1. Discuss how the findings of this study are relevant to the scope of HTAs of programs or interventions for persons with Autism Spectrum Disorder (ASD)

This review provides relevant information to the scope of assessment because it looked at deficiencies in the evidence base on services for persons with ASD. These deficiencies should be addressed by future assessments. Particularly, they concluded that:

  • The scope of previous research has been too narrow for the assessment of services for adults with ASD, especially given the heterogeneity between persons with ASD (differences in demographic characteristics, severity of autism, impairments).
  • Previous research has ignored broader societal, financial, demographic and political aspects that could have an impact on the effects of programs.
  • Difficulties in combining and navigating between different services for persons with ASD have not been addressed properly.
  • Outcome measures, like functional independence, should capture long-term effects.

In addition, the findings of these study contribute to our knowledge about the particular needs of patients with ASD. This is helpful because this reduces the risk that a program level assessment concludes that a particular intervention is effective, whereas it may be ineffective at a societal level (e.g. because it does only satisfy the needs of a subgroup of patients, or it only addresses needs that are not deemed as most important by patients; this requires a societal-level scope of HTA).

2. The authors discuss Amartya Sen’s capability approach to human development. How does the capability approach relate to the issue of the scope of an HTA?

In general, starting from the capability approach as an evaluative framework in HTA (in contrast to the dominant utilitarian framework) could lead to new questions, methods and outcome measures that are taken into account in HTA. It makes a difference whether you want to assess if a health technology will promote well-being in terms of welfare (utilities, QALYs) or in terms of capabilities.

The capability approach states that people should be provided real opportunities to be and do what they have reasons to value. Individuals should have the freedom to pursue their own desirable goals, and this freedom is constituted both by individual factors (conversion factors) as the societal environment (resources). Therefore, interventions should be aimed both at the individual and the societal context. Interventions at both these levels are needed to increase opportunities, capabilities, for patients. Currently, services for persons with autism primarily intervene at the individual level. But their ability to intervene at the level of society, to change the societal context, should also be assessed. This should be taken into account in an HTA, expanding the scope from assessing the effect of the service on individual abilities to its potential impact on society, in order to evaluate the value of the service in improving capabilities of adults with ASD.