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

OHE Consulting Report for PhRMA
5 January 2011
9.4 Issues for PhRMA in developing public policy positions
The PhRMA, EFPIA, and IFPMA principles for good practice in HTA and Evidence-­‐based Medicine
provide a consistent approach to “micro HTA” and continue to provide a solid framework for
approaching HTA issues globally. They are intended to be applied in a reactive way – in the event of
a payer and/or government proposing the use of “micro HTA”.
We have sought to develop a framework for putting such a position into the context of health care
system development and HTA evolution. Our key points are that HTA is resource intensive and that
an appropriate initial focus for skilled people may well be on “macro HTA” or other health system
issues rather than “micro HTA”.
This gives rise to several issues:
As compliance with good HTA principles is resource-­‐intensive for governments (and for
industry), countries may seek to “free ride” on the systems of other countries to avoid using
scarce skills and resources. Indeed, as we have noted earlier, the global public good nature of
much evidence means that “not reinventing the wheel” can make sense and be efficient.
However, use of alternative “low resource” options may be less efficient than an efficient use of
HTA. For example, the use of international reference pricing to countries at a similar stage of
income-­‐per-­‐capita and with similar health care systems can make sense if the referenced
countries have used appropriate methods to derive their prices. However, international
reference pricing in practice can lead individual country markets to seek lower-­‐than-­‐optimal
price levels not consistent with long-­‐term, global dynamic efficiency (Danzon et al, 2010). HTA
may therefore be preferable to international reference pricing if it is used to assess value in a
way that reflects local willingness to pay for health gain;
The use of therapeutic reference pricing requires less input than HTA but can discourage
innovation and reduce the likelihood of efficient use of the product (Drummond et al, 2010). It
saves input resources by assuming medicines are the same instead of exploring the appropriate
use of different treatments in a given therapy area.
This suggests that the industry be willing to support ‘efficient’ HTA, i.e. appropriate to a given
country market and subject to the lessons we have set out in 8.1 above.
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