The role of health economics within health technology assessment: past, present, and future - an Austrian perspective.

In many countries, the economics domain forms a routine part of health technology assessments (HTA) next to analyzing the comparative effectiveness and safety of a technology. The method applied most often is economic evaluation, such as cost-effectiveness analysis, which is supposed to support the efficient use of resources. In Austria, economic evaluation has played a negligible role in HTA and reimbursement decisions, even though the country faces the same public healthcare sustainability challenges as others. In this commentary, we argue that while health economics will need to play a more active role in HTA-related decision support to deal with those challenges, current approaches in other countries may have to be broadened to fit the Austrian context. We are outlining four arguments to underpin this perspective: First, economic evaluations (in their current form) are of limited benefit for supporting reimbursement decisions of new high-priced technologies. Second, a broader variety of health economic methods is needed to address the scope of technologies. Third, applying health economic methods requires a reflection on their underlying values. Finally, health economics within HTA needs to go beyond microeconomic analysis of interventions. We are suggesting several alternative methods and approaches, encouraging out-of-the-box thinking and experimenting with methods developed in the academic context but rarely applied in routine HTA. Although some of our topics are unique to Austria, others may equally apply to other healthcare systems. With our thoughts, we aim to stimulate discussions for further developing health economics within HTA in Austria and internationally.