Scielo RSS <![CDATA[Revista médica de Chile]]> vol. 142 num. lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>Evaluación</b><b> de Tecnologías Sanitarias</b>]]> <![CDATA[<strong>Evaluación de Tecnologías Sanitarias</strong>: <strong>marco conceptual y perspectiva global</strong>]]> The increasing concerns of nations to improve efficiency, access and quality of health care, have encouraged a more appropriate use of health interventions. Thus, the interest of clinicians and decision-makers has shifted towards evidence-based medicine, comparative effectiveness research and health technology assessment (HTA). Although these concepts should not be understood as synonyms, they converge on common characteristics: a systematic approach to evidence, the focus on relevant outcomes for the patient, and the notion that policy-making for a group of patients will affect others. As a consequence, concerns not only involve efficiency and effectiveness, but also transparency, clinical practice and opportunity costs. This paper introduces the concept and processes of HTA in the first and second sections. Section three reviews the evolution of HTA in developed and Latin-American countries, analyzing the aspects that influence the structure and scope of HTA. The last section concludes with reflections on the challenges to implement HTA in Chile. <![CDATA[<strong>Principales aspectos metodológicos en la Evaluación de Tecnologías Sanitarias</strong>]]> This article reviews the most relevant methodological aspects involved in Health Technology Assessment (HTA). Firstly, it addresses the process of defining the research problem (or scoping). Then it explains some specific aspects of systematic reviews of evidence, as well as indirect and mixed comparisons of the effectiveness of interventions. It covers also the methods for economic evaluation in healthcare and the budget impact analysis of interventions. Finally, the paper provides an empirical insight on the methodological emphasis used by HTA agencies around the world, and reflects on the available capacities in our country in the topics discussed. <![CDATA[<strong>Determinación de prioridades para la evaluación de tecnologías sanitarias</strong>]]> The aim of this article is to analyze the different approaches of priority setting for health technology assessments (HTA). First, the paper identifies the reasons that make necessary to establish priorities and its importance for the success of the HTA models. Second, it studies the main stages that consider the determination of priorities based on the analysis of the models currently used by HTA agencies of developed countries. In the third place, the article describes the different criteria, methods of scoring and deliberation bodies included in the mechanism of priority setting of those agencies. Finally, the paper concludes mentioning lessons from the international experience that potentially can be an input for the design of a model of priority setting for HTA in our country. <![CDATA[<strong>Participación ciudadana en el contexto de la evaluación de tecnologías sanitarias</strong>]]> Citizen participation is important in all economic sectors of the democratic world, as it is also in the field of health. This is due to the significant value of life and therefore enjoying this in a healthy condition. This paper seeks to provide an overview of public participation in the context of Health Technology Assessments (HTA), covering from conceptualization to practical experiences. Within the existing literature, the definitions and methodological aspects of the topic discussed are reviewed, as well as how citizen participation in HTA agencies is manifested, presenting barriers as well as enablers for public involvement. In the Chilean case, where there are no public participation experiences in the context of HTA, a review of these initiatives in the health care sector is performed. In light with the studies examined, it is concluded that there is much to advance in the concreteness of citizen participation in HTA's agencies; efforts at institutional level as well as from community organizations are needed. This review can be useful as an antecedent for countries that are considering incorporating HTA in the future. <![CDATA[<strong>Evaluación de Tecnología Sanitaria y su impacto en políticas de tarificación y cobertura de medicamentos</strong>]]> The article conceptualizes the pharmaceutical pricing and reimbursement policies related to financial coverage in the context of health systems. It introduces the pharmaceutical market as an imperfect one, in which appropriate regulation is required. Moreover, the basis that guide the pricing and reimbursement processes are defined and described in order to generate a categorization based on whether they are intended to assess the 'added value' and if the evaluation is based on cost-effectiveness criteria. This framework is used to review different types of these policies applied in the international context, discussing the role of the Health Technology Assessment in these processes. Finally, it briefly discusses the potential role of these types of policies in the Chilean context. <![CDATA[<strong>La investigación en salud y la evaluación de tecnologías sanitarias en Chile</strong>]]> Health research is considered an essential element for the improvement of population health and it has been recommended that a share of the national health budget should be allocated to develop this field. Chile has undertaken efforts in the last decades in order to improve the governmental structure created to promote the development of health research, which has increased human resources and funding opportunities. On the other hand, the sustained economic growth of Chile in the last decades suggests that the health expenditure will maintain its increasing trend in the following years. This additional funding could be used to improve coverage of current activities performed in the health system, but also to address the incorporation of new strategies. More recently, health technology assessment (HTA) has been proposed as a process to support decisions about allocation of resources based on scientific evidence. This paper examines the relationship between the development of health research and the HTA process. First, it presents a brief diagnosis of the situation of health research in Chile. Second, it reviews the conceptual basis and the methods that account for the relationship between a HTA process and the development of health research. In particular, it emphasizes the relevance of identifying information gaps where funding additional research can be considered a good use of public resources. Finally, it discusses the challenges and possible courses of action that Chile could take in order to guarantee the continuous improvement of an articulated structure for health research and HTA. <![CDATA[<strong>Equidad en Salud y Evaluación de Tecnologías Sanitarias en Chile</strong>]]> Equity has been recognized as one of the driving principles of many health systems in the world. In Latin America, Chile has led the explicit inclusion of equity in their health policies, which is reflected in its recent health reform. On the other hand, Chile faces the challenge of defining and implementing a policy for health technology assessment (HTA), which should be consistent with the equity principles that underlie the Chilean national health system. This paper reviews the equity concept emphasizing the relevance of socioeconomic inequalities. Furthermore, it examines how international HTA agencies have explicitly included this element in the evaluation and decision processes. It presents the English case, which highlights the elements of procedural justice rather than adopting a normative position regarding equity. Finally, it examines the methods that have been developed aiming to make explicit consideration of equity in HTA. It concludes that the methodological development to incorporate equity elements with empirical basis is recent and limited. The consideration of equity is, in most of the cases, left to the instances of deliberative participation. <![CDATA[<strong>Fundamentos para la Institucionalización de la Evaluación de Tecnologías Sanitarias en Chile</strong>]]> The Chilean health system has not been completely oblivious to health technology assessment (HTA). In fact, significant advances in the areas of health prioritization using criteria of disease burden, effectiveness and cost-effectiveness among others, can be acknowledged. The introduction of the reform of Explicit Health Guarantees (GES) has been an important milestone in this arena, allowing the consideration of other dimensions such as social preferences in health. However, the application of HTA encompasses the entire health system and in that sense the institutionalization of a process properly defined and extensively validated in our country, is imminent. This paper discusses the foundations on which progress must be made in institutionalizing HTA, starting from the architecture of our health care system and in light of the economic and social reality. We review some background information first, and then discuss some important considerations in our context, including information on the institutional and legal framework. It concludes with the authors' view on some key elements to consider in HTA in Chile, which does not necessarily represent the vision of the Ministry of Health.