Now at its 5^th year, the conference has received its highest number of abstract submissions and highest number of participants to date. The network has grown substantially since its inception in 2010, starting with only five member organizations to this year’s astonishing 28 organizations from at least 15 different countries. It is noteworthy to mention that the HTAsiaLink conference has not only been a platform for research to be shared amongst peers and colleagues across Asia and the west but has increasingly emerged to become the stage with which countries who wish to incorporate HTA into their decision-making process can learn about HTA case-studies from other countries who already have an HTA institutional arrangement embedded in their policy-making, such as Thailand or as hospital-based, like Singapore.

Plenty of newcomers and HTA neophytes emerged at this year’s conference. A delegate from the Essential Medicines and Technology Division (EMTD), Department of Medical Services, Ministry of Health, Bhutan, has noted that this was his second time to attend the HTAsialink conference and hopes to attend in the incoming years. He remarks that the HTAsialink conference was a good platform of learning on how to conduct HTA as it would apply to Bhutan.

This year, the conference was divided into four parts – on opening day, it began with pre-conference workshops from various HTA experts flown in from Europe, Australia and Singapore with lectures on economic models, multi-criteria decision analysis (MCDA), health care systems dynamics and how to present your research at a conference. The second and third day was filled with plenary sessions and the presentation of relevant research from all the members of the network. On the last day a plenary session was held in the morning on, how much do institutional arrangements make for HTA discussing the different types of HTA bodies that countries can have and whether they make a difference for evidence-based policy. In the afternoon, the closing session included the members and the board meeting. These meetings were substantial to set the direction of the network as a whole.

One of the features in the line of workshops during the pre-conference was a session on Value focused thinking in MCDA in HTA and Health policy jointly held by Professor Alec Morton from the University of Strathclyde and Ms. Laura Morris from NICE International. In the session, Professor Morton highlights that HTA practitioners not only focus on providing analyses that showcase cost-effectiveness and budgetary impacts. Analyses may also include how specific interventions will perform under different criterion. The advantage of providing these types of analyses to decision-makers is for them to have a better knowledge of the trade-offs they are making when embarking on a specific policy, not simply in terms of cost-impact but also in terms of operations and implementation impacts.

In the second and third day, the following abstracts were awarded for the successful presentation of relevant research under Economic Evaluations:

1st Place: Steven Yingpeng Qiu, CNHDRC, China, Cost-effectiveness analysis of Tenofovir Disoproxil Fumarate nucleotide antiviral therapy for chronic hepatitis B patients in China

2nd Place: Wantanee Kulpeng, HITAP, Thailand, Cholangiocarcinoma screening program in Thailand: a cost-utility analysis

3rd Place: Mohamed Ismail Abdul Aziz, Ministry of Health, Singapore, Cost-Effectveness of Nucleos(t)ide analogues for the treatment of hepatitis B

The following abstracts were awarded for the successful presentation of relevant research under Health Systems Research:

1st Place: Sally Wortley, University of Sydney, Australia, Tailoring public engagement to HTA decision-making: a discrete choice study

2nd Place: Sarocha Chootipongchaivat, HITAP, Thailand, Estimating human resource impact from introduction of pneumococcal vaccination program in the Philippines: an alongside economic evaluation study

3rd PLace: Roongnapa Khampang, HITAP, Thailand, Developing quality indicators for the Quality and Outcomes Framework program in Thailand

3rd Place: Roza, Sarimin, MaHTAS, MoH, Malaysia, Water Birth: How Safe and Effective?

This year’s lineup of research has markedly improved,  according to Dr. Peter Coyte of the University of Toronto, a frequent commentator and participant in HTAsiaLink’s panel of judges over the years. This only shows how much the capacity and the expertise for HTA in Asia has improved and will continue to improve.

The 6th HTAsialink conference is set to be hosted by Vietnam’s Health Strategy and Policy Institute (HSPI). There is certainly more in store for HTA in Asia. HTAsiaLink is poised to be one of the vehicles for the diffusion of HTA in Asia. In this same manner, IDSI’s partnership with the HTAsiaLink Network will undoubtedly become a linkage to look forward to in years to come.

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The APO, with support from HITAP and NICE international, brought together HTA practitioners from China, Korea, Malaysia, Taiwan, and Thailand to develop a policy brief on Conducive Factors to HTA Development in Asia. In addition to the country working paper authors, Mr Manoj Jhalani (Joint Secretary – Policy, Ministry of Health and Family Welfare) gave the keynote on India’s progress in UHC through the National Health Mission, and its need for HTA as a “system of knowledge to address what needs to be prioritised”. Researchers from respective institutes in Indonesia, the Philippines, Vietnam and India also shared their countries’ experiences on the recent efforts for HTA introduction in these settings.

