Page 51 - Htain Manual

W
hen framing a proposal for a health technology assessment, one needs to

be aware of the applicability of the study to the decision problem. This

awareness will enhance the validity of the conceptual model and would

increase use of the results for decision-making. First, the objective, the audience or the
intended users of the assessment, and the perspective of the analysis should be defined.

The main audience may be an user department allocating funds, but providers of that

particular service, hospital managers and even patients may also be supplementary users.

The costing perspective of the analysis could be only that of the patient which would

then focus on effectiveness, and reduction of out of pocket expenditure. It could be the

perspective of the provider which would also be concerned about efficiency in terms of

reducing the inputs costs - but not perhaps so concerned about out of pocket expenditure.

Or it could be societal costing perspective where both reduction of out of pocket expenditure,
and costs of care matter. Societal costing perspectives will also give greater weightage to

equity concerns.

Further, the population, intervention, and comparators need to be specified. By

population we mean the potential users of the services and their background charactereistics,
and intervention refers to the technology or programme being assessed. Comparators are

alternative ways of providing this service or implementing the programme. Comparators

chosen are often the technology or programme that is in use before the intervention is
introduced. If the intervention is addressing an unmet need than the comparator would be a

situation where there is no intervention. Or comparators may be a choice between two new

technologies vying for uptake by public services or public financing.

Further the research proposal must specify, the time horizon for the intervention and
its impact, the boundaries of the analysis, as also the type of analysis and cycle length.

Although sometimes it is inherent to evaluate the intervention against the standard practice,

this choice of a comparator is not made explicit as another technology might be taken up as

a comparator; provided the data on its clinical and cost-effectiveness is available and its use

is prevalent in the system.

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