Value Judgments in HTA: are we still living the cartesian angst?

In a recent study published in the International Journal of Technology Assessment in Health Care, researchers question how the value judgments impact the conduct of health technology assessments (HTA).

 

Entitled “Revealing and Acknowledging Value Judgements in HTA” was a study conducted by Professor Bjørn Hofmann’s group during a workshop on methodology in ethics for HTA in Cologne-Germany, in January 2012. Different international experts in applying this methodology in health technologies gathered and presented their experiences on how value issues were recognized and managed. They aimed to identify the value judgments and its corresponding role in the validity of the results in HTA.

 

The importance of this study is ratified by the results of Dr. Luis Arellano’s group, which found that 90% of 104 specialists in HTA -which had publications between the years 2005 and 2007- recognized that decisions in health care involve value judgments and that, in fact, the ethical analysis in HTA is an important process. Nevertheless, it was still unclear for them to define what is the real role of value judgments in this context.

 

Allied to this factor, the idea of acknowledging such influence of said value judgments, supposedly threatens the basic principle of the scientific objectivity of HTA, making it subjective, relative and unreliable; the so-called “Cartesian Angst”. However, Hofmann et al demonstrate that value judgments are linked to crucial stages of HTA and also emphasizes that making them explicit can promote a more transparent and reliable assessment, as well as lead to a more effective and robust decision-making.

 

They defined that value judgments consist on the evaluation of what would be considered “appropriate”. Applying this concept to HTA, it can be identified that the process involves the employment of appropriate scientific methods, aiming good clinical outcomes and morally appropriate in order to facilitate socially acceptable decisions, at bearable costs. Throughout this process permeates moral, methodological, legal, social and economic value judgments.

 
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