Engaging Stakeholders in Technology Assessment for Health ... Forum 2013...  Engaging Stakeholders

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Engaging Stakeholders in Health Technology Assessment for Health Policy

NUS INITIATIVE TO IMPROVE HEALTH IN ASIABetter healthcare in Asia through improved research, governance and sustainable financing

NUS INITIATIVE TO IMPROVE HEALTH IN ASIABetter healthcare in Asia through improved research, governance and sustainable financing

1 2 July 2013The Gallery Room, Level 2, Traders Hotel, Singapore

Engaging Stakeholders in Health Technology Assessment for Health Policy

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INTRODUCTION Health systems in Asia and the rest of the world are under pressure. The double burden of chronic and infectious disease among aging populations coupled with rising user expectations and promises for universal coverage have led to growing fiscal demands on strained public-sector resources. At the same time, rapid technological innovation and an expanding global marketplace for health technology bring new promise as well as untried risks, leading to new interest in evidence-based decision making for resource allocation and strategic planning from policy makers as well as other non-governmental stakeholders.

Formal health technology assessment (HTA) is increasingly conducted and used by both the public and private sector, including national and sub-national government bodies but also academic, nonprofit and private research organisations and increasingly, by various players in the healthcare industry, from hospitals introducing new technologies into their facilities to drug companies seeking to market new products and members of the public advocating for their best interests as patients and consumers.

The region now faces the challenge of how best to channel this diverse and increasingly active set of voices into a constructive and transformative dialogue that advances technology-related health policy-making. In this white paper, we highlight emerging issues related to stakeholder engagement in HTA processes that guide health policy making, which covers a range of needs such as:

regulation,licensingorguidancerelatedtotheuseofspecifictechnologies

listingdecisionsforformulariesandprioritizationofdrugsandservicesforbenefitspackages

determinationofvalue-basedpricesforcontractnegotiationsandpurchasing

We discuss the background to these issues relevant to the Asia Pacific, drawing on a growing array of regional experiences with building and integrating this capacity into healthcare systems.

EXECUTIVE SUMMARYGlobally, Health Technology Assessment (HTA) is increasingly conducted and used by both the public and private sector in a range of processes that guide policy making such as:

regulation,licensingorguidancerelatedtotheuseofspecifichealthtechnologies

listingdecisionsforformulariesandprioritizationofdrugsandservicesforbenefitspackages

determinationofvalue-basedpricesforcontractnegotiationsandpurchasing

Such processes affect multiple parties, including the government, industry, providers, patients and members of the public. How best to channel this diverse set of voices into a constructive and transformative dialogue that advances technology-related healthpolicy-making is a challenge that faces HTA practitioners in not just Asia but the world over.

The quality, effectiveness and efficiency of HTA can be enhanced by open and consultative processes. Decision makers around the world are adopting a range of measures to constructively engage multiple stakeholders throughout the HTA process. A few key strategies include:

ensuringthatstakeholdergroupsareproperlyrepresented

enablingaflowofinputfromallgroups

puttingintoplaceformalcriteriaandprocessforthelodgingandreviewofappeals

communicatingHTAevidenceandresearchappropriatelyacrossdiverseaudiences

In Asia, a diverse set of health systems and social, political and cultural backgrounds have led to a range of HTA models in different stages of development, and similarly varying scope and practices of stakeholder engagement. Effective engagement can be challenging for a number of reasons, including:

thecostoftimeandresources

thechallengeofbalancingconflictsofinterest

theneedforstakeholdereducation

thepotentialriskofpubliccontroversy

Meeting these and other challenges to engagement in this context involves bringing together:

astrongcommitmenttoclearandtransparentprocesses

investmentofresourcestoensuresoundimplementation

recognitionoftheneedforflexibilityandadaptability

Strategically investing in appropriate health technologies can improve both health and the quality of life. It is important to appreciate fully the role of the different actors that are involved in this process and provide them with due consideration in HTA processes. This years NIHA Forum aims to provide a platform to build regional networks and begin a dialogue about key issues in HTA such as stakeholder engagement, to ensure that technological development continues to support population health in Asia, now and in the future.

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THE ROLE OF STAKEHOLDERS IN HTA

The World Health Organization defines healthtechnology assessment as the systematic evaluation of properties, effects, and/or impacts of health technology [1], where technology is broadly defined as the application of organized knowledge and skillsin the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve quality of life. Health technologies therefore are not limited to pharmaceuticals, diagnostic technologies and medical equipment but also include therapeutic and preventive care procedures, interventions such as health promotion and workplace health and safety programmes and organisational or support platforms such as electronic medical record keeping.

Rather than any one technical approach, HTA is most often characterized by (a) a decision-making focus (b) sensitivity to a particular setting and (c) the use of a rigorous and sound methodology. HTA generally calls for a clearly-articulated decision model aimed at a particular problem, which is then analysed by integrating technical evidence of clinical performance such as efficacy and efficiency studies with context-specific situational analyses, using non-scientific or colloquial evidence such as expert opinion to adapt the findings and resolve gaps or inconsistencies. The specific objectives and methods used vary from horizon scanning to safetyand effectiveness assessments economic evaluation - whether cost-benefit analysis, cost-efficiency analysis, cost-minimization analysis, or budget impact analysis and beyond. The HTA process often follows a typical path: topic selection and prioritization, followed by adetermination of the appropriate analytic criteria and benchmarks and/or comparators, evidence gathering,

evaluation and weighting of the evidence according to the decision criteria, the drawing of conclusions, making recommendations and finally a process of review, dissemination, implementation, all three (sometimes but not always) preceded by an appeal stage.

The outcome of any HTA process that guides public policy affects multiple parties with different interests, including the government, industry, providers, patients and members of the public. These stakeholders have very different immediate objectives and long-term goals, resources and operational capacities. For instance, when prioritizing certain procedures

The field [of HTA]is large, diverse, competitive, and highly

innovative. This is an area of great promiseIt is also an area with

a number of problems and pitfalls, some familiar, others unique. As

many have noted, the field requires, and deserves, its own unique

agenda. Health officials and hospital managers in all countries, at all

levels of development, need guidance.Dr Margaret Chan, WHO Director-General

FIGURE 1: HTA STAKEHOLDER GROUPS

Government and private sector policy and biomedical research agencies, academic health centres

Patient and consumer organisations

Government and private sector payers

Regulatory agencies and standards setting organisations

Venture capital groups and other investors

Hospitals and health care networks, health professional organisations

Technology manufacturers

for coverage under a national insurance fund, a local health body may heavily weight the potential for improvements relative to highly-local conditions related to quality of care, whereas a national HTA agency may take a broader social perspective. On the other hand, product development and innovation at pharmaceutical companies or medical technology companies may be driven by access to markets and competitive forces on a global level. In the absence of engagement mechanisms, such groups may pursue their own interests independently or myopically, leading to inefficient policymaking and potentially ineffective policies.

The quality, efficiency and effectiveness of HTA can all be enhanced by open and consultative processes. HTA strives for a delicate balance, in that the results need to meet high research standards, but also need to fulfill standards of acceptability, fairness and feasibility of implementation. To accomplish this, HTA needs to be interdisciplinary (in that it covers the clinical, social, economic, legal and ethical implications of the health technology), deliberative [2] (in that it that implies the collection and synthesis of evidence of different kinds and from different sources) and pragmatic (in that objectives, approaches a