Why is a health technology assessment agency so necessary?
In healthcare, as in few other areas of social life, timely and fair access to technological advances can make the difference between life and death. This is not a grandiose statement: it is the reality of those facing complex diagnoses and requiring interventions ranging from new medications to surgical procedures or medical devices. And it is precisely at this point that Argentina exhibits one of its most serious structural shortcomings: the absence of a National Agency for Health Technology Assessment (AETS).
Unlike the National Administration of Drugs, Food, and Medical Technology (ANMAT), which approves products based on their safety and efficacy, an AETS (National Agency for the Protection of Medical Devices) is tasked with evaluating already approved technologies from a broader perspective: clinical, ethical, economic, and social. In short, its task is not to validate whether a product can be used, but rather to decide whether it should be used, how, under what conditions, and for whom.
In countries like the United Kingdom, Sweden, Canada, Brazil, and even Colombia, health technology assessment (HTA) agencies are pillars of healthcare decisions. These institutions' primary objective is not to "cut costs," but rather to optimize resources. Optimization means nothing more than obtaining the maximum value for each peso invested, prioritizing those interventions that generate the most health, especially among those most in need.
One of the major contributions of modern HTA is the incorporation of a distributive equity approach into its evaluations. This means measuring not only whether an intervention is cost-effective, but also for whom it is cost-effective. The methodology known as DCEA ( Distributional Cost-Effectiveness Analysis) allows for estimating how the benefits and costs of a technology are distributed among different population groups: by socioeconomic level, age, gender, or place of residence. This is particularly crucial in systems like Argentina's, which is fragmented and unequal, where access to certain therapies depends more on the location of coverage than on clinical need.
A few examples suffice to illustrate the point. The introduction of a new, high-cost cancer drug may benefit a small fraction of patients with premium private insurance, while consuming resources that could have been allocated to essential medications or preventive programs for thousands of people without coverage. A well-designed HTA brings order to these decisions, not based on technocratic whim, but on evidence, healthcare justice, and ethical rationality.
Another key element is citizen participation. The most modern agencies in the world, such as the National Institute for Health and Care Excellence (NICE) in the United Kingdom, include formal mechanisms to incorporate the voices of patients, professionals, and communities in setting priorities. This not only legitimizes decisions but also improves their relevance and social acceptance.
In Argentina, the absence of an AETS creates a paradoxical situation: we have cutting-edge technologies, often imported at exorbitant prices, but we lack a system that allows us to evaluate, using our own criteria, which of them truly add value.
As a result, we live with excesses ( overuse of expensive, low-impact technologies ) and deficiencies ( lack of access to basic but effective interventions ).
The stakes are not insignificant. The creation of an AETS with functional autonomy, robust methodology, complete transparency, and absence of conflicts of interest is not a technocratic luxury. It is a necessary condition to ensure that the Argentine healthcare system uses resources efficiently and fairly. And, above all, to ensure that decisions about which technologies to fund no longer respond to sectoral lobbies, judicial pressure, or historical inequities, but rather to technical, ethical criteria focused on the well-being of the population.
The creation of a Health Technology Assessment Agency (HTAA) is not a magic bullet in itself. It must, as an essential condition, be part of a robust and coherent national health plan that gives it meaning and real impact . No one disputes whether its opinions should be binding: they must be. Otherwise, the agency risks becoming a mere advisory body with no impact on key decisions regarding coverage and financing.
Meanwhile, within the framework of a republican regime that respects the separation of powers, the judiciary may—as is its authority—make the decisions it deems appropriate. However, it may not omit prior consultation with an AETS (Spanish Supreme Court of Justice), as the latter must be recognized as the natural and specialized technical body, superior—in knowledge, method, and legitimacy—to any official or party expert.
The participation of the AETS before a technology is actually incorporated into the health system gives the State the strategic tool to negotiate prices and conditions of entry based on scientific evidence and health value. This mechanism also allows for the neutralization or mitigation of monopolistic effects that—due to the very logic of innovation, exclusivity, and information asymmetry —accompany any new technology, especially in its initial commercialization phases .
Ultimately, an AETS is a tool to ensure that the right to health does not depend on luck, coverage, or purchasing power, but on evidence and equity. Like any important political decision, it requires will, consensus, expertise, and clarity of purpose. The National Congress has the right to speak, and society has the right to demand it.
Head of the Argentine Health Union (UAS) and director of Cemic
lanacion
