History of HTA: Introduction.

For the past several years, we have discussed the idea of producing a publication on the history of health technology assessment (HTA). It seemed important to us to develop this history now, while those who lived it can give their own accounts. An exception is Seymour Perry, the first president of ISTAHC and the Director of the first national public program in HTA, the U.S. National Center for Health Care Technology (NCHCT). See the In Memoriam in this issue. When we finally took action and approached the international community of researchers in HTA, we were overwhelmed by the positive response. We turned to many of the people we knew to be part of the history of HTA, albeit far from everyone due to practical limitations. The great majority of these people present their views of HTA’s history in the following studies. More than eighty authors have contributed with forty-four essays on the subject. With this series of studies, we intend to introduce the history of HTA. To date, no broad-based effort has been made to trace the international history of HTA, now spanning more than three decades. However, some historical documentation has been published on the early development of HTA in different countries (8), the International Society of Technology Assessment in Health Care (ISTAHC) (2;14;19;20), and the International Network of Agencies for Health Technology Assessment (INAHTA) (7). Inevitably, the essays presented here reflect our own and all other authors’ own experiences, biases, and perspectives. We encourage commentaries from those who have been involved in HTA for many years, and have their own perspectives on HTA and its history, to supplement our necessarily imperfect and limited story. These would be welcomed contributions to the special section of the Journal on Commentaries, Views, and Developments in HTA. Although this compilation of studies on the history of HTA is impressive, we would like to point out that it is far from the whole picture. Several omissions are obvious. First, this set of studies focuses on developments within the public sector, largely the ministries of health and HTA agencies, and occasionally the public health insurance programs in selected countries. One might argue that a parallel activity in the public sector involves those agencies that register pharmaceuticals. They perform assessments and make critical decisions on an important class of technology. Likewise, funding agencies, the universities, and industry play a key role in HTA as perhaps the largest funding sources for HTAs and as sponsors and organizers for many HTAs. A much longer publication would be needed to explore these dimensions and actors involved in HTA. In addition, the roles of international organizations would need to be further illuminated, such as the many aid agencies, the World Bank, and the European Commission (EC), a strong supporter of the HTA concept in both Europe and some developing countries. Second, a tragedy of today’s world is that the poorest countries, which often have the greatest need for critical assessment to make appropriate and affordable investments in health technology, have a limited basis for making those choices. We are conscious that the many countries of Africa receive little mention in these studies. To our knowledge, no country on that huge continent has an active HTA program, although the African office of the World Health Organization (WHO) has shown interest in the field from time to time. South Africa has some experts in HTA and may move to develop an HTA program. However, it should be noted that evaluative work related to HTA has been carried out in developing countries under the auspices of organizations outside of those countries, for example, by aid agencies, universities, industry, the European Union (EU), and WHO. Likewise, some countries in Eastern Europe and Latin America, and many countries in Southeast Asia are not yet part of the story. This is unfortunately the case, although some countries show a strong and growing interest in the field, and there are scattered experts and emerging interests in, for example, Turkey, Iran, India, Pakistan, Laos, and Vietnam. Russia has substantial expertise in HTA and evidence-based