Avoiding health technology assessment: a global survey of reasons for not using health technology assessment in decision making

Teerawattananon, Yot; Painter, Chris; Dabak, Saudamini Vishwanath; Ottersen, Trygve; Gopinathan, Unni; Chola, Lumbwe; Chalkidou, Kalipso; Culyer, Anthony J.

doi:10.1186/s12962-021-00308-1

Cited by 20 publications

(16 citation statements)

References 23 publications

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“…In recent years, countries have developed a considerable capacity to support HTA implementation, particularly following the World Health Organization’s resolution WHA67.23 on health intervention and technology assessment in support of universal health coverage [ 23 ]. It must be recognized that the ability to undertake robust HTAs in resource-constrained settings—where it might also be most helpful in informing efficient allocation of scarce resources—paradoxically remains significantly underdeveloped [ 24 ].…”

Section: What Does Hta Mean When Applied To Cancer Medicines?mentioning

confidence: 99%

“…It is worth noting that critics of the harmonization processes had expressed their concern that overarching and dominant, general decisions may be too inflexible to respond to local contexts. Therefore, some degree of autonomy is desirable to enable context-appropriate implementation–one of the core aims of HTA [ 21 , 24 ]. While harmonization would not overcome the uncertainties associated with data per se, by enhancing the capacity to develop timely and more robust HTA methodologies through pooling national efforts and expertise, harmonization could reduce the likelihood of HTA misinforming decisions when there are limited data.…”

Section: What Could Be Donementioning

confidence: 99%

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Implications of Oncology Trial Design and Uncertainties in Efficacy-Safety Data on Health Technology Assessments

et al. 2022

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Background: Advances in cancer medicines have resulted in tangible health impacts, but the magnitude of benefits of approved cancer medicines could vary greatly. Health Technology Assessment (HTA) is a multidisciplinary process used to inform resource allocation through a systematic value assessment of health technology. This paper reviews the challenges in conducting HTA for cancer medicines arising from oncology trial designs and uncertainties of safety-efficacy data. Methods: Multiple databases (PubMed, Scopus and Google Scholar) and grey literature (public health agencies and governmental reports) were searched to inform this policy narrative review. Results: A lack of robust efficacy-safety data from clinical trials and other relevant sources of evidence has made HTA for cancer medicines challenging. The approval of cancer medicines through expedited pathways has increased in recent years, in which surrogate endpoints or biomarkers for patient selection have been widely used. Using these surrogate endpoints has created uncertainties in translating surrogate measures into patient-centric clinically (survival and quality of life) and economically (cost-effectiveness and budget impact) meaningful outcomes, with potential effects on diverting scarce health resources to low-value or detrimental interventions. Potential solutions include policy harmonization between regulatory and HTA authorities, commitment to generating robust post-marketing efficacy-safety data, managing uncertainties through risk-sharing agreements, and using value frameworks. Conclusion: A lack of robust efficacy-safety data is a central problem for conducting HTA of cancer medicines, potentially resulting in misinformed resource allocation.

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Section: What Does Hta Mean When Applied To Cancer Medicines?mentioning

confidence: 99%

Section: What Could Be Donementioning

confidence: 99%

Implications of Oncology Trial Design and Uncertainties in Efficacy-Safety Data on Health Technology Assessments

et al. 2022

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“…While contextual factors must be considered to establish suitable HTA processes, considering cost-effectiveness information enhances the “good value-for-money” approach which is especially crucial in low- and middle-income country (LMIC) settings where resources are limited. Despite misconceptions that persist about HTA and feasibility issues, and hindrances to HTA processes created by values, attitudes and politics (17), establishing HTA is still a worthwhile ambition.…”

Section: Introductionmentioning

confidence: 99%

A model-based study to estimate the health and economic impact of health technology assessment in Thailand

