Evaluation of Ethical Aspects Associated With Health Technology: Lessons Learnt from Indian HTA Reports

OBJECTIVES: Despite the potential of health technology assessment(HTA) to ensure distributive justice for access to health technology, ethical evaluation of health technology is not frequently seen exclusively in HTA reports. We reviewed the presence of ethical evaluations in Indian HTA studies.

METHODS: We critically studied ethics-specific sections from HTAs published on the website of the Indian government HTA body(HTAIn). Relevant information was then mapped with the principles of principlism, casuistry, and those delineated in the European network of the HTA core model. We disregarded reports mentioning only economic evaluation and technical details with no scope of ethical review. We assessed the presence of bioethicist's inputs in all HTA reports and reflections of ethical review of technologies on final HTA recommendations if any.

RESULTS: Of 10 included HTA studies, only three contained exclusive sections on equity issues. Except for the mention of safety data from secondary sources, we found a lack of terminology related to bioethics. Also, no studies used the expert opinion or participatory approach with primary data orientation to address ethical challenges. Policy recommendations in all studies directly followed the assessment findings with no deliberative processes. The majority of team members belonged from public health, health economics with limited to no experience regarding bioethics.

CONCLUSIONS: Our study showed an alarming fact of poor attention to ethical aspects in Indian HTA reports. Such lack of methodological rigor needs to be immediately addressed through the apriori involvement of bioethicists or professionals with similar experience to safeguard stakeholders’ rights and integrity.