rethinking HTA: do we need a patient centric framework

Health Technology Assessment (HTA) is often described as a neutral, evidence based process designed to support fair and efficient healthcare decision making. HTA is a structured, evidence based process that defines and operationalizes value through specific metrics, and those metrics systematically exclude or underweight certain dimensions of value that matter to patients.

The central problem is not just that patients are absent from HTA.It is that value itself is narrowly defined. And value is narrowly defined because patients are not meaningfully integrated. Without patients, critical dimensions of value cannot be seen, measured, or understood.

Today, value in HTA is still predominantly expressed as an economic function- incremental cost effectiveness ratios (ICERs), budget impact, and quality adjusted life years (QALYs). These tools offer comparability, but they also impose a constrained understanding of what counts — and what does not.

This raises a fundamental question that current frameworks do not adequately answer:

Is value only an economic calculation, or is it also shaped by patient needs, goals, unmet needs, and lived realities?

When Value Ignores Unmet Need

From a patient perspective, value is inseparable from unmet need.Yet unmet need is often interpreted narrowly — as a lack of therapeutic alternatives — rather than as a lived condition shaped by delayed diagnosis, limited access, treatment burden, or inequitable care pathways.

Patients do not experience disease as an abstract clinical state. They experience it as

• time lost waiting for diagnosis

• functional decline while navigating access barriers

• financial and caregiver strain

• psychological burden from uncertainty and delay

If these dimensions are not explicitly considered in how value is defined, then HTA risks endorsing decisions that are economically rational yet humanly misaligned.

A Drug Has No Value If It Cannot Reach Patients

One of the most striking omissions in current value frameworks is delay to access.

HTA may determine that a therapy provides value to a health system on paper — yet if that therapy takes years to reach patients, its real world value approaches zero. For patients with progressive or life limiting conditions, time is not a secondary consideration. It is the outcome.

Yet delays caused by fragmented diagnostics, reimbursement lag, or jurisdictional variation are rarely incorporated into value discussions in a structured way. The system evaluates technologies as if access were instantaneous, when patients know it is anything but.

Where Are Social Determinants of Health in Value Assessment?

HTA frameworks frequently claim to consider equity, yet social determinants of health remain poorly operationalized within value assessment.

Factors such as income, geography, gender, race, education, and social support directly influence:

• who gets diagnosed

• who accesses innovation

• who benefits from treatment

• who bears disproportionate burden

If value is assessed without accounting for these realities, HTA may inadvertently reinforce — rather than mitigate — inequities.

Patient centricity, in this context, is not about adding 'equity language' to submissions. It is about asking whether value assessments reflect the conditions under which patients actually live and receive care.

The Real Question HTA Must Answer

The challenge before HTA is not how to better 'include' patients but how to integrate them into a process that has historically been designed without them—where patient perspectives are treated as an input, rather than as a core component of value definition and deliberation.

Whose definition of value governs access to care?

If value continues to be defined primarily by economic efficiency, patient experience will remain peripheral — regardless of how many engagement mechanisms exist.

If, however, value is reconceptualized as multidimensional — shaped by unmet need, timeliness, lived experience, and social context — then patient centricity becomes foundational rather than supplemental.

A Call to Rethink Value — Together

This is why the cancer collaborative has launched a global survey on patient centric frameworks in HTA. The goal is not to critique individual agencies, but to examine how value is currently defined, operationalized, and experienced across systems — and to ask whether existing frameworks are fit for today’s realities.

We are asking:

• How is value actually understood in HTA today?

• Are patient goals, unmet needs, and delays to access meaningfully reflected?

• How — if at all — are social determinants of health incorporated into value assessment?

• Where do current frameworks fall short, and why?

If we want HTA decisions to be legitimate, trusted, and responsive, we must first be honest about what our value frameworks reward — and what they overlook.

👉 Participate in the survey

👉 Share your perspective on how value should be defined

👉 Want to be involved in shaping patient centric HTA frameworks email us at hello@cancercolab