HTA RECONSTRUCTION PROGRAM AND FEES

A NEW START CURRICULUM IN HEALTH TECHNOLOGY ASSESSMENT 

LEGACY HTA: A SUBJECT NOT FIT FOR PURPOSE

NEW CURRICULUM

The legacy health technology assessment (HTA) curriculum is not fit for purpose. For over forty years, successive generations of students have been taught quantitative methods that fail the fundamental requirements of representational measurement. The result is an institutionalized system of arithmetic without lawful measurement. A new curriculum, founded on lawful measurement and the standards of normal science, is available now. It offers a direct transition to credible, empirically evaluable, replicable and falsifiable claims concerning therapy impact.

The legacy HTA failure began with the pursuit of numerical valuations of health states in the 1980s. Rather than beginning with independently defined attributes and demonstrating the properties necessary for measurement, legacy HTA adopted preference elicitation as the foundation for constructing utilities and quality-adjusted life years (QALYs). Subjective judgments were transformed into numbers intended for arithmetic without establishing the quantitative relationships required to justify those operations. A curriculum founded on arithmetic without measurement.

As demonstrated in the newstart  nine-unit curriculum, the time trade-off (TTO) technique produces preference scores that fail the requirements of lawful representational measurement. Utilities derived from these scores have no demonstrated status as quantitative measures, while constructing the QALY demands mathematically inadmissible operations. The new start curriculum provides explicit proofs of these failures through sequential process validation, applying the established requirements of representational measurement, dimensional homogeneity and commensurability.

These are not problems that can be resolved through statistical refinement, sensitivity analysis or improved simulation models. They are fundamental failures to recognize measurement. The resulting cost-per-QALY claims lack a defensible quantitative foundation. Institutional endorsement cannot make mathematically inadmissible operations scientifically legitimate.

The answer is not to repair the legacy curriculum. It is to abandon it.

The Maimon Research nine-unit curriculum provides a new foundation for graduate HTA education. Beginning with the definition of manifest and latent attributes, it establishes lawful measurement, admissible arithmetic and the requirements of normal science. It develops linear ratio measurement for manifest attributes and Rasch measurement for latent attributes, progressing to attribute possession, prospectively specified therapy-impact claims, empirical protocols and new formulary guidelines. Its objective is the progressive development of objective knowledge through empirical evaluation, replication and falsification.

Understandably, many universities and faculty will continue teaching the numerical storytelling of legacy HTA. Four decades of institutional commitment, textbooks, professional guidelines and entrenched teaching practices will not disappear overnight. But continued teaching carries an academic responsibility.

Students must be told that the legacy HTA curriculum they are being taught fails lawful measurement standards. They deserve to understand why its quantitative foundations are mathematically inadmissible under those standards and why a scientifically grounded alternative is available.

Forty years of arithmetic nonsense need not become fifty. The new curriculum is available now.

A detailed abstract for all Units is given below.

FEE STRUCTURE AND OPTIONS The fees are set to cover production and distribution costs. Unit 1 is seen as introductory and is priced accordingly (US$49). All other units are US$85. If Units 2 to 9 are purchased together the fee is US $575.

UNITS 2 – 9 PURCHASED TOGETHER

UNIT 1

MEASUREMENT BEFORE ARITHMETIC — THE FOUNDATION FOR A NEW HTA

For forty years, legacy health technology assessment (HTA) has relied upon preference utilities, QALYs and economic models without demonstrating the measurement properties required to justify their quantitative claims. The result is measurement inversion: arithmetic preceding measurement.

Unit 1 establishes the scientific foundations for reconstructing HTA. It distinguishes numerical assignment from lawful measurement, introduces Stevens’ nominal, ordinal, interval and ratio scales, and explains why admissible arithmetic depends upon demonstrated measurement properties.

Central to this reconstruction is the distinction between manifest and latent attributes. Manifest attributes, such as survival duration, require linear ratio measurement. Latent attributes, including functional ability and symptom burden, require validated Rasch measurement to assess changes in the degree of attribute possession.

The Unit examines evidence of curriculum and knowledge-base inversion, together with the measurement failures underlying preference utilities and QALYs.

The objective is not to improve legacy HTA but to replace its scientific foundations. Unit 1 establishes the starting point for the nine-unit reconstruction program: independently defined attributes, lawful measurement and empirically testable therapy-impact hypotheses. Measurement must precede arithmetic.

