The Evolution of HTA in Emerging Markets Health-Care ... - TREE

OHE Consulting Report for PhRMA
5 January 2011
HTA would therefore be helpful in determining adoption of health technologies, for which the
marginal/incremental health benefits (in monetary terms), exceeds the marginal/incremental costs.
A3.10 Future of HTA in Taiwan: Findings and Issues
Despite its increased importance in the drug review process, HTA is still currently a pilot project.
There are about ten employees to conduct synthesis of evidence and analysis of new drugs. All
projects done by DHTA are currently delegated by BNHI, so they are subordinate to the DOH and
BNHI. It is, however, financially independent from the BNHI, and aims to make an unbiased,
independent assessment of the evidence.
According to Jirawattanapisal, et al. (2009), there is no legislative instrument backing the use of HTA
in pharmaceutical reimbursement decisions in Taiwan although some progress has been made. In
2007, the Minister of Health established an HTA system under the Centre for Drug Evaluation (CDE).
The CDE acts as an adviser to the BNHI – which is the single payer for all beneficiaries – in all matters
relating to HTA. The BNHI (specifically the Drug Benefit Committee (DBC) of BNHI) takes
consideration of HTA evidence as part of the information arsenal for pharmaceutical reimbursement
decision-­‐making. The CDE is thus not a healthcare payer as in the case of HIRA (the National Health
Insurance Review and Assessment, which is agency within the NHI) in South Korea: it is an
independent evaluator.
This independence, however, doesn’t guarantee complete lack of bias: HTA deliberations and
discussions are not made public in Taiwan. Few people outside of the BNHI and DBC members have
access to their reports. (It is the BNHI’s decision not to disclose the assessment report, not the HTA
group.)
Currently, the new law regarding the “second generation” of NHI is under review in the legislative
Yuan, and is expected to be completed in early December of 2010. There are two clauses related to
HTA. First, it states that BNHI “can” conduct HTA analysis in appraising new drug as opposed to
stating that they “should”; this clause has not yet been approved, which means that HTA’s function
or role is still not specified in the new law. The second clause was approved and stipulates the
following: if the BNHI cannot complete HTA analysis on a new drug within 90 days of the
submission, the BNHI has to directly accept the inclusion of new drug in the reimbursement list.
There can be no delay in the approval process due to tardiness from an HTA report.
It is noteworthy that the HTA assessment report for BNHI has been completed within 42 days since
the beginning, and has never been delayed. The decision on reimbursement and pricing is by DBC,
so that is the reason for any delay. The HTA assessment report does not recommend the listing and
pricing: it is given to the appraisal committee members to review before the DBC meeting, and they
make the recommendation.
The BNHI spends about 25% of its budget on drugs. However, this important statistic is somewhat
misleading. The fact that the reimbursement level is higher than the acquisition cost means that
providers are paid more by government than the amount they pay to purchase the drugs. This gives
them an incentive to prescribe more.
Understanding the role that HTA will, can, or should play in Taiwan requires an appreciation of the
fact that a centralized health care system can behave as a monopsony buyer, negotiating in the case
of innovative branded drugs with a monopoly seller-­‐-­‐the manufacturer. The price outcome of such
a “bilateral monopoly” negotiation is indeterminate (in terms of its relation to marginal cost),
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