Evidence-Informed Deliberative Processes for Health Benefit Package Design – Part II: A Practical Guide

Abstract

Background. Countries around the world are using health technology assessment (HTA) for health benefit package design. Evidence-informed deliberative processes (EDPs) are a practical and stepwise approach to enhance legitimate health benefit package design based on deliberation between stakeholders to identify, reflect and learn about the meaning and importance of values, informed by evidence on these values. This paper reports on the development of practical guidance on EDPs, while the conceptual framework of EDPs is described in a companion paper. Methods. The first guide on EDPs (2019) is further developed based on academic knowledge exchange, surveying 27 HTA bodies and 66 experts around the globe, and the implementation of EDPs in several countries. We present the revised steps of EDPs and how selected HTA bodies (in Australia, Brazil, Canada, France, Germany, Scotland, Thailand and the United Kingdom) organize key issues of legitimacy in their processes. This is based on a review of literature via PubMed and HTA bodies’ websites. Results. HTA bodies around the globe vary considerable in how they address legitimacy (stakeholder involvement ideally through participation with deliberation; evidence-informed evaluation; transparency; and appeal) in their processes. While there is increased attention for improving legitimacy in decision-making processes, we found that the selected HTA bodies are still lacking or just starting to develop activities in this area. We provide recommendations on how HTA bodies can improve on this. Conclusion. The design and implementation of EDPs is in its infancy. We call for a systematic analysis of experiences of a variety of countries, from which general principles on EDPs might subsequently be inferred.

Designing and Implementing Deliberative Processes for Health Technology Assessment: A Good Practices Report of a Joint HTAi/ISPOR Task Force

“…There is an opportunity among countries with less-developed deliberative processes to start building them with features that take account of decision-making needs and environmental and societal constraints. Most low- and middle-income countries are in the early stages of developing HTA systems and can potentially incorporate learnings from the experiences of others ( 6 ). In contrast, most high-income countries have already established institutions and processes that may be more difficult to change ( 33 – 34 ).…”

“…However, the core values and associated actions were developed with drug reimbursement recommendations specifically in mind, so their applicability to other stages of HTA and health technologies is unclear. Likewise, specific guidance for legitimizing health benefits package design has been developed ( 6 ).…”

Designing and Implementing Deliberative Processes for Health Technology Assessment: A Good Practices Report of a Joint HTAi/ISPOR Task Force

“…Most low- and middle-income countries are in the early stages of developing HTA systems and can potentially incorporate learnings from the experiences of others. 6 In contrast, most high-income countries have already established institutions and processes that may be more difficult to change. 33 , 34 This means that these countries will require approaches to evaluate their current deliberative processes and to identify where improvements might be made.…”

The Use of Evidence-Informed Deliberative Processes for Health Insurance Benefit Package Revision in Iran

“…The EDP framework is a practical and stepwise tool for priority setting, rooted in health technology assessment, with the explicit aim to optimize the legitimacy of benefit package decisions. [12][13][14][15] In this framework, the concept of legitimacy is translated into four elementsstakeholder involvement, ideally operationalised through stakeholder participation with deliberation; evidenceinformed evaluation; transparency; and appeal. The practical guidance on EDPs provides recommendations on how these elements can be implemented in each step of the decisionmaking process of HIBP design.…”