UNIT 2

REPRESENTATIONAL MEASUREMENT — THE AXIOMS OF LAWFUL MEASUREMENT

Unit 2 establishes the scientific foundations required to replace legacy health technology assessment (HTA) with a discipline grounded in representational measurement. Tracing developments from Stevens (1946) through Krantz and colleagues (1971), alongside Rasch’s independent contribution, it explains why measurement must precede arithmetic.

The Unit introduces the axioms governing lawful measurement, including unidimensionality, ordering, transitivity, additivity, cancellation, solvability, equal intervals, invariance and meaningful zero. It distinguishes two measurement pathways: linear ratio scales for manifest attributes, such as survival duration, and validated Rasch measurement for latent attributes, such as functional ability and symptom burden.

Particular attention is given to the historical divergence between representational measurement and legacy HTA, which developed from utility theory and decision analysis without independently establishing the measurement properties required for its quantitative claims.

The implications are decisive. Time trade-off scores, preference-based utility algorithms, QALYs and cost-per-QALY reference cases lack demonstrated measurement foundations. Unit 2 therefore establishes the axiomatic requirements for constructing empirically evaluable, replicable and falsifiable therapy-impact claims within a reconstructed HTA framework, replacing numerical convention with scientific measurement.

UNIT 3

THE DENIAL OF OBJECTIVE KNOWLEDGE

Unit 3 examines how legacy health technology assessment has departed from the scientific requirement that knowledge must evolve through measurable, replicable and falsifiable claims. The central problem is not simply the misuse of arithmetic but the acceptance of numerical constructions that cannot be subjected to meaningful empirical challenge.

The Unit considers the distinction between objective knowledge and assumption-driven modeling. Utilities, QALYs, cost-per-QALY estimates and reference-case simulations generate numerical conclusions without first demonstrating the measurement properties necessary for quantitative interpretation. Internal model validation and sensitivity analysis cannot substitute for independent empirical testing of claims.

Particular attention is given to falsification, replication and the role of criticism in advancing scientific understanding. Claims must identify measurable attributes, specify anticipated outcomes and establish conditions under which observations could demonstrate failure.

The Unit explains why measurement must precede arithmetic and why scientific progress requires abandoning analytical conventions protected from empirical contradiction.

The objective is to restore HTA as a discipline concerned with the progressive evolution of objective knowledge rather than the institutional reproduction of numerical storytelling.

UNIT 4

ORDINAL SCORES AND THE GREAT MEASUREMENT ILLUSION

Unit 4 exposes the measurement failures underlying time trade-off (TTO) preference scores, multiattribute utility algorithms and quality-adjusted life years (QALYs). It demonstrates why assigning numbers to preferences cannot establish quantities suitable for lawful arithmetic.

The Unit introduces sequential process validation, requiring mandatory STOP decisions whenever the axioms of representational measurement are not satisfied. Unlike model validation, process validation examines whether each stage of numerical construction is scientifically admissible.

The analysis demonstrates that TTO duration ratios cannot be interpreted as preference ratios without an empirically established mapping between time and preference spaces. Regression algorithms cannot repair this failure or transform preference scores into lawful utilities. Multiplication of these utilities by survival duration introduces further violations of measurement requirements, dimensional homogeneity and commensurability.

The consequence is the collapse of the measurement foundations supporting QALYs, cost-per-QALY estimates and legacy HTA reference cases.

The Unit establishes a decisive principle: statistical sophistication cannot rescue arithmetic without measurement. When measurement fails, the analytical process must STOP, allowing reconstruction around lawful measurement and falsifiable therapy-impact claims.

UNIT 5

RASCH MEASUREMENT — CONSTRUCTING THE PROVISIONAL LOGIT CONTINUUM

Unit 5 introduces the Rasch framework as the foundation for lawful measurement of latent attributes, including symptom burden, treatment satisfaction, need fulfilment and quality of life. Unlike manifest attributes, latent attributes cannot be observed directly. Their measurement requires more than assigning numerical scores to questionnaire responses.

The Unit explains the conjoint person–item structure developed by Georg Rasch, distinguishing respondent possession of an attribute from item difficulty. It introduces the principles of unidimensionality, invariance and specific objectivity, demonstrating why summed ordinal scores cannot independently establish measurement.

A detailed worked example using five respondents and five items illustrates the construction of a fixed response matrix, initial person and item logits, expected response probabilities and iterative parameter estimation. The observations remain unchanged while the developing measurement ruler is progressively adjusted.

The Unit emphasizes a critical distinction: convergence produces only a provisional logit continuum, not a validated measure. Further testing is required to establish the final invariant measurement ruler, addressed in Unit 6.

