Abstract：
Healthcare innovations often represent important improvements in population welfare, but at what cost, and to whom? Health technology assessment (HTA) is a multidisciplinary process to inform resource allocation. HTA is conventionally anchored on health maximization as the only relevant output of health services. If we accept the proposition that health technologies can generate value outside the healthcare system, resource allocation decisions could be suboptimal from a societal perspective. Incorporating \"broader value\" in HTA as derived from social values and patient experience could provide a richer evaluative space for informing resource allocation decisions. This article considers how HTA is practiced and what its current context implies for adopting \"broader value\" to evaluating health technologies. Methodological challenges are highlighted, as is a future research agenda. Ireland serves as an example of a healthcare system that both has an explicit role for HTA and is evolving under a current program of reform to offer universal, single-tier access to public services. There are various ways in which HTA processes could move beyond health, including considering the processes of care delivery and/or expanding the evaluative space to some broader concept of well-being. Methods to facilitate the latter exist, but their adaptation to HTA is still emerging. We recommend a multi-stakeholder working group to develop and advance an international agenda for HTA that captures welfare/benefit beyond health.
摘要：
医疗保健创新通常代表着人口福利的重要改善，但代价是什么,卫生技术评估（HTA）是一个多学科的过程，为资源分配提供信息。HTA通常以健康最大化为基础，作为卫生服务的唯一相关输出。如果我们接受医疗技术可以在医疗系统之外产生价值的主张，从社会角度来看，资源分配决策可能是次优的。从社会价值和患者经验中得出的HTA中纳入“更广泛的价值”可以为资源分配决策提供更丰富的评估空间。本文考虑了HTA的实践方式以及其当前背景对于采用“更广泛的价值”来评估健康技术意味着什么。强调了方法上的挑战，这是未来的研究议程。爱尔兰是医疗保健系统的一个例子，该系统既对HTA具有明确的作用，又在当前的改革计划下不断发展，以提供普及，对公共服务的单层访问。HTA流程可以通过多种方式超越健康，包括考虑提供护理的过程和/或将评估空间扩展到更广泛的福祉概念。存在促进后者的方法，但是他们对HTA的适应仍在出现。我们建议成立一个多利益攸关方工作组，以制定和推进HTA的国际议程，以获取健康以外的福利/福利。
