We need to talk about values: developing a new taxonomy for describing normativity in health technology assessment

Victoria Charlton1

1King’s College London, United Kingdom

Health technology assessment (HTA) is an inherently normative activity. Decisions about society’s adoption of particular technologies are shaped by the interaction between empirical evidence and the many values, principles, norms and judgements that are essential to its interpretation and use. The normative aspects of HTA have historically been described using terminology (for example, ‘social value judgement’, ‘contextual consideration’, ‘ethical issue’) that is ambiguous, open to inconsistent usage, understood differently across disciplines, and incapable of fully articulating the complex interaction of evidence and values in this context. Such shortcomings of language have made it difficult for healthcare priority-setters (and those who seek to analyse their work) to clearly conceptualize and articulate the normative basis for decision-making, undermining transparency and leaving questions about the moral justification of these decisions unanswered.

The work described in this presentation is the result of an international cross-disciplinary collaboration involving more than 20 researchers and other experts in healthcare priority-setting. It attempts to address these problems by offering a more clear and nuanced taxonomy for describing normativity in HTA. This taxonomy is presented in the form of a high-level conceptual framework, populated with several well-defined and specified terms that distinguish between different types of normative consideration and illustrate the relationships that exist between them. The framework will be applied to a hypothetical case to demonstrate how it can provide a useful, practical tool for researchers and policy-makers with an interest in understanding, describing, analysing and evaluating the normative grounds for HTA-led decision-making.


  • Michael DiStefano, Johns Hopkins Berman Institute of Bioethics
  • Polly Mitchell, School of Education, Communication and Society, King’s College London
  • Liz Morrell, Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford
  • Leah Rand, Division of Pharmacoepidemiology and Pharmacoeconomics, Harvard Medical School and Brigham & Women’s Hospital



Victoria Charlton is a Wellcome Trust funded PhD student at the Department of Global Health & Social Medicine, King’s College London. Prior to joining King’s, she worked in science policy. Her current research explores normativity in health technology appraisal, as conducted by the UK’s National Institute of Health and Care Excellence (NICE).

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