RECONSTRUCTING HTA

RECONSTRUCTING HTA PROGRAMS

The closure of the reference-case framework does not mark the end of health technology
assessment. Rather, it creates an opportunity to reconstruct HTA on foundations consistent with
the standards of quantitative science. For more than four decades the discipline has relied upon
utilities, QALYs, simulation models and cost-effectiveness claims while largely ignoring the
requirements of scales of measurement and the axioms of representational measurement. The
result has been measurement inversion, arithmetic chaos and the progressive detachment of HTA
from empirical evaluation. Reconstruction begins with a return to first principles: measurement
must precede arithmetic.

The reconstruction program presented here is designed to support that transition. The program is
built around the recognition that there are only two lawful forms of measurement for therapy
assessment: linear ratio measures for manifest attributes and Rasch logit ratio measures for latent
attributes. Together these provide the foundation for credible, evaluable and replicable claims
regarding therapy impact. The emphasis shifts from simulation and imaginary futures to
protocol-driven assessment, empirical evaluation and falsification. Instead of constructing
numerical stories, HTA becomes a research program dedicated to the accumulation of objective
knowledge.

The nine Units provide a practical pathway for researchers, educators, students, health-system
decision makers and formulary committees. Topics include the scales of measurement,
representational measurement, measurement inversion, manifest and latent attributes, Rasch
measurement, attribute possession, protocol development and formulary assessment. The
objective is not to reform the reference case but to replace it with a framework capable of
supporting lawful quantitative claims and scientific progress. The future of HTA lies not in
increasingly sophisticated simulation models but in measurable attributes, empirical evidence
and the continuing evaluation of therapy impact.

LINK TO PROGRAM DESCRIPTION

RECONSTRUCTING HTA PROGRAMS: MEASUREMENT BEFORE
ARITHMETIC [1600] Need URL