An Equity Checklist: a Framework for Health Technology Assessments

Despite the inclusion of equity ideals in the design of many health care systems, pragmatic tools for integrating them into the efficiency categories of cost-effectiveness in HTA remain under-developed. This paper reviews approaches used to incorporate equity in HTA methods and develops a framework to help decision makers supplement the standard efficiency criteria of HTA and avoid building inequities, explicit or implicit, into their methodology. A ‘checklist’ is provided to alert decision makers to a wide range of equity considerations for HTA. This checklist is intended to be used as part of the process through which advisory bodies receive their terms of reference; the scoping of the agenda prior to the selection of a candidate intervention and its comparators for HTA; the accompanying background briefing for decision makers; and as a tool to help to structure the discussion and composition of professional and ‘lay’ advisory groups during the assessment process. The checklist is offered as only a beginning of an on-going process of deliberation and consultation, through which the matters covered can be expected to become more comprehensive and the record of past decisions and their contexts in any jurisdiction adopting the tool can serve to guide subsequent evidence gathering and decisions. In these ways, it may be hoped that equity will be more systematically and fully considered and implemented in both the procedures and decisions of HTA.