Thesis
Improving policymaking under uncertainty within health technology assessment (HTA)
- Creator
- Rights statement
- Awarding institution
- University of Strathclyde
- Date of award
- 2025
- Thesis identifier
- T17538
- Person Identifier (Local)
- 202268479
- Qualification Level
- Qualification Name
- Department, School or Faculty
- Abstract
- Effective policymaking under uncertainty is required for optimal resource allocation in health systems. Over the past 30 years, health technology assessment (HTA), the field for evidence-informed decisions in health, has become increasingly multi-disciplinary. The scope has expanded from medicine reimbursement to informing organisation of health services, evaluation of health promotion programmes, and cross-jurisdictional market shaping. Yet conceptualisations of uncertainty within HTA have not kept pace with this expanded scope. This thesis develops a multi-disciplinary framework for policymaking under uncertainty, based on an interdisciplinary review, to highlight when standard HTA practice may not be fit-for-purpose and alternative approaches to use. This framework was applied for the 2024 review of the kidney replacement therapy policy in Thailand, comparing the new approaches in the framework to standard HTA practice, and revised based on implementation findings. Findings suggest that a multi-disciplinary approach does improve policymaking, by broadening and making more systematic projections of policy impact, with low additional resource requirements compared to standard HTA practice. However, implementing approaches with a different philosophical basis to HTA requires time to build capacity and to align new approaches with accepted standards in HTA. The transition from established practice will likely require an incremental approach, alongside methods to evaluate changes in policymaking practice that are both rigorous and feasible to implement within policy constraints. The thesis explores how approaches from other disciplines, such as system dynamics and futures research, alongside frameworks from implementation science may support this transition. Further work is required to determine policy needs, to define standards in HTA for multi-disciplinary approaches, and to strengthen capacity for a multi-disciplinary approach to policymaking under uncertainty.
- Advisor / supervisor
- Quigley, John
- Megiddo, Itamar
- Colson, Abigail
- Resource Type
- DOI
Relations
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PDF of thesis T17538 | 2025-11-25 | Public | Download |