The central lesson is that Rasch measurement begins with observations but requires demonstrated measurement properties before quantitative therapy-impact claims become admissible.

UNIT 6

THE FINAL RASCH LOGIT RATIO SCALE

Unit 6 examines the transition from the provisional Rasch logit continuum developed in Unit 5 to a final measurement ruler capable of supporting quantitative claims concerning latent attributes. The central requirement is that observations must satisfy the conditions of representational measurement before the resulting continuum can be endorsed.

Unlike conventional item response theory approaches, which emphasize statistical fit and prediction, Rasch measurement places the requirements of measurement before accommodation of the data. The objective is an invariant ruler against which changes in latent attributes can be evaluated.

The Unit examines ten requirements for endorsing the Rasch continuum, including unidimensionality, item fit, specific objectivity, differential item functioning, local independence, ordered response categories, targeting, item hierarchy stability, separation and overall ruler stability. Together, these provide evidence that the measurement structure is reproducible and scientifically defensible.

The Unit also considers the distinction between the logit continuum and its underlying probability and odds structure. It establishes the foundation for Unit 7, where therapy impact is evaluated through changes in possession of a latent attribute.

UNIT 7

POSSESSION OF A LATENT ATTRIBUTE

Unit 7 introduces possession as the central concept for evaluating therapy impact on latent attributes. Building upon the Rasch measurement ruler established in Units 5 and 6, it demonstrates how individuals can be located on an invariant logit continuum representing their degree of possession of attributes such as symptom burden, treatment satisfaction and need fulfilment.

Unlike conventional patient-reported outcome scores, possession is not derived from summing ordinal responses. It is estimated through the relationship between respondent locations and calibrated item difficulties, allowing meaningful comparisons across individuals, populations and observation periods.

The Unit examines individual and aggregate possession, the interpretation of changes in logits, associated uncertainty and the expression of treatment effects as odds ratios. A worked example demonstrates how a prospective claim concerning improved need fulfilment can be evaluated against a predefined quantitative threshold.

The central contribution is the transition from descriptive scores to empirically testable therapy-impact claims. Rasch possession provides the foundation for independent replication, falsification and the progressive development of objective knowledge concerning latent treatment outcomes.

UNIT 8

ATTRIBUTE CLAIMS AND PROTOCOLS

Unit 8 establishes the framework for translating lawful measurement into empirically evaluable claims concerning therapy impact. Measurement must precede arithmetic, but measurement alone does not establish scientific knowledge. Every claim requires an explicit protocol specifying why the anticipated effect should occur and how it will be assessed.

The Unit distinguishes protocols for manifest attributes, measured through linear ratio scales, and latent attributes, requiring Rasch measurement of attribute possession. Each protocol identifies the target population, comparator, anticipated effect, observation period, measurement procedures and criteria for claim failure.

Particular attention is given to compliance, medication possession, treatment persistence and switching behavior. These become measurable claims rather than assumptions hidden within simulation models. Linked protocols establish a coherent profile of therapy impact without combining distinct attributes into composite scores.

The Unit also examines clinical justification, baseline distributions, pilot studies, sample size requirements and the development of real-world evidence.

The objective is to replace assumption-driven numerical projections with prospective, measurable and falsifiable propositions that support replication, empirical challenge and the progressive evolution of objective knowledge.

UNIT 9

FORMULARY GUIDELINES

Unit 9 establishes a new framework for formulary guidelines grounded in representational measurement. It replaces traditional submission requirements based on utilities, QALYs, cost-per-QALY estimates and assumption-driven simulation models with explicit, measurable and falsifiable claims concerning therapy impact.

Manufacturers must identify relevant attributes, justify anticipated treatment effects and develop protocols agreed with health systems. Manifest attributes require linear ratio measures, while latent attributes require Rasch measurement. Each protocol specifies the target population, comparator, expected outcomes, observation period and criteria for claim failure.

Particular attention is given to compliance, persistence and treatment switching as measurable claims underpinning therapy performance. Manufacturers must integrate attribute selection with pivotal clinical development and support continuing real-world evidence generation.

The Unit also examines manufacturer responsibilities for staff training, recruitment, financial commitments and performance-based contracting. Formulary submissions become part of an ongoing evidence program extending to disease-area and therapeutic-class reviews.

The objective is to end one-off numerical submissions and establish formulary guidelines that demand lawful measurement, empirical accountability, replication and falsification as foundations for objective knowledge.

ACKNOWLEDGEMENT

I acknowledge that I have used OpenAI technologies, including the large language model, to assist in the development of this work. All final decisions, interpretations, and responsibilities for the content rest solely with me