Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-23T20:27:25.706Z Has data issue: false hasContentIssue false
  • English
  • Français

Development of a checklist to guide equity considerations in health technology assessment

Part of: Special Collection - Methods

Published online by Cambridge University Press:  25 January 2021

Maria Benkhalti Open the ORCID record for Maria Benkhalti [Opens in a new window] ,
Manuel Espinoza ,
Richard Cookson ,
Vivian Welch ,
Peter Tugwell  and
Pierre Dagenais Open the ORCID record for Pierre Dagenais [Opens in a new window]
Maria Benkhalti*
Affiliation:
Unité d’évaluation des technologies et des modes d'intervention en santé et services sociaux (UETMISSS), CIUSSS de l'Estrie – CHUS, Sherbrooke, Quebec, Canada J1G 2E8 Faculty of Medicine and Health Sciences, Université de Sherbrooke, 1036 Belvédère Street, Sherbrooke, Quebec, CanadaJ1H 4C4
Manuel Espinoza
Affiliation:
Department of Public Health, Health Technology Assessment Unit, Centre for Clinical Research, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
Richard Cookson
Affiliation:
Centre for Health Economics, University of York, York, UK
Vivian Welch
Affiliation:
Bruyere Research Institute, Ottawa, Canada School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
Peter Tugwell
Affiliation:
Bruyere Research Institute, Ottawa, Canada Faculty of Medicine, University of Ottawa, Ottawa, Canada
Pierre Dagenais
Affiliation:
Unité d’évaluation des technologies et des modes d'intervention en santé et services sociaux (UETMISSS), CIUSSS de l'Estrie – CHUS, Sherbrooke, Quebec, Canada J1G 2E8 Faculty of Medicine and Health Sciences, Université de Sherbrooke, 1036 Belvédère Street, Sherbrooke, Quebec, CanadaJ1H 4C4
*
Author for correspondence: Maria Benkhalti, E-mail: maria.benkhalti.ciussse-chus@ssss.gouv.qc.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

Health technology assessment (HTA) can impact health inequities by informing healthcare priority-setting decisions. This paper presents a novel checklist to guide HTA practitioners looking to include equity considerations in their work: the equity checklist for HTA (ECHTA). The list is pragmatically organized according to the generic HTA phases and can be consulted at each step.

Methods

A first set of items was based on the framework for equity in HTA developed by Culyer and Bombard. After rewording and reorganizing according to five HTA phases, they were complemented by elements emerging from a literature search. Consultations with method experts, decision makers, and stakeholders further refined the items. Further feedback was sought during a presentation of the tool at an international HTA conference. Lastly, the checklist was piloted through all five stages of an HTA.

Results

ECHTA proposes elements to be considered at each one of the five HTA phases: Scoping, Evaluation, Recommendations and Conclusions, Knowledge Translation and Implementation, and Reassessment. More than a simple checklist, the tool provides details and examples that guide the evaluators through an analysis in each phase. A pilot test is also presented, which demonstrates the ECHTA's usability and added value.

Conclusions

ECHTA provides guidance for HTA evaluators wishing to ensure that their conclusions do not contribute to inequalities in health. Several points to build upon the current checklist will be addressed by a working group of experts, and further feedback is welcome from evaluators who have used the tool.

