Recently the ABPMJAY, which covers 10 million vulnerable families, reached a milestone of providing 100 million treatments. However, given the size of the scheme, ensuring cost-effectiveness within such a large scheme is highly dependent upon having detailed and robust information on economic costs within the health system. Here we discuss, the role of costing in priority setting, price negotiations and the measures that India is taking in this area, as part of its efforts to ensure equity and cost-effectiveness within its healthcare system.

Poor cost data can lead to the misallocation of resources 

Priority setting is the process of making decisions about how best to allocate limited resources to improve population health. Priority setting within healthcare can be facilitated through health technology assessments (HTA) which includes quantifying whether investments in healthcare are both clinically effective and cost-effective and through exploring the key factors within the healthcare system that drive costs.

In India, as in many low- and middle-income countries (LMICs), there have been challenges in systematically incorporating explicit priority setting or HTA into healthcare decision-making in India. A key barrier has been the complex and fragmented healthcare system with several different insurance and “assurance” arrangements, at both the central and state level. Despite these challenges, the government of India has begun to take proactive steps towards institutionalising HTA. It has established its own HTA agency at the national level (HTAIn) in the Ministry of Health and Family Welfare, and HTAIn has been developing HTA standards and initiating the first health technology appraisals.

But, as HTA rolls out in India, the limited availability of cost data has been highlighted as a key concern by both government actors and the press. The availability of cost data is in turn constrained by limited  cost data collection activities, the inadequacy of information systems to meet costing needs, and the lack of political interest in costing. A typical problem is when only some of the costs relevant to delivery of a drug or diagnostic tool are assessed (e.g. excluding patient monitoring or patient incurred costs). An intervention can then appear more or less cost-effective than they actually are and fail to acknowledge the cost burden placed on patients.

This is a problem found in many LMICs but with political will, a standardised, central, and freely available source of health service cost data can be developed to address this gap (such as in Thailand or Cambodia). As a result it will lead to a fall in the duplication of efforts and the expense of data collection to improve the quality of HTA.

Good quality cost information can help governments negotiate better prices

The terms “cost” and “price” are often, mistakenly used interchangeably. However, they are extremely different things. Specifically, prices do not necessarily reflect costs. Prices are the negotiated rate for a good e.g. drugs or service such as consultations. Set too high, prices can over-stretch a budget, limiting spending in other areas and setting up barriers to care and, where individuals pay for care, lead to catastrophic health expenditure. At the same time, high reimbursement rates can result in the over-use of certain treatments such as c-sections and have even led to unwanted hysterectomies. Set too low and the prices can contribute to over-use of some therapies such as antibiotics. Good quality cost information and HTA can help regulate prices so that they reflect value for money.

Regulating prices can be easier within health systems that have a central purchaser such as the UK, France, Australia and Thailand where prices are set in accordance with costs. Within these countries, uniform reimbursement rates are set using data on the cost of health service provision collected through the mandated submission of cost data from all providers or, in the case of Thailand, comprehensive cost surveys conducted by the Health Intervention and Technology Assessment Program of the Ministry of Public Health (HITAP).

Such a system which involves a central regulator encourages transparency and can help contain growth in costs through both accountability as well as economies of scale. For example, using reliable cost information in an HTA process allowed the Thai government to negotiate an affordable price for the HPV vaccines, demonstrating how monopsony power (when there is only one buyer in a market) combined with good cost information can contain costs.

Regulating prices is trickier in fragmented healthcare systems (e.g. USA or India) which have many different types of providers and purchasers (insurers/government). In India, the fragmented system has resulted in large scale variations in prices for similar services across and between states and providers. The majority of fee rates within India’s many public health insurance schemes have been set using various processes and fee rates with different incentives for different services resulting in a process that is “non-transparent and often arbitrary and irrational.” These prices are likely to be inefficient and highly incentivise certain types of services at the expense of others, such as the use of high technology stent implants that have no evidence based benefit over cheaper models. Gathering information on  coronary stent prices revealed price mark ups of between 4-6 times the cost price, leading government price capping and up to 85 percent price reductions. Similarly, a recent Indian initiative to improve TB testing in the private sector has shown how standardisation of prices can be achieved by bringing private laboratories together under a single regulatory body, India has reduced the cost of accredited TB tests to affordable levels. The issue has been highlighted during the COVID-19 pandemic with private hospitals accused of charging exorbitant prices, making the government mandate hospitals to share COVID-19 fee details and some evidence of drops in non COVID related healthcare utilisation due to financial barriers.

