Utilisation of medical technology assessment in health policy

Objective: To assess the contribution of medical technology assessment (MTA) to health policy decision making, the question has to be answered whether MTA is actually being used in decision-making processes and what factors are related to its utilisation. Design: We investigated recent Dutch policy decision making concerning four cases, i.e., breast cancer screening, serum alphaprotein (AFP) screening, in vitro fertilisation (IVF) and lung transplantation. Methods: A search of the international literature yielded 351 articles that reported MTA results concerning the four cases studied. Policy documents, advisory reports and parliamentary discussions were analysed to identify the utilisation of existing MTA knowledge in The Netherlands. Additionally, 23 structured interviews with experts in the field of MTA and/or policy decision-making were conducted. Results: Numerous articles report results of MTA studies of breast cancer screening and in vitro fertilisation. In both cases the Dutch government commissioned MTA studies, but the outcomes of these studies did not substantially affect the decision-making process. MTA knowledge about AFP screening is more limited and studies dealing with lung transplantation are scarce. Nevertheless, policy decisions were made. Conclusion: Policy decisions concerning the introduction of (new) technologies in health care are not based on the results of MTA studies. Political arguments and interest groups decide the outcomes. At best, MTA results are used to implement (new) technologies more effectively. (C) 1997 Elsevier Science Ireland Ltd.