Best-worst scaling to assess the most important barriers and facilitators for the use of health technology assessment in Austria

ABSTRACT

Background: Although Health Technology Assessment (HTA) is increasingly used to support evidence-based decision-making in health care, several barriers and facilitators for the use of HTA have been identified. This best-worst scaling (BWS) study aims to assess the relative importance of selected barriers and facilitators of the uptake of HTA studies in Austria.

Methods: A BWS object case survey was conducted among 37 experts in Austria to assess the relative importance of HTA barriers and facilitators. Hierarchical Bayes estimation was applied, with the best-worst count analysis as sensitivity analysis. Subgroup analyses were also performed on professional role and HTA experience.

Results: The most important barriers were ‘lack of transparency in the decision-making process’, ‘fragmentation’, ‘absence of appropriate incentives’, ‘no explicit framework for decision-making process’, and ‘insufficient legal support’. The most important facilitators were ‘transparency in the decision-making process’, ‘availability of relevant HTA research for policy makers’, ‘availability of explicit framework for decision-making process’, ‘sufficient legal support’, and ‘appropriate incentives’.

Conclusion: This study suggests that HTA barriers and facilitators related to the context of decision makers, especially ‘policy characteristics’ and ‘organization and resources’ are the most important in Austria. A transparent and participatory decision-making process could improve the adoption of HTA evidence.

KEYWORDS:

• Health technology assessment
• barriers
• facilitators
• best-worst scaling
• decision-making
• stakeholders

Acknowledgments

We specifically would like to thank three experts for their feedback on the master list of Austria-specific barriers and facilitators. We are grateful for the opportunity to present first study findings at the ‘Wissenschaftslunch’ at the Center for Public Health, Medical University of Vienna (June 2017), and appreciate the feedback and comments received from the participants. No external funding was received for this work.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplemental Data

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.

Notes on contributors

Chiara Feig

CF, MH, JS and SM were involved in the conception and design of the study. CF conducted the analysis under the supervision of KLC, MH, JS and SM. Data interpretation was carried out by CF with input from MH, JS and SM. CF drafted the manuscript with contributions from SM and input from KLC, MH, SE and JS. All authors approve the final version and all authors agree to be accountable for all aspects of the work.

Kei Long Cheung

CF, MH, JS and SM were involved in the conception and design of the study. CF conducted the analysis under the supervision of KLC, MH, JS and SM. Data interpretation was carried out by CF with input from MH, JS and SM. CF drafted the manuscript with contributions from SM and input from KLC, MH, SE and JS. All authors approve the final version and all authors agree to be accountable for all aspects of the work.

Mickaël Hiligsmann

CF, MH, JS and SM were involved in the conception and design of the study. CF conducted the analysis under the supervision of KLC, MH, JS and SM. Data interpretation was carried out by CF with input from MH, JS and SM. CF drafted the manuscript with contributions from SM and input from KLC, MH, SE and JS. All authors approve the final version and all authors agree to be accountable for all aspects of the work.

Silvia M. A. A. Evers

CF, MH, JS and SM were involved in the conception and design of the study. CF conducted the analysis under the supervision of KLC, MH, JS and SM. Data interpretation was carried out by CF with input from MH, JS and SM. CF drafted the manuscript with contributions from SM and input from KLC, MH, SE and JS. All authors approve the final version and all authors agree to be accountable for all aspects of the work.

Judit Simon

CF, MH, JS and SM were involved in the conception and design of the study. CF conducted the analysis under the supervision of KLC, MH, JS and SM. Data interpretation was carried out by CF with input from MH, JS and SM. CF drafted the manuscript with contributions from SM and input from KLC, MH, SE and JS. All authors approve the final version and all authors agree to be accountable for all aspects of the work.

Susanne Mayer

CF, MH, JS and SM were involved in the conception and design of the study. CF conducted the analysis under the supervision of KLC, MH, JS and SM. Data interpretation was carried out by CF with input from MH, JS and SM. CF drafted the manuscript with contributions from SM and input from KLC, MH, SE and JS. All authors approve the final version and all authors agree to be accountable for all aspects of the work.