No Value Without Equity: Transforming Power, People and Process for Equity in Health Technology Assessment

OBJECTIVES: U.S. healthcare systems have identified health disparities and inequities as significant factors contributing to poor health outcomes. To be relevant in shifting decision-making contexts, Health Technology Assessment (HTA) must consider health disparities and/or account for inequity. This research identifies accountability actions important for integrating equity throughout HTA practice and defines the diverse stakeholders' roles in achieving equity-centered HTA.

METHODS: IVI engaged stakeholders through qualitative methods including key informant interviews, expert roundtables, and its Methods Summit to identify actionable changes to ensure accountability in HTA for identifying health disparities and addressing equity. IVI developed a comprehensive HTA equity framework that addresses four key domains for necessary shifts in HTA practice: Power, People, and Processes; Data and Inputs; Methods; and Communications and Use.

RESULTS: Stakeholders prioritized actions in the Power, People and Processes domain of the IVI Health Equity framework, emphasizing the foundational changes needed for equity-centered HTA. This includes recognizing patients and caregivers as equal partners in HTA, prioritizing representation from marginalized communities, acknowledging and compensating patient and caregiver contributions, and diversifying the HTA workforce. The results also highlight the accountability actions necessary for key stakeholders, including researchers, patients and caregivers, professional association leaders, journal editors, research sponsors, and payers and purchasers, to drive lasting practice changes.

CONCLUSIONS: A systematic, multi-domain approach to incorporating equity considerations into HTA is needed to ensure equitable and patient-centered decision-making. Changes in the people involved and processes used in HTA will be required by all stakeholders, to ensure alignment with the goals of U.S. healthcare decision-makers.