TY - JOUR

T1 - We need to talk about values: a proposed framework for the articulation of normative reasoning in health technology assessment

AU - Charlton, Victoria

AU - diStefano, Michael

AU - Mitchell, Polly

AU - Morrell, Liz

AU - Rand, Leah

AU - Badano, Gabriele

AU - Baker, Rachel

AU - Calnan, Michael

AU - Chalkidou, Kalipso

AU - Culyer, Anthony

AU - Howden, Daniel

AU - Hughes, Dyfrig

AU - Lomas, James

AU - Max, Catherine

AU - McCabe, Christopher

AU - O'Mahony, James F.

AU - Paulden, Mike

AU - Pemberton-Whiteley, Zack

AU - Rid, Annette

AU - Scuffham, Paul

AU - Sculpher, Mark

AU - Shah, Koonal

AU - Weale, Albert

AU - Wester, Gry

PY - 2024/4

Y1 - 2024/4

N2 - It is acknowledged that health technology assessment (HTA) is an inherently value-based activity that makes use of normative reasoning alongside empirical evidence. But the language used to conceptualise and articulate HTA’s normative aspects is demonstrably unnuanced, imprecise and inconsistently employed, undermining transparency and preventing proper scrutiny of the rationales on which decisions are based. This paper – developed through a cross-disciplinary collaboration of 24 researchers with expertise in healthcare priority-setting – seeks to address this problem by offering a clear definition of key terms and distinguishing between the types of normative commitment invoked during HTA, thus providing a novel conceptual framework for the articulation of reasoning. Through application to a hypothetical case, it is illustrated how this framework can operate as a practical tool through which HTA practitioners and policymakers can enhance the transparency and coherence of their decision-making, while enabling others to hold them more easily to account. The framework is offered as a starting point for further discussion amongst those with a desire to enhance the legitimacy and fairness of HTA by facilitating practical public reasoning, in which decisions are made on behalf of the public, in public view, through a chain of reasoning that withstands ethical scrutiny.

AB - It is acknowledged that health technology assessment (HTA) is an inherently value-based activity that makes use of normative reasoning alongside empirical evidence. But the language used to conceptualise and articulate HTA’s normative aspects is demonstrably unnuanced, imprecise and inconsistently employed, undermining transparency and preventing proper scrutiny of the rationales on which decisions are based. This paper – developed through a cross-disciplinary collaboration of 24 researchers with expertise in healthcare priority-setting – seeks to address this problem by offering a clear definition of key terms and distinguishing between the types of normative commitment invoked during HTA, thus providing a novel conceptual framework for the articulation of reasoning. Through application to a hypothetical case, it is illustrated how this framework can operate as a practical tool through which HTA practitioners and policymakers can enhance the transparency and coherence of their decision-making, while enabling others to hold them more easily to account. The framework is offered as a starting point for further discussion amongst those with a desire to enhance the legitimacy and fairness of HTA by facilitating practical public reasoning, in which decisions are made on behalf of the public, in public view, through a chain of reasoning that withstands ethical scrutiny.

U2 - 10.1017/S1744133123000038

DO - 10.1017/S1744133123000038

M3 - Article

VL - 19

SP - 153

EP - 173

JO - Health Economics, Policy and Law

JF - Health Economics, Policy and Law

SN - 1744-1331

IS - 2

ER -