REVIEW – August 2012

Establishment of health technology assessement in Estonia


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Rapid development of knowledge and technology has placed national health care systems all over the world into a difficult situation where finding a balance between investments and health outcomes has become part of everyday decision making. Health technology assessment (HTA) has evolved from the discipline of health economics and aims to provide support for decision-making in health care and public health policy. Since the 1990s the majority of developed countries have established national HTA institutions working as independent agencies or departments of academic research institutions. In Estonia, the Ministry of Social Affairs and the Estonian Health Insurance Fund have been using elements of HTA in their analyses and decisions on reimbursement of medical services.

In 2011 the first steps of establishing a specialized HTA centre at Tartu University Department of Public Health were taken. During the next three years 25 full reports should be completed. The technologies to be assessed will be selected by a HTA council taking into account suggestions from the Ministry of Social Affairs, the Estonian Health Insurance Fund and from other professional organizations and specialists. A single HTA starts with the formulation of research questions relating to a technology of interest, alternatives and target population, as well as the costs and expected health outcomes included in analysis. The efficacy, effectiveness, safety and cost-effectiveness of the technology are thereafter described on the basis of published research findings. This process includes gathering local data on health conditions, epidemiology and costs for health care systems. The obtained information is used for economic analysis. The method of analysis is selected according to input data and aims of assessment. As an end result, an HTA report is published in which input data and results are described in detail. The discussion part of the report addresses ethical, social and organizational aspects not included in economic analysis, because of their possible inf luence on the implementation of using the technology and final health outcomes. Finalized HTA reports together with the supporting documentation will be available in the public domain at