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

Calnan, Michael .W., DiStefano, Michael, Mitchell, Polly, Morrell, Liz, Charlton, v, Baker, Rachel, Rand, Leah, Chalkidou, Kalipso, Culyer, Anthony, O'Mahony, James F., and others. (2023) We need to talk about values: a proposed framework for the articulation of normative reasoning in health technology assessment. Health Economics, Policy and Law, . pp. 1-21. ISSN 1744-1331. (doi:10.1017/S1744133123000038) (KAR id:101309)


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

Item Type: Article
DOI/Identification number: 10.1017/S1744133123000038
Uncontrolled keywords: healthcare priority-setting, ethics, social values, moral values, practical public reasoning
Subjects: H Social Sciences
J Political Science
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research
Funders: University of Kent (
Wellcome Trust (
Depositing User: Michael Calnan
Date Deposited: 27 Sep 2023 17:29 UTC
Last Modified: 16 Nov 2023 12:26 UTC
Resource URI: (The current URI for this page, for reference purposes)

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