We need to talk about values: a proposed framework for the articulation of normative reasoning in health technology assessment

Victoria Charlton, Michael Distefano, Polly Mitchell, Liz Morrell, Leah Rand, Gabriele Badano, Rachel Baker, Michael Calnan, Kalipso Chalkidou, Anthony Culyer, Daniel Howdon, Dyfrig Hughes, James Lomas, Catherine Max, Christopher Mccabe, James f. O'mahony, Mike Paulden, Zack Pemberton-Whiteley, Annette Rid, Paul ScuffhamMark Sculpher, Koonal Shah, Albert Weale, Gry Wester

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


It is acknowledged that health technology assessment (HTA) is an inherently value-based activity that makes use of normative reasoning alongside empirical evidence. But the language used to conceptualise and articulate HTA’s normative aspects is demonstrably unnuanced, imprecise and inconsistently employed, undermining transparency and preventing proper scrutiny of the rationales on which decisions are based. This paper – developed through a cross-disciplinary collaboration of 24 researchers with expertise in healthcare priority-setting – seeks to address this problem by offering a clear definition of key terms and distinguishing between the types of normative commitment invoked during HTA, thus providing a novel conceptual framework for the articulation of reasoning. Through application to a hypothetical case, it is illustrated how this framework can operate as a practical tool through which HTA practitioners and policymakers can enhance the transparency and coherence of their decision-making, while enabling others to hold them more easily to account. The framework is offered as a starting point for further discussion amongst those with a desire to enhance the legitimacy and fairness of HTA by facilitating practical public reasoning, in which decisions are made on behalf of the public, in public view, through a chain of reasoning that withstands ethical scrutiny.
Original languageEnglish
Pages (from-to)1-21
JournalHealth economics policy and law
Publication statusPublished - 27 Sept 2023


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