Lifecycle Approach: Coming Together to Make it Happen

Calls for a lifecycle approach to determine the value of medicines, devices and other health services have grown over recent years in response to the challenges of innovative and novel technologies, disconnected and disparate stakeholders and data requirements, public expectations and achieving patient-centric health systems. Lifecycle, here, refers to the lifecycle of health technologies. It conveys the idea that HTA needs to explore the value of health technologies from an early stage of development throughout their maturation, as various stakeholders go through the learning curve, indications shift, technological improvements transpire, or parallel developments render the technology obsolete. Such dynamics defy the notion that HTA could be a one-off undertaking.

A lifecycle approach may aim to support better reimbursement decisions and more appropriate use of health technologies while encouraging efficiencies. It could avoid the disconnects that may occur between stakeholders when health technologies are introduced in a linear or stepped process. As such, it has been suggested that a lifecycle approach should promote continuous dialogue and the exchange of knowledge between all stakeholders while ensuring that better outcomes for patients are central to the activities of HTA bodies as they meet their remits. But realization of this approach has been slow. 

Some HTA organizations have recently started to implement the lifecycle approach more actively in their daily practice. For instance, Health Technology Wales uses more explicitly the lifecycle approach for non-drug health technologies while others such as the Canadian Agency for Drugs and Technologies in Health refer to the lifecycle approach in their promotion of Health Technology Management or implement elements of a lifecycle approach such as regular reassessments in their (French) HTA program (Haute Autorité de Santé). The Dutch National Health Care Institute (ZIN), the local host for AM2022, has recently described an approach that links safeguarding quality, affordability, and accessibility of healthcare in the Netherlands to a lifecycle approach of HTA. This approach to HTA should be a central element to ensure the right choices regarding the reimbursement of health technologies including supporting appropriate use of health technologies. Finally, a lifecycle approach may also support a more active contribution to disinvestment of obsolete and/or non-effective health technologies. 

For the health technology assessment (HTA) community to transition and for individual HTA bodies to find their place in a more proactive, global ecosystem that considers whole system value, key questions must be urgently addressed with stakeholders across the lifecycle. Main questions are:  

  • What are the implications for the position and role of HTA in healthcare decision-making at a global level and potential for HTA bodies to participate across the whole lifecycle of health technologies? 
  • How does a lifecycle approach to HTA contribute to legitimacy, relevance, and public confidence in healthcare decision-making? 
  • What are the implications of taking a lifecycle approach for setting HTA priorities and ensuring sustainability of the HTA process?
  • How can unmet medical need influence HTA priority setting, and which elements of unmet medical need should be considered? 
  • What does effective and efficient integration of stakeholder perspectives look like in a lifecycle approach? 
  • What are best practices in terms of interaction between different healthcare authorities and how do they perceive different types of evidence over the lifecycle of health technologies? 
  • How do other stakeholders such as innovators and patients feel this interaction between healthcare authorities and what improvements do they seek? 

Building on initiatives from a variety of HTA bodies and previous HTAi Annual Meeting and Policy Forum, the HTAi 2022 Annual Meeting will offer a global platform to deepen awareness of the consequences of a lifecycle approach to HTA from pre-market, market approval, post-market and disinvestment; improve knowledge of suitable methods and processes; strengthen connections across stakeholders; and prioritize activities. 

HTAi invites those with an interest in finding answers to these challenges to come together to make a lifecycle approach happen when HTAi 2022 Annual Meeting is held in Utrecht and virtually, on June 25- 29, 2022.