Keywords

EquityHealth technology assessmentHealth disparity
Type
Method
Information
International Journal of Technology Assessment in Health Care , Volume 37 , Issue 1 , 2021 , e17
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Canadian Institutes of Health Research [Internet]. Equity and diversity questionnaire for applicants. 2020 [cited 2020 Apr 28]. Available from: https://cihr-irsc.gc.ca/e/50956.html.Google Scholar
Bellemare, C, Dagenais, P, Suzanne, K-B, Béland, J-P, Bernier, L, Daniel, C-É, et al. Integration of ethics in health technology assessment: A systematic review. Int J Technol Assess Heal Care. 2018;24:447–57.CrossRefGoogle Scholar
World Health Organization. 2015 Global survey on health technology assessment by national authorities. Main findings. Geneva: WHO; 2015.Google Scholar
Marmot, M, Friel, S, Bell, R, Houweling, T, Taylor, S. Commission on social determinants of health. Closing the gap in a generation: Health equity through action on the social determinants of health. Lancet. 2008;372:1661–8.CrossRefGoogle Scholar
CSDH. Closing the gap in a generation: Health equity through action on the social determinants of health. Final report of the commission on social determinants of health. Geneva: WHO; 2008.Google Scholar
Whitehead, M. The concepts and principles of equity and health. Int J Heal Serv. 1992;22:429–45.CrossRefGoogle ScholarPubMed
Braveman, P, Arkin, E, Orleans, T, Proctor, D, Plough, A. What is health equity? And what difference does a definition make? Princeton, NJ: Robert Wood Johnson Foundation; 2017.Google Scholar
Friedman, E. Health equity programs of action: An implementation framework. Washington (DC): O'Neil Institute for National and Global Health Law; 2019.Google Scholar
Welch, AV, Petkovic, J, Jull, J, Hartling, L, Klassen, T, Pardo, JP, et al. Chapter 16: Equity and specific populations. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.1 (updated September 2020). London, UK: Cochrane; 2020.Google Scholar
Hopkins, P. Social geography I: Intersectionality. Prog Hum Geogr. 2019;43:937–47.CrossRefGoogle Scholar
Culyer, AJ, Bombard, Y. An equity framework for health technology assessments. Med Decis Mak. 2012;32:428–41.CrossRefGoogle ScholarPubMed
Norheim, OF, Baltussen, R, Johri, M, Chisholm, D, Nord, E, Brock, D, et al. Guidance on priority setting in health care (GPS-Health): The inclusion of equity criteria not captured by cost-effectiveness analysis. Cost Eff Resour Alloc. 2014;12:1–8.CrossRefGoogle Scholar
Cookson, R, Griffin, S, Norheim, OF, Culyer, A, editors. Distributional cost-effectiveness analysis: Quantifying health equity impacts and trade-offs. Oxford, UK: Oxford University Press; 2020.CrossRefGoogle Scholar
Cookson, R, Mirelman, AJ, Grif, S, Asaria, M, Dawkins, B, Norheim, OF, et al. Using cost-effectiveness analysis to address health equity concerns. Value Heal. 2017;20:206–12.CrossRefGoogle ScholarPubMed
WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity [Internet]. Equity-oriented toolkit for HTA. 2008 [cited 2020 Jan 24]. Available from: http://www.cgh.uottawa.ca/whocc/projects/eo_toolkit/index.htm.Google Scholar
Bennett, K, Tugwell, P. Iterative loop gives framework for assessing technology. Dimens Heal Serv. 1986;63:68–71.Google ScholarPubMed
Mahoney, M, Simpson, S, Harris, E, Aldrich, R-M, Williams, JS. Equity-focused health impact assessment framework. Newcastle, Australia: The Australian Collaboration for Health Equity Impact Assessment; 2004.Google Scholar
Espinoza, MA, Cabieses, B. Equidad en Salud y Evaluación de Tecnologías Sanitarias en Chile. Rev Med Chile. 2014;142:S45–9.CrossRefGoogle Scholar
Love-koh, J, Griffin, S, Kataika, E, Revill, P, Sibandze, S, Walker, S. Methods to promote equity in health resource allocation in low- and middle-income countries: An overview. Glob Heal. 2020;16:6.CrossRefGoogle ScholarPubMed
Lobè, C, Brassard, J, Fournier, M, Renaud, J, Dagenais, P. Cadre, processus et méthodes pour la réalisation du guide méthodologique d’élaboration et d'adaptation des guides de pratique. Quebec, Qc: INESSS; 2017 10p. Available from: https://www.inesss.qc.ca/fileadmin/doc/INESSS/DocuMetho/INESSS_Normes_production_revues_systematiques.pdfGoogle Scholar
Panteli, D, Kreis, J, Busse, R. Considering equity in health technology assessment: An exploratory analysis of agency practices. Int J Technol Assess Health Care. 2015;31:314–23.CrossRefGoogle ScholarPubMed
Hofmann, B. Toward a procedure for integrating moral issues in health technology. Int J Technol Assess Health Care. 2005;3:312–8.CrossRefGoogle Scholar
Health Quality Ontario. Health technology assessments: Methods and process guide, version 2.0. Toronto, ON: Queen's Printer for Ontario; 2018 66p. Available from: http://www.hqontario.ca/Evidence-to-Improve-Care/Health-Technology-Assessment/Ontario-Health-Technology-Advisory-CommitteeGoogle Scholar
Thomas, D. A general inductive approach for analyzing qualitative evaluation data. Am J Eval. 2006;27:237–46.CrossRefGoogle Scholar
Benkhalti, M, Dagenais, P. A preliminary HTA equity checklist to support the HTA process. Int J Technol Assess Health Care. 2019;35:94.CrossRefGoogle Scholar
Benkhalti, M, Dagenais, P, Poder, T, Carroll, M-S. Infiltrations de corticostéroïdes, autres traitements et modes de prise en charge pour la douleur chronique musculosquelettique lombosacrée d'origine non-cancéreuse [Internet]. Sherbrooke; 2019. Available from: https://www.santeestrie.qc.ca/clients/SanteEstrie/Professionnels/UETMISSS/2019/Infiltration_de_corticosteroides_vol_1_2019-10-01.pdfGoogle Scholar
Street, J, Stafinski, T, Lopes, E, Menon, D. Defining the role of the public in Health Technology Assessment (HTA) and HTA-informed decision-making processes. Int J Technol Assess Health Care. 2020;36:87–95.CrossRefGoogle ScholarPubMed