As publicly funded health insurance schemes expand to cover a greater portion of the population and consume a greater portion of the healthcare budget, the need for prices to be set at efficient levels is more pressing. The demand for freely available good quality cost information to inform price-setting therefore becomes increasingly important.

India is beginning to build a cost evidence-base

Until now, costing information in India has largely been fragmented, not available across states or levels of the health system and highly disease specific. In fact, the major source of cost data has been individual cost studies which have been mixed in validity and reliability. This has been further compounded by the fact that there is a limited pool of health system experts with costing experience in India.

In recognition of the lack of costing capacity within India, the Department of Health Research (DHR) along with academic experts like PGIMER Department of Community Medicine and School of Public Health have taken a proactive approach to strengthen the costing capacity of the health system. Alongside the establishment of a technical working group on costing, there has been support for the development of training material for economic evaluation more generally and subsequently in specific topics including costing. These take the form of online modules, workshops for policy-makers and practitioners and a forthcoming costing manual which lays out principles and standards for costing health services in India.

To improve the availability of data, a National Health System Cost Database website is being built as a public good, by PGIMER Chandigarh, with the support of the International Decision Support Initiative (iDSI). This database currently includes data on the unit costs of health services from 167 public health facilities (district and below) located in 6 different states across India, collected in collaboration with PGIMER’s partners IIT Madras, PHFI Delhi, TISS Mumbai.

In addition to the development of the database and website, the HTAIn has launched a national cost study-Costing of Health Systems (CHSI)-to collect further cost information from public and private healthcare tertiary and district level providers located across 11 different Indian states. The data will be used for HTA and has been used to estimate the unit costs of the AB-PMJAY health benefit packages (HBP). The National Health System Cost Database website continues to be updated with new data (such as the CHSI results) as these become available, as well as the latest methodological standards and guides.

The database website also hosts a user friendly and unique unit cost predictor (based on a statistical cost function). The predictor allows users to generate state specific average outpatient visit and inpatient admission costs for use in their own analyses. For example, a researcher wanting to do an HTA specific to the state of Andhra Pradesh would be able to extract a mean cost for their locality rather than use a national level average.

These first incremental steps towards generating nationally representative health service cost data for India are already proving their value. Since the launch of these two initiatives, the CHSI study costs results have been used to inform reimbursement rates for AB-PMJAY as well as for as well as for the costing of PMJAY COVID-19 HBPs.

What next?

India has initiated a welcome and multi-faceted approach for increasing costing capacity, improving cost data and generating a robust evidence base for HTA. These initiatives are already facilitating priority setting and a more transparent price setting process. But there is still work to be done. The role of costing in decision-making needs to be higher up in the healthcare policy makers’ agenda and become an integral part of the evidence base. Healthcare providers and academic centres can facilitate this by adapting information systems to meet cost data collection needs. More critical, is the need for greater transparency around fees and charges. In the future, Ministry of Health; State Departments of Health; National and State public health insurance agencies can make publication and/or submission of provider healthcare costs or fees a mandatory requirement for all providers and in particular publicly funded healthcare. These incremental but exceedingly important steps will help create more transparent healthcare decision-making in the country.

Authors: Lorna Guinness, Hiral Anil Shah, Abha Mehndiratta and Shankar Prinja

Thank you to Kalipso Chalkidou for valuable oversight.

