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

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OHE Consulting Report for PhRMA 5 January 2011 4 Our Approach 4.1 Workstreams To fulfil the study objectives we have divided the work into four separate, interrelated, workstreams. 4.1.1 Workstream 1: Categorisation of health care systems We started our analysis with a classification of health care systems to help understand the roles of payers – distinguishing between a single national/public payer and multiple private payers/insurers – and the roles of doctors and patients in the final choice of treatments and/or the management of disease. To do this we did the following: 1. Reviewed relevant literature including reports published by the World Health Organization (WHO), Organisation for Economic Co-‐operation and Development (OECD), World Bank, and academic groups such as The European Observatory on Health Systems and Policies (which produces country profiles for western Europe, central and eastern Europe and the central Asian republics); 2. Identified in the literature review references to the three countries of particular interest in the study -‐ Brazil, China and Taiwan; 3. Developed possible ‘evolutionary pathways’ that countries are in principle following in an attempt to improve their health care systems as income per-‐capita increases. There are several different starting points and potential pathways, but from a dynamic viewpoint it is possible to identify the key trends. In the second part of the project we used the theoretical framework to review the experience of the three countries. 4.1.2 Workstream 2: Categorisation of HTA Based on the experience of developed countries and current policy and academic debate in Europe and North America, we set out to analyse different definitions and approaches to HTA (e.g. decentralised versus centralised, comparing effectiveness versus cost-‐effectiveness) to understand how HTA can work in different settings and how it has worked in practice in a number of countries... In our literature reviews for Workstreams 1 and 2, we searched for and reviewed published literature, including papers and reports commissioned or conducted by key international organisations that are in the public domain but are not part of the peer-‐reviewed journal literature (the so-‐called grey literature). Our approach was not meant to be exhaustive or comprehensive: we followed a selective approach mainly driven by: 20
OHE Consulting Report for PhRMA 5 January 2011 1. Our accumulated knowledge and experience and that of our expert advisers as to the most relevant literature; 2. Core references from past reviews of HTA processes to help in identifying key authors in the fields. 4.1.3 Workstream 3: Mapping HTA onto health care systems in emerging economies The third element of the project is to map the outputs of the Workstream 1 analysis of the evolution of health care systems onto the Workstream 2 analysis of options for HTA. This is intended to enable us set out policy recommendations as to whether and in what way HTA processes can help lower income and emerging economy countries to obtain more value for money from their health care expenditure whilst providing access to innovative technologies, including new medicines, which can significantly improve health outcomes within their systems. We do this in the context of PhRMA’s perspective that it does not wish to promote the use of HTA where it doesn't exist but to be prepared with an appropriate response to engage and shape HTA when it is put forward. 4.1.4 Workstream 4: Developing options for HTA development in the three countries We have complemented this approach with a more detailed analysis in the second part of the project on the use of and proposed use of HTA within the three countries Brazil, China and Taiwan. These three countries are selected as important markets in their own right, and because they span a range of different sorts of emerging markets with respect to size and state of development. For example, Brazil and China, along with India and Russia, comprise the large, powerful ‘BRIC’ economies, although Brazil is considered in some classifications (e.g. FTSE) to have a higher state of development than China. Taiwan is smaller than both, but in some classifications (e.g. Dow Jones) is considered to have achieved a level of development that puts it outside the emerging markets category. China Taiwan Brazil Dow Jones MSCI FTSE Advanced Emerging markets FTSE Secondary Emerging markets By linking appropriate HTA use to the stage of health care system evolution we sought to translate the general analysis undertaken for the previous workstreams to indicate potential HTA reform pathways relevant for these three countries when HTA is proposed by the government and/or payers. As part of this we have examined how these markets are currently planning to use or using HTA. In particular we reviewed whether it is seen as a tool to improve effectiveness or as a cost-containment tool. We aimed to identify reform options for PhRMA to consider and also to identify relevant opinion leaders for these three countries. We took note of the PhRMA, IFPMA, and EFPIA 21
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