Kingkaew

Budtarad

Khuntha

et al. 2022

Int J Technol Assess Health Care

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ObjectivesHealth technology assessment (HTA) plays a central role in the coverage and reimbursement decision-making process for public health expenditure in many countries, including Thailand. However, there have been few attempts to quantitatively understand the benefits of using HTA to inform resource allocation decisions. The objective of this research was to simulate the expected net monetary benefit (NMB) from using HTA-based decision criteria compared to a first-come, first-served (FCFS) approach using data from Thailand.MethodsA previously published simulation model was adapted to the Thai context which aimed to simulate the impact of using different decision-making criteria to adopt or reject health technologies for public reimbursement. Specifically, the simulation model provides a quantitative comparison between an HTA-based funding rule and a counterfactual (FCFS) funding rule to make decisions on which health technologies should be funded. The primary output of the model was the NMB of using HTA-based decision criteria compared to the counterfactual approach. The HTA-based decision rule in the model involved measuring incremental cost-effectiveness ratios against a cost-effectiveness threshold. The counterfactual decision rule was a FCFS (random) selection of health technologies.ResultsThe HTA-based decision rule was associated with a greater NMB compared to the counterfactual. In the investigated analyses, the NMB ranged from THB24,238 million (USD725 million) to THB759,328 million (USD22,719 million). HTA-based decisions led to fewer costs, superior health outcomes (more quality-adjusted life-years).ConclusionsThe results support the hypothesis that HTA can provide health and economic benefits by improving the efficiency of resource allocation decision making.

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“…Health technology assessments (HTAs) evaluate the benefits and costs of health technologies, and when used can inform policy decisions about whether a particular intervention represents value for money. In Bangladesh, India and Viet Nam [ 4 ], and in low- and middle-income countries (LMICs) in general [ 5 , 6 ], it is noted that economic evaluations and HTAs seem to make only a limited impact on health policy decisions, and less, it is claimed, than in certain high-income countries. Nevertheless, even from North American perspectives, it is also suggested there are limitations on the impact economic evaluations seem to make on health policy decisions, even when they might be taken into consideration [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Research can be integrated into public health policy-making: global lessons for and from Spanish economic evaluations

Trapero‐Bertran

Pokhrel

Hanney

2022

Health Res Policy Sys

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WHO promotes the use of research in policy-making to drive improvements in health, including in achieving Sustainable Development Goals such as tobacco control. The European Union’s new €95 billion Horizon Europe research framework programme parallels these aims, and also includes commitments to fund economic evaluations. However, researchers often express frustration at the perceived lack of attention to scientific evidence during policy-making. For example, some researchers claim that evidence regarding the return on investment from optimal implementation of evidence-based policies is frequently overlooked. An increasingly large body of literature acknowledges inevitable barriers to research use, but also analyses facilitators encouraging such use. This opinion piece describes how some research is integrated into policy-making. It highlights two recent reviews. One examines impact assessments of 36 multi-project research programmes and identifies three characteristics of projects more likely to influence policy-making. These include a focus on healthcare system needs, engagement of stakeholders, and research conducted for organizations supported by structures to receive and use evidence. The second review suggests that such characteristics are likely to occur as part of a comprehensive national health research system strategy, especially one integrated into the healthcare system. We also describe two policy-informing economic evaluations conducted in Spain. These examined the most cost-effective package of evidence-based tobacco control interventions and the cost-effectiveness of different strategies to increase screening coverage for cervical cancer. Both projects focused on issues of healthcare concern and involved considerable stakeholder engagement. The Spanish examples reinforce some lessons from the global literature and, therefore, could help demonstrate to authorities in Spain the value of developing comprehensive health research systems, possibly following the interfaces and receptor model. The aim of this would be to integrate needs assessment and stakeholder engagement with structures spanning the research and health systems. In such structures, economic evaluation evidence could be collated, analysed by experts in relation to healthcare needs, and fed into both policy-making as appropriate, and future research calls. The increasingly large local and global evidence base on research utilization could inform detailed implementation of this approach once accepted as politically desirable. Given the COVID-19 pandemic, increasing the cost-effectiveness of healthcare systems and return on investment of public health interventions becomes even more important.

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Avoiding health technology assessment: a global survey of reasons for not using health technology assessment in decision making

Cited by 20 publications

References 23 publications

Implications of Oncology Trial Design and Uncertainties in Efficacy-Safety Data on Health Technology Assessments

Implications of Oncology Trial Design and Uncertainties in Efficacy-Safety Data on Health Technology Assessments

A model-based study to estimate the health and economic impact of health technology assessment in Thailand

Research can be integrated into public health policy-making: global lessons for and from Spanish economic evaluations

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