By Abha Mehndiratta, Kalipso Chalkidou, Saudamini Dabak, 5^th May 2020

Health Technology Assessment (HTA) is a policy tool to support rational priority-setting. In India, it allows decision-makers to make informed comparisons to ensure cost-effective, high-quality health services and interventions are supplied or purchased by the Ministry and State Departments of Health and Family Welfare. As India moves towards the achievement of Universal Health Coverage (UHC) with the Ayushman Bharat Scheme, HTA is critical for choosing services/interventions which provide value for money. This is applicable for both the health benefits package of the Pradhan Mantri Jan Aarogya Yojana (PMJAY) health insurance scheme and primary care services provided by the Health and Wellness Centres. It can also help improve quality control of the growing private healthcare sector in India by improving return-on-investment of public-private partnerships with better quality and appropriate care.

The International Decision Support Initiative (iDSI) was invited by the Bill & Melinda Gates Foundation (BMGF) India Country Office to share its experience of supporting institutionalisation of HTA in India with other BMGF partners. During the webinar iDSI partners from the Center for Global Development (CGD), Health Intervention and Technology Assessment Program (HITAP) – Thai Ministry of Public Health, Imperial College London and the Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh shared their work within India on the healthcare priority setting agenda. Links to the recorded video and slides from the webinar are available and a brief overview of the session is provided below:

iDSI is a global network of priority setting institutions that has been collaborating with partners in low-and-middle income countries (LMICs) to build capacity for HTA. Since 2013, iDSI has partnered with countries such as Indonesia and China on institutional strengthening, data and analytics, development of global public goods on methods and tools, and smart purchasing.

The Individual, Node, Network and Enabling Environment (INNE) framework was used as a systematic approach to share iDSI’s capacity building activities with stakeholders at various levels for institutionalisation of HTA in India to accelerate sustainable UHC.

• Individual: Increased technical capacity of users and producers of HTA via training workshops, higher education programs and technical support on HTA studies.
• Node: Strengthened institutional frameworks by supporting the Department of Health Research (DHR) in establishing HTAIn (Health Technology Assessment in India) infrastructure. For example, by sharing relevant documents on HTA process and methods, country experiences etc.
• Network: Facilitated and encouraged participation of partners from India who routinely undertake HTA studies at relevant HTA network meetings like HTAsiaLink Conference, the Prince Mahidol Award Conference (PMAC) etc.
• Enabling Environment: Catalyzed increased political commitment and buy-in for evidence informed priority setting through high-level engagements and awareness raising events.

Examples of applications of HTA in India were shared such as (i) HTA on anti-viral drugs for Hepatitis C that led to its inclusion in Punjab Government’s health benefits package and also caused change in standard treatment guideline for Hepatitis C management (ii) HTA on safety-engineered syringes leveraged by the Government for price negotiation and procurement. The government of Andhra Pradesh to decide on this topic subsequently cited this study.

HTA related knowledge products from India were briefly discussed during the webinar. This included the HTA methods manual; budget impact modelling guidelines; health related quality of life value set (EQ5D5L) for India, Cost of Health Services in India (CHSI) study and the National Cost Database for India. The National Cost Database is a central resource for users and producers of cost data and currently includes data from 200 public facilities in 6 states. Analytic work using the National Cost Database is being continued to develop a unit cost predictor to estimate unit costs of healthcare service delivery in India.

IDSI’s work with partners has laid the groundwork for the future by increasing capacity of users and producers of HTA. It has supported in country efforts in building an infrastructure for evidence-informed policymaking, developing a range of knowledge products and strengthening networks with partners in other countries. In addition, based on current trends, the importance of prioritising healthcare resources will become all the more acute as India emerges from the COVID-19 crisis. In the post-COVID-19 era it is unlikely to be business as usual. India will need to balance pre-COVID-19 UHC commitments with clearing up backlog of elective procedures and resuming vaccination and screening campaigns during what is forecast to be the deepest recession since 1979. Demonstrating value for money through systematic processes will therefore be a policy priority and ought to be seen itself as a Best Buy for healthcare systems.

