Assessing the value of healthcare innovations: a proposal for an integrated health technology assessment-responsible innovation in health approach in the "new normal".

There has been tremendous technological innovation in the healthcare sector, but it has also raised serious ethical and social concerns. The COVID-19 pandemic has only magnified these existing challenges. Hence, addressing these challenges becomes imperative in the "new normal." In this context, this article uses a narrative synthesis approach to discuss the linkages of health technology, innovation, and policy to identify the challenges of this complex interaction by applying the principles of pragmatism and historicity to the existing literature. Moreover, the existing scientific mechanisms in the form of health technology assessment (HTA) and responsible innovation in health (RIH) are described to address these challenges. Using inductive epistemology, the linkages between HTA and RIH within a health innovation ecosystem framework are discussed for the future application of an integrated approach to address societal challenges. The proposed integrated approach of HTA and RIH is a work in progress and conceptualized as transdisciplinary, flexible, and adaptive, which is expected to facilitate future discussion, research, and policy action.

Cost-Benefit Analysis and Assessment of Quality of Care in patients with Hemophilia undergoing treatment at National Rural Health Mission in Maharashtra, India.

BACKGROUND: Hemophilia is a genetic disorder with high health care burden. In India, most patients with hemophilia seek care through self-purchasing factor concentrate and incur huge out-of-pocket (OOP) expenditure. In March 2013, the government of India launched a pilot hematology program through the National Rural Health Mission for providing free treatment services to patients with hemophilia in the state of Maharashtra. OBJECTIVES: To estimate the benefit-cost ratio of the program from a patient perspective, to estimate reduction in OOP expenditure of the patients and their families, and to assess the quality of care delivered and the barriers to access care among patients with hemophilia. METHODS: This cross-sectional study evaluated the intervention of free treatment to patients with hemophilia at four district civil hospitals of Maharashtra. The study sample included 232 people with hemophilia (193 with hemophilia A, 31 with hemophilia B, 6 with von Willebrand disease, and 2 others) under four study arms over a 1-year study period. Cost-benefit analysis was performed for patients undergoing treatment at government hospitals and through nongovernmental organizations. RESULTS: The benefit-cost ratio for the government program was 1.89. There was reduction in OOP expenditure by 21% per patient annually for the families. About 98% patients were highly satisfied with the services, whereas a major barrier to access was difficulty in commuting during active bleeding episodes. CONCLUSIONS: The government intervention through the National Rural Health Mission was cost-beneficial to the patients with hemophilia. It helped in reducing the OOP expenditure by 21%.