Another issue is that HTA agencies frequently fail to implement existing ethical guidance documents because most of them are complex and require expertise, time, and other resources that are not always available within their organizations. Ethics evaluations were often undertaken by individual, mostly external, ethicists or multi-disciplinary teams including ethicists in just 15% of the participating international HTA agencies, according to a recent study of worldwide HTA agencies. When it came to conducting ethical evaluations, the majority of the studied HTA organizations used nonethicist HTA personnel. The basic goal of HTA is to help people make better healthcare decisions. This is a normative issue since the goal of health care is moral, the appraisal of its means is normative, and the methods themselves are normative, yet decision-making has its norms, such as political (re-election) and organizational norms. Ethics can help people think about these concerns and bridge the gap be--ween Parliamentary Technology Assessment (PTA) and Health Technology Assessment (HTA). HTA has been dominated by a "clinical perspective" and has lacked PTA's "societal perspective," which appears to be crucial in decision-making. Addressing the normativity of decision-making would also make HTA more in line with the process of implementing technology in practice: integrating social negotiation, actor placement, interactive technology definition and resolution, and addressing the heterogeneity of technology.