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Leonor Varela Lema

Leonor Varela Lema

AVALIA-T – Galician Agency for Health Technology Assessment | Spain

Title: Priority setting of health interventions: Comprehensive review of criteria, approaches and role of health technology assessment agencies


Leonor Varela is a senior officer in the Health Technology Assessment Department (avalia-t) of the Galician Knowledge Assessment Agency, based in Spain. She has a 15 years background in Health Technology Assessment and recognized experience at the national and international level. During her career she has published and lectured extensively on topics related to HTA and health care decision making, and has done exhaustive research in this field. Currently, she holds the position of International Project Manager in avalia-t, and leads two activity centre departments in the on-going European Network for Health Technology Assessment (EUnetHTA) JA3 EU-funded project, which focus on HTA Joint Production and generation of cross border post-launch evidence for medical devices. She is an active member of the International Network of agencies for HTA (INAHTA) and the Health Technology International (HTAi), being the coordinator of the Adaptation of the Spanish INAHTA-HTAi glossary.


Statement of the Problem: Rationalizing healthcare resources constitutes a fundamental challenge to all health care systems. The current work, Commissioned by the Spanish Ministry of Health, was carried out with the purpose of developing an explicit priority setting methodology to support decision making regarding the technologies to be assessed for inclusion in the Spanish NHS service portfolio.

Methodology & Theoretical Orientation: The main aim of the work was to identify and analyse the criteria, approaches and conceptual frameworks used for priority setting internationally which could serve as basis for the development of the national priority-setting framework. For this purpose, a systematic search of the main biomedical electronic databases was performed and additional sources such as web pages of international health technology assessment agencies consulted.

Findings: In general terms, it was found that there are no standardised processes for priority setting, although some consensus and common trends have been identified regarding key elements (criteria, models and strategies, key actors, etc.). Globally, 8 key domain were identified: 1) Need for intervention; 2) Outcomes of intervention; 3) Type of benefit; 4) Economic consequences; 5) Existing knowledge/quality of evidence and uncertainties; 6) Implementation complexity/feasibility; 7) Priority, justice and equity and 8) Context. HTA agencies that were directly involved in supporting coverage decision making considered from 4-12 criteria.

Conclusion & Significance: The following work provides a thorough analysis of the relevant issues and offers recommendations regarding considerations for implementing successful HTA based prioritisation approaches. Findings are envisioned to be useful for different public organisations that are aiming to establish health care priorities.

Recent Publications

  1. Goetghebeur MM, Wagner M, Khoury H, et al. Bridging health technology assessment (HTA) and efficient health care decision making with multicriteria decision analysis (MCDA): applying the EVIDEM framework to medicines appraisal. Med Decis Making. 2012;32:376-88.
  2. Tanios N, Wagner M, Tony M, et al. Which criteria are considered in healthcare decisions? insights from an international survey of policy and clinical decision makers. Int J Technol Assess Health Care. 2013;29:456-65
  3. Devlin NJ, Sussex J. Incorporating multiple criteria in HTA. Methods and processes. London 2011
  4. Tromp N, Baltussen R. Mapping of multiple criteria for priority setting of health interventions: an aid for decision makers. BMC Health Serv Res. 2012;12:454
  5. Golan O, Hansen P, Kaplan G, et al. Health technology prioritization: which criteria for prioritizing new technologies and what are their relative weights? Health Policy. 2011;102:126-35

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