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

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OHE Consulting Report for PhRMA 5 January 2011 6 Categorisation of health technology assessment (HTA) systems 6.1 Literature search strategy This stream of the work programme aimed to analyse different definitions and approaches to HTA, drawing mostly on experience of developed countries and current policy and academic debate in Europe and North America. The objective was not to provide a rationale for HTA (specifically we do not aim to answer the question of whether HTA is an appropriate policy response or not) but, conditional on the use of HTA (without an implicit endorsement of the appropriateness of HTA), we aimed to explore how one can understand types of HTA, and their strengths and weaknesses, in different contexts. For this purpose, we carried out a number of searches using the following search words: “health technology assessment”, “HTA”, “classification”, “taxonomy” and “categorization”) in various electronic databases and general search engines including PubMed and Google. Within a selected set of relevant articles, we also looked at references sections to identify articles that might be of relevance to our work programme but were picked out by our searches. We found, unlike the work programme for health system categorisation that very little has been done in terms of categorising HTA systems. Below we present summaries of relevant literature with a distillation of some of the issues concerning the implementation and execution of HTA (policy) discussed in the papers identified and which, we deem useful for developing taxonomy of HTA systems. 6.2 Some relevant literature for HTA classification EUnetHTA (2008) draws various issues underlying the adoption and use of HTA as an aid to decision-making in health systems. It describes how HTA has allowed a move from sole reliance on clinical evidence (in which it includes “unilateral” industry information), clinical opinion/consensus or ‘gut feelings’. It embraces expansion of the scope of HTA to include not just assessment of the value for money of new health technologies but also reviewing existing technologies, interventions and organisation structures and potentially disinvesting from those that are ineffective and obsolete. The report advocates expanding the breadth of technologies to be evaluated (albeit this raises the question of whether the same methods, tools and principles will apply to different technologies) and emphasises continuing methodological research and development in HTA, educational and training programmes and appropriate supporting policies and legislation (to anchor and mandate HTA), proactive identification of technologies that will improve healthcare quality and reduce costs, and the need for greater convergence between health priorities and innovation. The report also advocates a step-‐wise approach to institutionalization of HTA (i.e., ‘promoting the structures and processes suitable to produce technology assessments that will be powerful in guiding policy and clinical practice towards the best possible health and cost outcomes’.) The report also highlights a number of issues relevant to classification of HTA systems. 32
OHE Consulting Report for PhRMA 5 January 2011 First is having a definition of what is a ‘health technology’ and what health technology assessment is or involves. According to the EUnetHTA report, a health technology is ‘any [health] intervention that may be used to promote health, prevent, diagnose or treat disease, or for rehabilitation or long-‐term care. This includes pharmaceuticals, devices, procedures and organizational systems used in health care’. In the EUnetHTA (2008) report health technology assessment is defined as ‘a multidisciplinary process that summarizes information about medical, social, economic and ethical issues related to the use of health technology in a systematic, transparent, unbiased, robust manner. The aim of HTA should be to inform the formulation of safe, effective, health policies that are patient focused and seek to achieve the best value’. Second, EUnetHTA (2008) recommends labelling HTA systems according to: The working level of the HTA organization (i.e., whether it is local-‐regional, national, local-regional and national, international, national and international, local-‐regional, national and international) Profile of the HTA organization (i.e., whether it is a governmental agency, compulsory health insurance, other private company, professional association, private medical insurance or other) Who took the initiative in establishment of HTA organizations (i.e., whether it is only governmental, governmental, decision-‐makers and researchers, only health researchers, health researchers and decision-‐makers, only decision-‐makers and other) Whether there is collaboration, at the international level, between HTA institutions. The type of collaboration is separated into: academia, governmental agency, professional associations, hospital, industry, patient associations and other Who are the results and findings of HTA disseminated to (is it public healthcare providers, policy makers, health professionals, professional associations, health-‐related professionals, health service researchers, researchers, compulsory healthcare insurance, pharmaceutical/ devices industry, patient groups/carers, private healthcare providers, media, general public, private medical insurance, consumer associations?) Third, the EUnetHTA (2008) report considers the possibility of adapting HTA results from one context to another (something which requires greater ‘standardisation’ of country-‐specific methods) although it recognises the lack of generalisability of clinical and most economic data; for instance, there are problems of generalising data collected in clinical trials to routine clinical practice as well as economic (cost) data from one place to another. When there is no evidence at all, or it is impossible to adapt HTA findings from one context to another, performing and commissioning primary research (where feasible) to answer the assessment question will be needed. Another relevant report is that by Sorenson, et al. (2008), which provides a general look at the role and functions of HTA and supports this with a number of case studies on European countries. 33
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