The Health Technology Assessment programme (HTAIn) which is funded by the Government of India, is now fully operational. Coordinated by a dedicated Secretariat based at the DHR, the HTAIn also works with ten designated Indian technical partners who produce Health Technology Assessment (HTA) studies on topics of national importance. iDSI has provided key technical assistance to the HTAIn Secretariat to train their technical partners on all steps required to conduct an HTA study. In the past 6 months over ten HTA reports have been finalised and approved by the Technology Appraisal Committee (TAC). Among them, the results of the HTA study on Intra Ocular Lens for cataract Surgery and safe syringes informed the definition and costing of the Health Benefits Package for the Pradhan Mantri Jan Arogya Yojana (PM_JAY )in India, the largest nationally funded public healthcare scheme in the world. States across India are increasingly looking to HTAIn for evidence-based advice on how to incorporate health technologies into the health system.

A recent and exciting development is that HTAin has launched its dedicated website: Among other things, the website features information on HTAIn structure including theTAC and its HTA methods process. The website also features HTAIn current activities and the HTA reports prepared by HTAInTechnical partners. The HTAIn website also links with major national initiatives, including the Post Graduate Institute of Medical Education & Research (PGIMER) PGIMER Costing database, a tool for health policy makers and analysts that provides unique information on the unit costs of health services in India.

With these new tools, a host of different stakeholders at both central and state level in India have access to valuable resources that will help them make evidence-based priority decisions on health technologies in India. They also ensure transparency in the way HTAIn operates, working to international standards. As the PM_JAY evolves HTAIn will play an increasingly important role in helping the Government of India make considered decisions on the distribution of health budget resources, as well as timely uptake of good value technologies  and in advancing Universal Health Coverage (UHC) for its population.

As part of three recent events, which saw hundreds working in health policy gather in Accra, Liverpool and London, iDSI sought to delve into important factors that guide the design of Essential Medicines Lists and Health Benefit Packages that can evidentially identify the potential value of different interventions.

The events allowed for an increased understanding of the value of Health Technology Assessment (HTA) and how it underpins strategic purchasing of health services for achieving UHC; and shone a light on ‘demonstration’ countries such as China and Ghana which are making large strides towards ensuring HTA is at the forefront of their policy agenda. Events on this scale are a result of the culmination of many years of engagement; and new partnerships that have enabled iDSI access to new LMIC partners, allowing for regional and global networking and knowledge sharing.

Setting Priorities Fairly: Sustainable Policies for Effective Resource Allocation saw almost 100 policy representatives from across Africa and Europe gathered in Accra, Ghana for a special event in September 2018 that focused on sustainable resource allocation policies for LMICs, co-hosted by iDSI and Health Technology Assessment International (HTAi). The event marks an important milestone in iDSI’s collaboration with Ghana which began in 2008 (via the Global Health and Development Group at Imperial College, formerly NICE International), as well as the nation’s commitment to realising a “Ghana beyond aid” as its booming economy puts it on course to transition from external development aid.

The two-day event, opened by Ghana’s Deputy Minister for Health Mr Kingsley Aboagye-Gyedu, set out to address the difficulties LMICs face with attaining UHC; and how to navigate inconsistent and dwindling healthcare funding. HTA was a key focus, with presentations including global experiences of HTA from eminent researchers, health economists and clinicians from the University of Ghana, Ghana’s National Health Insurance Authority, The Global Fund to Fight AIDS, Tuberculosis and Malaria, World Health Organization, HTAi, iDSI and more.

During his keynote speech Mr Aboagye-Gyedu described how Ghana had incorporated HTA recommendations in its Standard Treatment Guidelines and Essential Medicines List because of its usefulness as tool to assuring value-for-money – from the design and management of benefit packages to the determination of reimbursement list of medicines. This follows a View our iDSI timeline to read more about Ghana’s journey towards UHC to date.

iDSI‘s newly released Health Technology Assessment Toolkit was launched at the event, with each delegate receiving the resource on a USB stick. The HTA Toolkit is a free, accessible resource for technical staff working in health policy keen to build HTA processes in their own countries and was developed in consultation with staff working in health policy around the world.

