Presentation (CTI)

OBJECTIVES: HTA has devoted substantial attention to technologies that deliver health gains at additional cost. That emphasis was reasonable in periods of fiscal expansion. In many European countries, however, fiscal space is tightening as demographic aging increases pressure on pension and other age-related entitlements, while defense pressures also rise, leaving less room for health. Using the HTA glossary definition of technology, including tests, devices, medicines, vaccines, procedures, programs, and systems, we argue that HTA should rebalance its attention toward technologies that generate cost offsets, preserve capacity, or enable resource reallocation.
METHODS: We propose an attention-allocation framework for tracking HTA attention distribution across the value plane. The framework is illustrated using INAHTA examples from selected European countries, showing how attention has been distributed across technology types over time. The key conceptual gap is the imbalance in HTA attention, which remains concentrated in the upper-right quadrant and continues to dominate the agenda. The framework is intended to inform future work on how agencies could allocate evaluative effort more deliberately across the full range of health technology.
RESULTS: In the current fiscal environment, technologies that reduce downstream spending, reduce low-value utilization, shorten care pathways, or release capacity may create substantial value even when their primary effect is not additional health gain. Overconcentration on upper-right quadrant technologies may crowd out interventions that improve efficiency, access, and sustainability across the care pathway. Vaccines, digital health, diagnostic tests, system redesign, and other resource-preserving technologies may warrant more systematic attention.
CONCLUSIONS: HTA agencies in Europe should examine whether current evaluative attention appropriately reflects the full spectrum of health technology, including technologies that generate cost offsets, preserve capacity, or enable resource reallocation. Further work is needed to operationalize this framework, identify barriers to broader assessment of such technologies, and explore how those barriers could be overcome.