MOST IMPORTANT BARRIERS AND FACILITATORS REGARDING THE USE OF HEALTH TECHNOLOGY ASSESSMENT

Objectives: Several studies have reported multiple barriers to and facilitators for the uptake of health technology assessment (HTA) information by policy makers. This study elicited, using best-worst scaling (BWS), the most important barriers and facilitators and their relative weight in the use of HTA by policy makers.

Methods: Two BWS object case surveys (one for barriers, one for facilitators) were conducted among sixteen policy makers and thirty-three HTA experts in the Netherlands. A list of twenty-two barriers and nineteen facilitators was included. In each choice task, participants were asked to choose the most important and the least important barrier/facilitator from a set of five. We used Hierarchical Bayes modeling to generate the mean relative importance score (RIS) for each factor and a subgroup analysis was conducted to assess differences between policy makers and HTA experts.

Results: The five most important barriers (RIS > 6.00) were "no explicit framework for decision-making process," "insufficient support by stakeholders," "lack of support," "limited generalizability," and "absence of appropriate incentives."The six most important facilitators were: "availability of explicit framework for decision making," "sufficient support by stakeholders," "appropriate incentives," "sufficient quality," "sufficient awareness,"and "sufficient support within the organization."Overall, perceptions did not differ markedly between policy makers and HTA experts.

Conclusions: Our study suggests that barriers and facilitators related to "policy characteristics"and "organization and resources"were particularly important. It is important to stimulate a pulse at the national level to create an explicit framework for including HTA in the decision-making context.