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

OHE Consulting Report for PhRMA
5 January 2011
Industry perspective
Industry has argued that HTA should serve as a reference tool rather than a mandatory process: it
can only play a meaningful role when several critical conditions are met, including availability of -­‐
sufficient data and evaluation standards. In the short-­‐run, China is unlikely to roll out HTA. The
recent negotiations between the government and the pharmaceutical industry indicate that the
government is not well prepared for such negotiations. Experience with the Essential Drug List
reform shows how inefficient it can be if a policy is put forward without sufficient information.
Ideally, an HTA organisation should be independent to avoid bias even if it is affiliated with
government institutions. HTA should take the role of balancing patient access and cost-­‐containment
for the government and should not be used a cost-­‐saving tool only. HTA should take a broad view of
value, and should not just look at drugs.
There are problems in conducting studies in China. Most hospitals are state-­‐owned with hospital
charges tightly controlled below cost. The data developed from this kind of system will not be
suitable for a rigorous HTA analysis, which assumes prices reflect resource use. Currently, the
Chinese government has its eyes on the Australian and Korean systems but these countries have
very different healthcare systems to China.
A6.3 Taiwan
Industry View
In industry interviewees commented that the current role of HTA in Taiwan is very limited. It is not
actually used and may not be needed for cost control given the other constraints, especially the
global budget. HTA is not currently used in drug pricing. HTA (i.e., cost-­‐effectiveness) is only used as
an argument when a drug is rejected. In its appraisal, the Drug Benefit Committee will read the HTA
report produced by the Division of HTA (DHTA) in the Center for Drug Evaluation (CDE).
Currently, the BNHI is the sole payer, and there are no clear rules or policies for applying HTA. They
decide who can participate in the discussion. Furthermore, current HTA is only a systematic review
of other developed countries’ reports: no local Taiwanese analysis or model is required or provided.
The HTA information is not disseminated though it should be—as part of a transparent process.
The CDE-­‐HTA pilot project (the DHTA) is beginning to ask companies to make a submission. Some in
industry have asked: Why should companies participate in this if it is eventually going to be used in
pricing—but not in a well-­‐defined way-­‐-­‐it is just creating another hurdle for companies? This
comment may be in response to the new drug reimbursement application form which was
announced by BNHI to become effective on Nov 1, 2010. This form was revised by CDE-­‐HTA team at
the request of the BNHI.
From a historical perspective, HTA in Taiwan could be described as the one-­‐off brain-­‐child of an ex-­‐
CEO of the BNHI that resulted in this pilot project. The project was headed by a scholar who aimed
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