• Solicit feedback from a diverse group of stakeholders on how iDSI can maximise its impact in support of government priority-setting.
• Solicit input on the form and agenda of an ongoing iDSI stakeholder engagement mechanism.

The iDSI Stakeholder Engagement report summarises the outcomes of interviews and concludes with an initial set of options for ongoing stakeholder engagement. The interviews revealed a very high level of interest in and support for iDSI’s efforts to support processes of HTA development and priority-setting.  Interviewees also pointed to where there is a need for greater clarity, both in terms of the services iDSI offers and how it plans to engage the wide range of stakeholders interested in these issues.

The findings will inform iDSI’s future governance & accountability, engagement with stakeholders, and the definition of roles among partner organisations.

The full report can be downloaded in the iDSI Knowledge Library and on the Meteos website

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We needed to know who were making priority-setting decisions in the respective health systems, how these decisions were being made and financed, what technical capacity countries had to implement HTA processes, as well as the key challenges facing their health systems. But at the time, there was no comprehensive literature covering all of these issues of relevance to priority-setting, within a broad enough geographical scope. Existing surveys on HTA (including those done by NICE International and HITAP) tended to focus narrow on its technical aspects, whereas studies from the health systems research field didn’t go deep enough into the important facets of priority-setting such as who are the stakeholders, what evidence is used, and so on.

With the end goal of selecting a country to offer iDSI practical support that would be feasible, in demand, and generate significant impact, we set out to assess how ready countries were for priority-setting support. We developed a conceptual framework, methods (including a country selection process), qualitative and quantitative indicators, and data collection tools (including questionnaires and interview guides) for priority-setting readiness. The mapping combined published and grey literature, insights from iDSI partners, and primary data collection from in-country key opinion leaders. And thanks to the hard work of iDSI partners worldwide, we successfully completed mapping of 17 countries within the space of 7 months.

Since completing the mapping, we have used it to select Indonesia as our focal country partner, where HITAP, NICE International and PATH are working in collaboration with local decision makers and academics to support HTA development. We have also subsequently secured additional funding to support a Sub-Saharan African regional hub for priority-setting around PRICELESS SA, South Africa.

One year on from the HITA resolution, there has been a proliferation of regional mapping exercises for priority-setting capacity, coinciding with the global momentum to support HITA. These include WHO-led efforts as well as iDSI partnerships with WHO regional initiatives (such as the Asia Pacific Observatory on Health Systems and Policies, and Advance HTA with PAHO). As the global health and political scene is so fast moving, some of the findings in the iDSI mapping report are inevitably already out of date. My hope is that these latest efforts will add to our global knowledge and provide practical insights to international donors and development partners, in order to support country partners in building capacity for better priority-setting in health.

– See more at: https://www.ohe.org/news/international-decision-support-initiative-idsi-mapping-priority-setting-health-17-low-and#sthash.lz3LaQkb.dpuf

Regardless of the structure or budget of the national health assurance scheme that is finally decided on, there will always remain difficult questions of which interventions (from drugs, diagnostics, devices to public health interventions) the benefits package will cover, how, and for whom. This is where evidence-informed priority-setting tools and processes, such as HTA and clinical guidelines, can help to provide a robust framework for stakeholders to make and act on informed decisions, taking into account society’s values and preferences, and for regularly reviewing these decisions.

The discussions and insights from the Better Decisions for Better Health workshop in October 2014 (co-hosted by NICE International, the Ministry of Health and Family Welfare and the World Bank in India), which brought together iDSI experts and other international and Indian partners, remain as relevant as ever.

Making decisions in healthcare is never easy. As one keynote speaker remarked: “How do we choose between buying 5,000 infant warmers, or stents for cardiac patients, or drugs for someone with cancer?” But these decisions still need to be made, since not doing so amounts to a decision that someone else will make instead.

We argue that evidence-informed priority-setting is the way to better decisions for better health, and that is no different for the UK, Thailand, or India.

Download: Priority-setting and Health Technology Assessment for Universal Health Coverage in India: Workshop Summary

With thanks to Abha Mehndiratta

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