Health technology assessment: a perspective from Germany.

Health technology assessment (HTA) has been discussed in Germany since the late 1990s, closely related to the advent of evidence-based medicine. The idea of technology assessment was initially discussed in Germany by the “technology assessment office of the parliament.” This was further supported by a scientific project to evaluate the use and benefit of HTA in the German health-care setting at the Hanover Medical School [1]. The German Scientific Working Group Technology Assessment for Health Care was then founded in 1997 with the objectives to develop a database comprised of HTAs already available and improve the methodology for HTA. The project group consisted of university-based scientists and representatives of the various institutions within the statutory health insurance (SHI). The project was sponsored by the federal government and supervised by the German Institute for Medical Documentation and Information (Deutsches Institut für Medizinische Dokumentation und Information [DIMDI]). The project was finished in 2001. HTA was formally established with the German Health Care Reform 2000. The reform included the assignment of the implementation of a database and a scientific working program on HTA within the remit of DIMDI. In the same year, the German Agency for HTA was established within DIMDI (Deutsche Agentur für Health Technology Assessment [DAHTA@DIMDI]). Based on the work done by the German Working Group Technology Assessment for Health Care, the principles and methods of HTA were continuously adopted by various decision-making bodies in Germany, such as the predecessors of the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA). In Sections I and II of this paper, German organizations involved in HTA and their processes for conducting HTA are described. In Sections III and IV, current issues for the assessment and use of HTA are discussed. In Section V, HTA in Germany and lessons learned are presented.