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

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

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OHE Consult<strong>in</strong>g Report for PhRMA<br />

5 January 2011<br />

to implement systems similar to other countries. <strong>The</strong> project has not really ga<strong>in</strong>ed much traction<br />

because the government already has tools—reference pric<strong>in</strong>g and price surveillance—for controll<strong>in</strong>g<br />

drug prices.<br />

It would be good if <strong>HTA</strong> could be used to establish efficient disease management or guidel<strong>in</strong>es. But<br />

Taiwan needs more time to develop a consensus on how to use <strong>HTA</strong>. <strong>The</strong>re are ongo<strong>in</strong>g hear<strong>in</strong>gs on<br />

a new public law. <strong>The</strong> patient stakeholder group seems to support <strong>HTA</strong> as a rational process;<br />

however, they don’t seem to realize that it is more likely that it will be used to reduce access to new<br />

expensive, but <strong>in</strong>novative drugs.<br />

<strong>The</strong> generic drug <strong>in</strong>dustry is robust <strong>in</strong> Taiwan and doubts that the research-­‐based <strong>in</strong>dustry will<br />

support <strong>HTA</strong>. This is because there is pressure on the BNHI to provide access to new breakthrough<br />

drugs, and the current median-­‐based external reference pric<strong>in</strong>g (with a basket <strong>of</strong> 10 countries)<br />

provides a reasonable price (from their perspective) for these drugs. <strong>The</strong> generic <strong>in</strong>dustry would<br />

favour <strong>HTA</strong> for these drugs because it is likely to reduce prices on branded drugs and allow more<br />

money for generics. <strong>The</strong>y would also favour creat<strong>in</strong>g greater <strong>in</strong>dependence <strong>of</strong> the <strong>HTA</strong> unit from the<br />

CDE.<br />

<strong>The</strong> use <strong>of</strong> drugs is driven by the pr<strong>of</strong>it marg<strong>in</strong>—the difference between what the NHI reimburses<br />

and what the acquisition cost from wholesalers. <strong>The</strong> generic <strong>in</strong>dustry is concerned about open<strong>in</strong>g<br />

the market to generics made <strong>in</strong> Ch<strong>in</strong>a.<br />

Academic View<br />

Academic <strong>in</strong>terviewees commented that, currently, Taiwan does not really have <strong>HTA</strong>. <strong>The</strong> only<br />

guidel<strong>in</strong>e is from ISPOR <strong>in</strong> Taiwan: there is no <strong>of</strong>ficial government guidel<strong>in</strong>e. Neither the BNHI nor<br />

the D<strong>HTA</strong> unit <strong>in</strong> the CDE is lobby<strong>in</strong>g strongly for a greater role for <strong>HTA</strong>. <strong>The</strong>y do not really seem to<br />

want to be accountable to the public.<br />

D<strong>HTA</strong> currently conducts literature review and summarizes the evidence from other countries as<br />

outl<strong>in</strong>ed above; it does not do a local pharmacoeconomic analysis. Knowledge about this process is<br />

very limited and manufacturers have no access to this report and no opportunity to challenge it. If<br />

properly set up, <strong>HTA</strong> could help to provide a better, efficient resource allocation <strong>of</strong> health care<br />

resources. <strong>The</strong> BNHI currently exploits its monopsony power.<br />

<strong>HTA</strong> is a rational policy, and should be applied to all drugs, not just new ones. But BNHI only worries<br />

about the f<strong>in</strong>ancial costs, and does not pay much attention to efficiency, i.e., health ga<strong>in</strong> for the<br />

money spent.<br />

Reform <strong>of</strong> the NHI is under discussion but the focus is on f<strong>in</strong>ance and the <strong>in</strong>surance premium, not<br />

<strong>HTA</strong>. <strong>The</strong> current work<strong>in</strong>g on <strong>HTA</strong> is vague: the BNHI could apply it <strong>in</strong> the appraisal and pric<strong>in</strong>g <strong>of</strong><br />

new drugs. <strong>The</strong> public representatives support it as a rational and scientific approach that would<br />

also help to combat bureaucracy and corruption.<br />

112

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