In October 2018 iDSI co-hosted a satellite session on the opening day of the Fifth Global Symposium on Health Systems Research in Liverpool, with Sida and CHAI, on Health financing towards UHC. Through the collaboration, the session brought together officials from Kenya, Zambia, Indonesia, Malawi – as well Eswatini and Rwanda, with whom iDSI had not previously engaged – representing ministries of health, national health insurers, a Prime Minister’s cabinet and academia. The panellists shared practical experiences from health financing reforms in their countries, with a focus on priority-setting and strategic purchasing. The overarching theme of the symposium was Health Systems for all in the Sustainable Development Goals era and it commemorated anniversaries of two significant global health events – the Alma Ata declaration and the 70 years of the UK National Health Service (NHS).

The same week saw iDSI welcome 22 delegates from China, from both clinical and non-clinical backgrounds, representing various departments within the Chinese Ministry of Health (National Health Commission); the China National Health and Development Research Center (Beijing and Shanghai); local policy makers from three provinces; and academics from Huazong, Beijing and Shanghai universities, to develop their understanding of the UK healthcare system, including health-related legislation and regulatory mechanisms, policy development and health reforms. The momentum behind HTA in China has in part been facilitated by longstanding relationships between the Global Health and Development Group and the enthusiasm of Chinese policy makers following UK study tours to learn about the NHS approach to setting priorities fairly.

The visit preceded the National HTA Congress in Beijing on 25 October 2018 which saw the formal launch of the National Center for Integrated Assessment of Pharmaceuticals and Health Technologies in China, and where iDSI support was noted at the opening event. One of the first major tasks of the national HTA Center will be to update the National Essential Drugs List taking into consideration cost-effectiveness criteria. The HTA Center’s work will be carried out by iDSI core partner the China National Health Development Research Center, a national think-tank set up in 2008 that provides evidence-based technical advice to national and provincial health policy-makers.

iDSI Director Professor Kalipso Chalkidou has said China “can lead the way” with regards to using HTA as a policy tool to contain spending and drive more equitable care. This follows Professor Chalkidou’s attendance to the National HTA Congress, detailed also in an View our iDSI timeline to read more about the evolution of HTA in China.

The annual study tours, which started in 2014 (under NICE International) have involved talks from expert representatives from the Department of Health, the Medicine and the Healthcare Products Regulatory Agency, Public Health England, National Institute for Health and Care Excellence, the UK Health Forum and the London School of Economics.

2017’s study tour was timed so key individuals from the National Health and Family Planning Commission (replaced by the National Health Commission in 2018), CNHDRC and GHD could participate in the 5th UK-China People-to-People Health dialogue, attended by UK Secretary of State Jeremy Hunt; NHFPC Vice Minister Cui Li; and the Parliamentary Under Secretary of State for Public Health and Primary Care Steve Brine and Margaret Chan, former Director-General of the World Health Organization.

We have made slides available from:

Setting Priorities Fairly: Sustainable Policies for Effective Resource Allocation

Health financing towards UHC HSR 2018 satellite session

Chinese delegation visit 2018

What’s In What’s Out contains in-depth case studies of how LMICs have grappled with and guidance on designing Health Benefits Packages for UHC.

The first day started with the dissemination meeting of a project supported by the UK Prosperity Fund. The project, led by CNHDRC, focused on utilising UK expertise to support the development of standardised methods to generate evidence-based care pathways for chronic disease in China. The division director of CNHDRC, Prof Kun Zhao, outlines the aim of developing a standardized approach to developing and updating clinical guidelines in China, with a practical application to existing care pathways and guidelines in hypertension and diabetes, currently in use in Xiamen and Qingdao.

