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

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OHE Consulting Report for PhRMA 5 January 2011 6.3 Where does HTA fit into the healthcare system? Garrido, et al. (2010) discuss a way of fitting HTA into health systems. They start by describing an input-‐outcome model (Figure 5) where the health system contributes to the production of health through processing two types of inputs: (1) risk-‐related inputs (i.e., the incidence and prevalence of disease and disability that affects the health status of the population) and (2) resource-‐related inputs (i.e., the financial, human and technological resources devoted to the production of healthcare). The paper broadens the definition of ‘health technologies’ to include more than just medical products since health production requires healthcare and non-‐healthcare inputs. Figure 5: Input-‐output model of the healthcare system: Garrido et al (2010) They describe three types of ‘health technologies’: (1) healthcare products like drugs, devices and procedures used for the production of health services [so-‐defined as technologies applied within the healthcare system] (2) technologies applied to the healthcare system in order to organize access, service delivery, payment of providers etc. [i.e., regulatory and policy measures on ‘patient demand/access’, ‘structures and organisations’, ‘processes’, ‘healthcare outcomes’] (3) technologies that promote and protect health outside of the health system (for instance public transportation, educational and social services etc.). Health is produced from a combination of these three types of ‘health technologies’. The authors argue that selecting the right ‘health technologies’ is important for everyday management, organisation and delivery of healthcare and health. They note that policy-‐makers and health planners rely on different sources of information on health technologies: evidence from research and ‘colloquial evidence’ including expert and profession opinion, political judgement, 36
OHE Consulting Report for PhRMA 5 January 2011 interpretation of values and traditions, and views from stakeholders. HTA is defined as systematic knowledge that fills the gap between scientific knowledge and decision-‐making; HTA is a tool for knowledge management and an aid to decision-‐making. The paper argues that HTA needs to be developed further (in response to demand for information by decision-‐makers) in two areas: the underlying methodological approach, and extension of HTA to assessment of other health technologies besides healthcare products. So far HTA has been almost exclusively applied to decisions regarding availability and reimbursement of healthcare products and services. It is better, the paper argues, to extend HTA to cover other health technologies (as they are also inputs for healthcare and health production). Figure 6 below shows the current focus on HTA and its possible extension to other two types of health technologies. Figure 6: HTA within the healthcare system: current application to coverage decisions (A) and proposed expansion of HTA role (B and C): Garrido et al (2010) By assessing the clinical and economic value of the three types of health technologies, HTA can contribute to achieving ‘community effectiveness’ (in routine clinical practice) that is as close as possible to efficacy levels measured in controlled clinical trial settings. The paper concludes by suggesting that countries embarking on HTA (including low-‐ and middle-‐income countries) should not consider establishing completely separate agencies for HTA, quality development, performance measurement and health services development; but rather combine these agencies into a common knowledge or evidence synthesis strategy for evidence-‐informed decision-‐making. 37
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