HTA:
What Can Ukraine Learn from
the International Experience
Milena Izmirlieva, Senior Manager
29 October 2013
Presentati...
Agenda
• What is HTA?
• Why do HTA?
• HTA role and criteria
• HTA process

• What are the benefits of HTA?
• What are the ...
What is HTA?
• Health Technology Assessment (HTA):
• the systematic evaluation of the properties and effects of a health

...
Why Do HTA?
• New health technologies of proven clinical value pose a dilemma:

their application may require additional (...
HTA is One Element of Decision-Making
HTA is not the
decision!!!

HTA serves to help
make the decision.
It provides a brid...
HTA Role Depends on Various Factors
• Existence of HTA agency
• Remit of HTA agency
• Timing of HTA review
• Link between ...
HTA Criteria Applied by Country
Criteria Applied to
HTA for
Pharmaceuticals
Budget Impact
Costs
Cost Effectiveness

Effica...
HTA Process
• Assessment request (submission or identification of research
•

•
•
•

need); prioritisation; commissioning
...
Decision Outcome
• Full or partial funding/reimbursement recommendation
• Coverage with evidence generation

© 2013 IHS

9
HTA Recommendation Implementation
HTA
Outcome

Recommendation to
decision-making body

HTA outcome is binding

HTA
Outcome...
Benefits of HTA
• Bring rationality to healthcare decision making
• Improve transparency
• Help decision-maker to balance ...
Costs of HTA
• HTA agencies tends to be non-profit bodies, funded by public

funds, with some contributions from the indus...
“Best Practice” in HTA
• There is no agreement on best practice in terms of methodology

for conducting HTA even if the st...
Does Ukraine Need HTA?
• A decision for Ukraine to make.
• When it comes to pharmaceuticals, HTA is typically used for

or...
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IHS Healthcare and Pharma expert slides from the Ukrainian Pharmaceutical Forum on HTA in the Ukraine.

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HTA: What can Ukraine learn from the international experience

  1. 1. HTA: What Can Ukraine Learn from the International Experience Milena Izmirlieva, Senior Manager 29 October 2013 Presentation at 2013 Ukrainian Pharmaceutical Forum
  2. 2. Agenda • What is HTA? • Why do HTA? • HTA role and criteria • HTA process • What are the benefits of HTA? • What are the costs of HTA? • “Best practice” in HTA • Does Ukraine need HTA? © 2013 IHS 2
  3. 3. What is HTA? • Health Technology Assessment (HTA): • the systematic evaluation of the properties and effects of a health technology, addressing the direct and intended effects of this technology, as well as its indirect and unintended consequences, and aimed mainly at informing decision-making regarding health technologies • HTA aims to inform health policy and decision-making in a bid to optimise care using the available resources, so that the most effective technologies are promoted while taking consideration of organisational, societal and ethical issues. © 2013 IHS 3
  4. 4. Why Do HTA? • New health technologies of proven clinical value pose a dilemma: their application may require additional (financial and nonfinancial) resources or redistribution of existing resources within the health system. • Is funding the given technology a good use of limited resources compared to existing options? • Support funding decisions!!! © 2013 IHS 4
  5. 5. HTA is One Element of Decision-Making HTA is not the decision!!! HTA serves to help make the decision. It provides a bridge between research and a real-life situation where multiple priorities need to be balanced. HTA brings rationality to health policy decisionmaking. © 2013 IHS Source: WHO, adapted from Davies, 2005 5
  6. 6. HTA Role Depends on Various Factors • Existence of HTA agency • Remit of HTA agency • Timing of HTA review • Link between HTA and funding decision • Other cost-containment tools in use © 2013 IHS 6
  7. 7. HTA Criteria Applied by Country Criteria Applied to HTA for Pharmaceuticals Budget Impact Costs Cost Effectiveness Efficacy Degree of Innovation Need Germany Denmark France Hungary √ √ (not systematically used) √ √ √ √ Italy √ √ (since Oct. 2013) √ √ √ Poland √ √ Netherlands √ √ √ √ √ √ √ √ √ √ √ UK Brazil √ √ √ √ √ √ √ √ √ √ Safety Relative Effectiveness √ √ √ √ √ √ √ √ √ √ √ Source: IHS © 2013 IHS 7
  8. 8. HTA Process • Assessment request (submission or identification of research • • • • need); prioritisation; commissioning Developing the remit and scope (treatment, comparators, outcome measures, measures of costs and length of time, stakeholders) Appraisal of the evidence: clinical and cost effectiveness and financial analysis in terms of the limits agreed at the scoping stage. Draft recommendation (potential to appeal, submit additional data) Final recommendation © 2013 IHS 8
  9. 9. Decision Outcome • Full or partial funding/reimbursement recommendation • Coverage with evidence generation © 2013 IHS 9
  10. 10. HTA Recommendation Implementation HTA Outcome Recommendation to decision-making body HTA outcome is binding HTA Outcome © 2013 IHS Government or other reimbursement body makes final decision (France, Switzerland, Poland, Romania) Payers/National Health System ( UK, Germany, Finland) 10
  11. 11. Benefits of HTA • Bring rationality to healthcare decision making • Improve transparency • Help decision-maker to balance different priorities • Improve fairness • Reflect societal expectation/ideals • And the unexpected: protect government/insurers from litigation (e.g., in Brazil) © 2013 IHS 11
  12. 12. Costs of HTA • HTA agencies tends to be non-profit bodies, funded by public funds, with some contributions from the industry • HTA agency budgets vary from EUR1 million to substantially more than EUR10 million depending on function • Opportunity cost: with limited resources, time spent on one appraisal could have been used to appraise another technology © 2013 IHS 12
  13. 13. “Best Practice” in HTA • There is no agreement on best practice in terms of methodology for conducting HTA even if the steps of the process are agreed: • Cost-effectiveness measured in ICER per QALY is the favoured approach in UK and certain other Anglo-Saxon countries • Cost effectiveness or cost utility analysis based on relative effectiveness to treatment alternatives is favoured in France and Germany © 2013 IHS 13
  14. 14. Does Ukraine Need HTA? • A decision for Ukraine to make. • When it comes to pharmaceuticals, HTA is typically used for originator medicines (i.e., pointless to use if you plan to reimburse only generics). • HTA needs to be seen in the context of the healthcare system: no point in conducting HTA if other cost-containment tools invalidate its effect (e.g., Bulgaria, Romania) • If the answer is “yes”, help is at hand: e.g., EUnetHTA initiative, NICE International. © 2013 IHS 14

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