The meeting continued with an overview by experts from Xiamen and Qingdao on the ongoing efforts to improve the management of patients with chronic diseases. At the end of the meeting Prof Mike Roberts from UCL Partners shared some experiences on transforming health care towards evidence-based practices and current thinking on new integrated care models in the UK. He emphasized the importance of establishing standardised guidelines to provide high quality and equitable care for the whole Chinese population.

During the afternoon of the 17th, a leadership training workshop was delivered. At the beginning of the workshop, participants were familiarized by the theory on how to implement change and introduce new guidelines into clinical practice.  Later on, effective team leadership strategies in implementing change were discussed.  The training was attended by senior officials from Xiamen Health Bureau and Qingdao Health Bureau, representatives from tertiary and secondary hospitals, nurses, local administrative officials as well as clinicians. The knowledge gained from the workshop is expected to help local stakeholders build effective clinical teams to implement the new guidelines in an efficient manner.

The following week, a workshop was held over two days on ‘Health Policy Evaluation and Technology Assessment Knowledge Sharing’. This workshop was organised in order to help support the momentum generated by the newly launched China Health Policy and Technology Assessment Network, with CNHDRC in the role of focal point of the network (the iDSI China HTA hub).  The workshop was opened by Hongwei Yang, the deputy Director General of CNHDRC, Prof Kun Zhao and Dr Kalipso Chalkidou, Director of the GHD. The aims, objectives and structure of the nascent China HTA network were introduced. In addition, the workshop explored a number of topics considered highly relevant for HTA development in China. These include the role of the iDSI Reference Case and how it may be adapted for a Chinese context; evaluating non-budgetary constraints; health system strengthening; measuring HTA impact; economic evaluation and public health; adapting HTAs; and HTA and medical devices.  For each thematic area there were presentations from UK-based academics and Chinese researchers, as well as experts from the Thai HTA agency, HITAP. HITAP colleagues shared their experiences of how HTA was used to inform UHC policy in Thailand. The workshop concluded with reflections on the working plan for the China network as an iDSI HTA hub, and exploring new collaborations and next steps.

In terms of next steps, it was highlighted that a key objective should be to increase the number of members of the China Health Policy and Technology Assessment Network and on standardising the methodology used in developing clinical guidelines, especially for chronic diseases in China.

1- Dissemination Meeting on Developing Evidence-based Care Pathways for Chronic Disease in China
February 17th – Morning

National Developments showcase & providing means for utilising UK expertise

Following successful launch of this UK supported Prosperity Fund project on July 28th 2016, the dissemination meeting had the key aim of communicating progress in establishing a standardised approach to clinical guidelines development, and in applying them to update existing care pathways in China. The topic areas selected for the pilot were on priority chronic disease areas namely hypertension and diabetes that were currently in use in Xiamen and Qingdao cities.

A representative on the behalf of CNHDRC Director General- Ms Wei Fu gave an opening speech where he provided an overview of the burden of chronic diseases in China. He described China’s aging population as a critical high priority issue, highlighting the estimated 220 million people aged above 60 in China, added to by about 8 million people per year. He emphasized the significance of establishing a ‘tiered healthcare system’ in China utilizing UK NHS expertise and experience to support the local development of standardised care pathways. He concluded by inviting the audience of about 50 in number consisting of senior officials from Xiamen Health and Qingdao Health authorities, representatives from tertiary and secondary hospitals, nurses, local administrative officials and clinicians- to share the results of the preliminary version of the guidelines handbook, and encouraged feedback and discussion among attendees.

Ashwini Kirchner, Head of Health and Social Care at the British Embassy in Beijing highlighted the importance of bilateral commitment between the UK and China, to learn from one another. She stated that healthcare is a key point of interest between the two countries. Kirchner highlighted the aims of Prosperity Fund Project in providing cutting edge policy in an area where the UK can offer expertise, and to give way for a real impact on the ground.

Kun Zhao, Division Director in CNHDRC, described the status quo and progress of Chinese guidelines development. She compared UK and Chinese guidelines, and provided recommendations for realizing the project aims. She linked the importance of robust guidelines development with the considerable uncertainty around the effectiveness of most of new technologies in China, and the absence of economic and equity perspective in setting hospital treatment standards in different regions in China.

