Exploring Collaboration on HTA Methodology for Medical Technologies in the Dutch ZonMw HTA Methodology 2021-2024 Subsidy Program

OBJECTIVES: The applicability of existing HTA methodology to medical technologies is disputed in scientific literature. In this study we explore different expectations around HTA methodology for medical technologies from researchers and policymakers. We explore the Dutch HTA methodology 2021-2024 program by ZonMw (the main Dutch health research funder) which engages with a diverse range of stakeholders in order to develop HTA methodology. We focus on the experiences and expectations of applicants and committee members of this particular subsidy program, aiming to draw conclusions on what this means for HTA and the governance of medical technologies more broadly.

METHODS: Our qualitative case-study consisted of interviews, observations, and document analysis. In total, 20 interviews with relevant subsidy program participants were held, including subsidy applicants and committee members. In addition, non-participant observations of relevant committee meetings were conducted, and documents related to the subsidy call were analyzed. Preliminary results were discussed with participants, after which final results are drafted.

RESULTS: The focus in the program is on input on HTA methodology from a wide range of stakeholders from the field, including health care financiers, health care providers, patient groups, and industry. Our results show the heterogeneity in expectations of the relevance and use of HTA for medical technologies. We underscore a dominant expectation from various stakeholders on a more practice oriented HTA for medical technologies, while at the same time laying bare the difficulties in changing the HTA paradigm to a more pragmatic approach.

CONCLUSIONS: This study reports on the different perspectives on HTA methodology for medical technologies from the program members, allowing us to reflect on who gets to decide what is relevant HTA and how HTA is translated between stakeholders with different backgrounds. The insights of our qualitative study can help stakeholders stimulate the development of appropriate evaluation methods for medical technology.