There was a fantastic turnout, and attendees came from different backgrounds, ranging academic institutions, civil society, donor agencies, HTA agencies, health and finance ministries, industry, and other public and private sector agents. The objectives of the meeting were to get feedback from this broad audience on the draft APO brief, to raise awareness of HTA establishment and its use in policymaking, and to share learning to other countries committed to UHC. As part of the team that collated and edited the draft report, the discussions were particularly relevant for me.

Topics for the presentations included:

• whether UHC itself is a conducive factor or challenge to HTA development
• the development of individual stakeholders, institutional capacity, and networking capacity, and their linkages to policy,
• the key enabling factors for the integration of HTA into health systems.

Some of the issues and challenges highlighted during the discussions were:

• the need for priority setting in all kinds of contexts (especially resource-limited countries)
• opportunities and difficulties in the political process and possible distortionary effects of technologies
• demand generation vs. answering current demand for HTA in countries
• the need for and challenge of good quality data from LMICs, and
• generalisability of research in one setting to another.

The findings from these discussions will be used to produce a practical guide (chapter on recommendations) for the policy brief.

With the introduction of the Universal Health Coverage (UHC) in Asian countries, priority-setting and HTA has become increasingly important.  However, only in the past decade has HTA been used to inform countries’ health programs and policies. As such, HTA agencies are relatively new in Asia.  In 2007, the Health Intervention and Technology Assessment Program (HITAP) was established in Thailand. Consecutively in 2008, a HTA division was established in Taiwan’s Center for Drug Evaluation (CDE) and the National Evidence-based healthcare Collaborating Agency (NECA) was founded in Korea.

CDE, HITAP, and NECA started to make concrete collaborations soon after.  The establishment of the HTAsiaLink in 2010 by these three organizations contributed to the subsequent release of the HTAsiaLink quarterly publication.  An annual HTAsiaLink conference was established with the aim of building capacity of junior staff and allowing them to build networks in the HTA field, alongside other joint activities.

These efforts garnered more international attention, such as the support and collaboration with the Asia Pacific Observatory on Health Systems and Policies (APO), an organization that promotes evidence-based health policy-making in Asia.

Co-hosted by HITAP and the APO, a meeting between representatives of formal and informal HTA agencies was conducted at HITAP’s offices on November 24-25, 2014.  Participating countries were China, Indonesia, Korea, Malaysia, the Philippines, Taiwan, Thailand, and Vietnam. The participants discussed in depth the history of HTA development in their countries, the characteristics of the country’s HTA researches and/or HTA agency, and the barriers as well as conducive factors to establishing an HTA agency.

Several key findings emerged from the discussions. In terms of potential interventions assessed, majority of the agencies included assessments on drugs, medical devices, and public health interventions, while only half included pricing recommendations.  Generally, characteristics of functioning HTA agencies are: having a significant proportion of population covered by government health plans; having a national health agency(ies) with full time staff dedicated to HTA; and finally, having a direct link with decision makers and consequently the decision-making process (though this is most effective if legislation supports the HTA system).

Factors conducive to establishment of HTA includes political will and legislation, health system infrastructures such as hospital database, strong domestic networking and engagement of stakeholders, and support from regional and international external partners.  Major barriers are over-reliance on expert opinions and deference to senior staff/physicians/the specific medical field’s experts instead of evidence-based decision making (which is perhaps a more characteristic of cultures in Asia), as well as HTA and HTA agencies’ dissociation from the government’s decision making process.

The policy brief meeting’s two outputs are expected to have a significant impact for HTA regionally and globally.  First, it aims to strengthen the HTAsiaLink network and individual agencies as well as promote the establishment of formal HTA country agencies.  Information from this meeting will be used for the APO’s Heath Systems in Transition (HiT) policy brief report for HTA.  Countries that foresee more HTA work in the future may also use the lessons learned in other countries to formalize their own agencies and policies.  Second, the policy brief will be launched at the Prince Mahidol Award Conference (PMAC) in 2016.  Strengthening country HTA agencies will come under international attention as this conference brings together leading public health leaders and stakeholders from around the world to discuss high priority global health issues, summarize findings, and propose concrete solutions.

A second meeting is set to be conducted in the end of January 2015, to coincide with the Prince Mahidol Award Conference (PMAC) 2015 in Bangkok, to finalize the report and discuss the next steps to establishing successfully functioning HTA agencies in the whole of Asia.

Visit the Asia Pacific Observatory on Health Systems and Policies to read Factors Conducive to the Development of Health Technology Assessment in Asia