The preliminary version of the Chinese guidelines handbook received strong positive feedback from the audience. Changqin Liu, Vice President of the first affiliated hospital of Xiamen University noted the professionalism underpinning the handbook and described it as a first of its kind to be developed in China.

“This guidelines handbook is very comprehensive…It is first time where we can align with UK Clinical Guidelines principles….I learned a lot”
Fusong Liu- Cardiology department Director of The Third People’s hospital of Qingdao.

Professor Mike Roberts of UCL Partners concluded the meeting by giving a brief presentation on new models of care in the UK, such as ‘Integrated Care Pioneers’ and ‘Vanguard sites’. His presentation can be found here.

2- Leadership & Change Management training
February 17th – Afternoon

Leading Change: New guidelines, new approach..

The afternoon session was dedicated to a training workshop that builds on the introduction of the new guidelines in Xiamen and Qingdao hospitals. According to Mike Roberts, the implementation of new guidelines depends on a number of factors, the most important of which are understanding and managing the change process involved, and developing effective leadership among the interdisciplinary teams adopting the new hypertension and diabetes clinical guidelines.

The training workshop took place over 3 hours and involved presentations on change management by Reetan Patel, effective team leadership by Mike Roberts, combined with an interactive discussion and group work scenarios. The group work emphasised the experience of trying to implement a new set of clinical guidelines and how they may be understood from different perspectives among the stakeholders affected such as management, clinicians and other various implementing teams. The audience were mainly senior officials from Xiamen and Qingdao health authorities, representatives from tertiary and secondary hospitals, nurses, local administrative officials and clinicians.

3- iDSI HTA workshop: knowledge sharing event to support newly launched China HTA network
February 20th – 21st

The role of HTA in international development & National Regulatory Authority strengthening

The iDSI HTA workshop in Xiamen builds on the MOU supporting informed implementation framework for HTA between GHD and CNHDRC. The two-day workshop revolved around 6 main themes: standardised methods for economic evaluation, non-budget constraints and health system strengthening, measuring HTA impact and return on investment, HTA and medical devices, economic evaluation modelling and public health, and adapting HTA to the Chinese context.

The workshop commenced with an opening statement by a representative of CNHDRC on the behalf of Deputy Director Hongwei Yang, who emphasized that the current leadership in China is very supportive of HTA capacity building especially in light of major technology transformation in China.

Kalipso Chalkidou gave an overview of the objectives of the HTA workshop including outlining the role of iDSI HTA hubs for supporting national and regional HTA related activities. Kun Zhao introduced the China HTA network, which is a network of 29 institutions and hospitals backed with a great amount of support by the Chinese healthcare authorities (the presentation can be found here). Tony Culyer briefly introduced the iDSI Reference Case, what it is and how it can be adapted to China context (see his presentation here).

Professor Pete Smith of Imperial College London delivered a presentation on developing a framework for evaluating interventions aimed at health system strengthening. Eleanor Grieve of University of Glasgow talked about developing a theoretical framework for assessing the impact of HTA and the return on investment. Professor Klim McPherson of Oxford University provided a presentation on role of epidemiological modelling to support decisions in public health, and Anastasia Chalkidou and Naomi Herz of KiTEC talked about assessing medical devices and the challenge of incorporating economic evaluations in that field (their presentations can be found here).

Chinese academics linked with the new HTA network also spoke about the role of HTA in China in line with the themes of the workshop. There were presentations on: Standards and procedures of HTA in China by Haiyin Wang, Division Director of Shanghai Health Development Research Center, Performance evaluation on public health system in China by Professor Zhachun of Tongji University, Outcome Evaluation of the Tiered healthcare system in China by Rui Zhao of CNHDRC, Rapid HTA on Proton and Heavy Ion radiotherapy by Michelle Li of CNHDRC; Economic Evaluation of hepatitis B management strategy in China by Steven Qiu of CNHDRC; and finally, a talk by Jenny Sui of CNHDRC on using international evidence to assess cellular immunotherapy.

