Item – Theses Canada

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OCLC number
1032930159
Link(s) to full text
LAC copy
LAC copy
Author
Stoklosa, Anna.
Title
The Concept of Evidence in Health Technology Assessment (HTA).
Degree
(PhD)--University of Toronto, 2013.
Publisher
Toronto : University of Toronto, 2013.
Description
1 online resource
Notes
Includes bibliographical references.
Abstract
This dissertation aims to make four contributions to knowledge. First, unlike other fields (e.g. science, medicine, etc.), the field of health technology assessment (HTA), has not thus far greatly benefited from a conceptually rigorous, philosophical analysis. Thus, the overall, and first, contribution of this dissertation is to begin to fill in some of this gap. Second, because cross-jurisdictional comparisons and analyses are uncommon in the HTA literature, the dissertation devises a heuristically useful scheme for this purpose, and subsequently utilises that scheme to compare Canada's, Australia's and UK's approaches to HTA at the national level (focusing on CADTH, MSAC and NIHR, respectively). This analysis reveals that although HTA is claimed to be an evidence-based endeavour, the agencies' assessments rely on a variety of probative inputs, raising the question of how, exactly, these bodies understand the concept of 'evidence'? An analysis of the HTA literature, as well as of the publications of the HTA agencies themselves, reveals that HTA, unlike other evidence based fields (such as evidence-based medicine (EBM) and evidence-based health policy (EBHP)), has thus far failed to flesh out an account of evidence. Thus, as a third contribution to knowledge, an account of evidence that is suitable for HTA purposes is proposed here. Evidence is argued to be: available data that is relevant to the issue being addressed, question asked, decision made, etc. It is further argued that this definition enjoys numerous benefits, whilst simultaneously bypassing some of the problems around the definitions of evidence proposed in the EBM and EBHP literature. The tenability and utility of the proposed definition is tested twice. First, the definition is tested against CADTH's, MSAC's and NIHR's evaluative practices vis-à-vis health technologies in general, and second, the definition is tested against the agencies' evaluative practices vis-à-vis genetic tests in particular. Thus, as a fourth contribution, the dissertation addresses genetic tests as an HTA issue, rather than as a bioethics issue, as it is predominantly done in the literature. In case of both the assessments of health technologies generally speaking, and assessments of genetic tests in particular, it is argued that the proposed definition of evidence is both tenable and useful, as it captures all and only the probative inputs that are required by the health technological assessments.
Other link(s)
tspace.library.utoronto.ca
hdl.handle.net
Subject
Health technology assessment.
HTA.
Evidence.
Health policy.