Ethical aspects in Hospital-based Technology Assessment: Systematic review

Health technology assessments carried out in hospital settings are called Hospital-based Health Technology Assessments. Defined as assessment activities done “for” or “within” hospitals, with a systematic, multidisciplinary and evidence-based perspective. They usually assess efficacy, safety, and economic impact for healthcare institutions, however ethical aspects are rarely considered. To identify and describe the ethical aspects assessed in Hospital-based Health Technology Assessments and the methods or processes for address them. A comprehensive literature search was carried out. 103 sources including medical databases, health technology agencies, specialized ethics journals, and gray literature were searched. Data selection and extraction was done independently by two reviewers. Qualitative data was analyzed and synthesized using a meta-synthesis approach. Seven articles were included in this review. Four different approaches to define the ethical aspects were found: a philosophical perspective, a structured, and an unstructured definition based on expert judgment, and the adoption of available results in ethical domain within comprehensive HTAs. Definitions were also different within the studies, considering moral, social, personal ethics, legal, political, and person-centered aspects. The evaluation of the ethical aspects was carried out from two epistemological approaches. Our results indicate a low integration of the ethical component in HB-HTA. There is an absence of conceptual frameworks to address these aspects and lack of standardized methodologies to assess them.