Abstract
Background Health technology assessments (HTAs) are an interdisciplinary method to support sustainable,
evidence-based healthcare decisions. They systematically assess medical products,
procedures, and technologies with respect to medical, economic, legal, social, and
ethical aspects.
Method This review analyzes the current use of HTAs in radiology in Germany and discusses
challenges associated with HTAs. In particular, incentive structures of various players
in the healthcare field involved in HTA implementation are considered for both the
inpatient and outpatient sectors. Taking into account that the Joint Federal Committee
(G-BA) has different authority between sectors ("ban reservation” for inpatients and
“authorization right” for outpatients), we focus on the repercussions on reimbursement
for new diagnosis or treatment methods by statutory health insurance companies.
Results The G-BA’s authority implicitly creates a paradox in terms of incentives to implement
and finance HTAs: in the outpatient sector HTAs are considered necessary to evaluate
new medical services while players may not have sufficient incentive to implement
and finance HTAs in the inpatient sector.
Conclusion Characteristics of HTAs differ widely with respect to the items to be assessed. Therefore,
an HTA for drug effectiveness is not easily transferable to radiological procedures.
Within radiology, each method must be assessed individually (e. g. according to tumor
stage). Despite these challenges, systematic compilation and critical assessment (regarding
both cost and medical effectiveness) of available evidence should be a basic component
of evidence-based radiology. As companies in healthcare fail to invest in studies
that advance evidence-based radiology and considering the lack of incentive for such
investments, public funding institutions need to accept the challenge to support studies
that assess the benefit of radiological procedures.
Key Points:
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HTAs should be a basic component of evidence-based radiology.
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G-BA’s authority implicitly creates a paradox in terms of inventives to implement
and finance HTAs.
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University hospitals and public funding institutions need to support studies that
assess the benefit of radiological procedures.
Citation Format
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Winkelmann C, Neumann T, Zeidler J et al. Health Technology Assessments in Radiology
in Germany: Lack of Demand, Lack of Supply. Fortschr Röntgenstr 2019; 191: 635 – 642
Key words
health technology assessment - radiology - efficacy analysis - efficiency analysis
- health economics