The iDSI HTA workshop provided an opportunity for new collaborations between Chinese HTA specialists, UK researchers, and colleagues from neighbouring countries. During the second day of the workshop, a roundtable discussion involving health officials and academics from Indonesia, Cambodia and China highlighted the interest in engaging in mutual cooperation, and the opportunity offered by the Chinese HTA network in providing regional support. The rise of China’s HTA capacity comes at a pivotal timing given the upcoming BRICS Summit scheduled to take place in Xiamen next September. The five key priority areas for BRICS collaboration are: deepening cooperation, strengthening global governance, making institutional improvements and building broader partnerships. Within this context, HTA capacity buidling and wider heathcare refirm offers one important route to achieve these aims. The Goa declaration highlights the importance of BRICS cooperation in the area of healthcare regulation.

“We will seek to identify possibilities for cooperation among our health and/or regulatory authorities, with a view to share best practices and discuss challenges, as well as identifying potential areas for convergence”
8^th BRICS Summit- Goa Declaration October 2016.

China’s role in international support has been given added impetus by a number of initiatives including the recent “One Belt One Road” strategy. Such initiatives can provide important opportunities for sustainable development in countries along the Silk Road Economic Belt, and will be crucial in supporting the spread of evidence informed healthcare decision making in LMICs, a key objective of iDSI.

Health Policy Technology Assessment China

6th December marked the launch of the China Health Technology Assessment hub to which Kalipso Chalkidou, Director Global Health and Development Group (GHD), was invited, representing iDSI and Imperial College London. Kalipso presented on the value of HTA as a means of managing expenditure and ensuring investment is made in those technologies and interventions most likely to benefit large numbers of those in need. The event was hosted by the China National Health Development Research Center (CNHDRC) and attended by the WHO and the World Bank with over 75 senior officials from the National Health and Family Planning Committee (NHFPC), the National Development Research Committee (NDRC), the Ministry of Finance, the Ministry of Labour and Social Security; provincial health bureaus, and scholars from major Universities including Renmin University, Peking University , Fudan University with a track record in health reform and HTA.

The event was opened by Vice Minister Ma who commented that “HTA is a necessary precondition for achieving Healthy China 2030…and a new approach to the supervision and reimbursement approach of the market economy which has succeeded the planned economy in China”. He also highlighted the value of HTA as a means of promoting “innovation driven development” and supporting policy makers make informed choices for NCD prevention, a major priority for the government.

Building on this work, we are proud to announce CNHDRC as the China hub for iDSI, a major centre for promoting evidence informed policy making in support of China’s national reforms as per the Healthy China 2030 report, as well as a regional and global hub which can support countries in the region struggling to attain and sustain Universal Health Coverage, such as Cambodia and Myanmar and beyond, such as South Africa and others SSA countries launching National Health Insurance plans. We are honoured and look forward to working with our Chinese partners and supporting the Chinese authorities in their task of ensuring good quality equitable care for the whole of their population.

The agenda for the launch can be found here 

The Forum, attended by 300 delegates from academia, provincial and central administration and the international HTA community, was an opportunity to share experiences and commit to institutional partnerships including with Fudan University.

Fudan has a long tradition in HTA training and capacity building since the early 90s. The University  is increasingly investing in HTA, including a soon to be launched MOOC in HTA for Chinese students and is keen to build international partnerships in the field of Priority Setting in health. This is an opportunity for Imperial College’s Institute for Global Health Development to further strengthen its Chinese links with academics and policy makers in the country.

The main aim of the visit was the signing a Memorandum of Understanding (MoU) between the China National Health and Development Research Center (CNHDRC) and the Institute for Global Health Innovations (IGHI). This agreement is the first collaboration between Imperial College and CNHDRC.

Find a more detailed visit report on the IGHI webpage 

The slides can be found here