SCIENTIFIC CONTRIBUTION Health technology assessment (HTA): ethical aspects Dario Sacchini Andrea Virdis Pietro Refolo Maddalena Pennacchini Ignacio Carrasco de Paula Published online: 9 June 2009 Ó Springer Science+Business Media B.V. 2009 Abstract ‘‘HTA is a multidisciplinary process that sum- marizes information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner. Its aim is to inform the formulation of safe, effective, health policies that are patient focused, and seek to achieve best value’’ (EUnetHTA 2007). Even though the assessment of ethical aspects of a health technology is listed as one of the objectives of a HTA process, in practice, the integration of these dimensions into reports remains limited. The article is focused on four points: 1. the HTA concept; 2. the dif- ficult HTA-ethics relationship; 3. the ethical issues in HTA; 4. the methods for integrating ethical analysis into HTA. Keywords Technology Á Health technology assessment Á Ethics Á Health policy Introduction During the last four decades, technological innovation has undoubtedly yielded significant advances in health care. Breakthroughs in areas such as biotechnology, antivirals, surgical techniques, molecular diagnostics, diagnostic imaging, organ and tissue replacement, wound care, com- puter technology, etc. have helped to improve health care delivery and patient outcomes (Goodman 2004, pp. 9–10). As a first step, it could be useful to bear in mind that the expression ‘health technology’ does not refer just to med- ical technology. In fact, according to the Health Technol- ogy Assessment (HTA) Glossary, edited in 2006 by the International Network of Agencies for Health Technology Assessment (INAHTA), ‘‘it covers a wide range of meth- ods of intervening to promote health, including the pre- vention, diagnosing or treatment of disease, the rehabilitation or long-term care of patients, as well as drugs, devices, clinical procedures and healthcare settings’’ (INAHTA 2006). A rapid introduction and diffusion of technologies within healthcare systems has followed the technological innova- tion. For example, in the United States, the coronary bypass surgeries realized in non-federal hospitals were 53,000 in 1974, 137,000 in 1980, 284,000 in 1986 and so on, with a continuous diffusion during the years (Preston 1989). The diffusion of health technologies has accompanied burgeoning health care expenditure, and the first has been generally considered as a ‘culprit’ for the second, although nature and development of this relationship are complex and evolving (Vanara 1998; Lucioni 1986). In this age of increasing cost pressures, restructuring of health care delivery and payment, and continued inade- quate access to care for many millions of people around the world, technology is—as CÁS. Goodman has highlighted— the ‘substance’ of health care (Goodman 2004). The use and implementation of technology is increas- ingly mediated by a widening group of policy-makers in the health care sector. In fact, health product makers, cli- nicians, patients, hospital managers, payers, political leaders and others increasingly demand well-founded information to support decisions about whether or how to implement technology, to allow it on the market, to acquire it, to pay for its use, and so on. D. Sacchini (&) Á A. Virdis Á P. Refolo Á M. Pennacchini Á I. Carrasco de Paula Institute of Bioethics, ‘‘A. Gemelli’’ School of Medicine, Universita ` Cattolica del Sacro Cuore, Largo F. Vito, 1, 00168 Rome, Italy e-mail: dsacchini@rm.unicatt.it 123 Med Health Care and Philos (2009) 12:453–457 DOI 10.1007/s11019-009-9206-y