The 2019 study tour represented another successful collaboration between core iDSI partners to support knowledge strengthening among key policy makers in China through interaction with representatives from UK government agencies, NHS, academic and private sector colleagues involved in healthcare.

The Chinese participants included seven representatives from the National Health Commission, including representation from the Department of Drug Policy and Essential Medicines Systems, and the Department of Healthcare Reform; a representative from the Department of Social Security, Ministry of Finance; and representatives from provincial health authorities, including the health commissions of Liaoning, Jiangsu and Henan. Researchers and policy advisers from CNHDRC and the Shanghai Health and Development Research Center also joined, in addition to colleagues from the academic sector in China, the latter including representation from Peking University, the Beijing Normal University, and the China Pharmaceutical University. Full details of all the participants can be found listed in the agenda.

As in previous years, all 27 delegates received a detailed introduction into the structure and financing of the NHS, including the role of HTA in supporting resource allocation decisions in the UK. In addition, there was a special focus on primary care, led by the Imperial College WHO Collaborating Centre for Public Health Education and Training, and an afternoon workshop hosted by the Centre for Health Economics at the University of York, which explored specific issues relating to the application of economic techniques to inform discussions on evaluating health system performance and efficiency.

For this year’s tour, we also placed a special emphasis on the UK’s approach to cancer care, specifically in relation to the process adopted by the National Institute for Health and Care Excellence (NICE) when evaluating new oncology products. We also explored the importance of considering the value that new innovations could bring within the context of delivering appropriate and timely pathways of care, including radiology, pathology, surgery, and radiotherapy. The UK’s experience in these issues can potentially provide useful insights for the Chinese setting, given that cancer has become a leading cause of mortality in the country. This is being driven by an ageing population and the prevalence of lifestyle factors such as smoking, with lung, stomach and breast being among the most common cancers. Policy makers in China have recognised the need to strengthen systems for assessing the clinical benefit of new cancer medicines, and this will be the focus of planned further collaboration between the Global Health and Development Group at Imperial and CNHDRC.

We would like to thank everyone who attended and contributed to the two-week study tour, with a special thanks to the British Embassy in Beijing, and Professor Kun Zhao and her team at the CNHDRC.

As countries move towards Universal Health Care coverage and transition from development assistance for health, there is an even more acute need to establish robust processes for assessing and integrating new cost-effective health technologies: a key pillar of financially sustainable, and transparent health systems.

A key strategy to support enhancing VfM is through the incorporation of context specific and economically informed evidence into all levels of health decision-making.

Last month iDSI was in Geneva running an introductory course for Unitaid and the Global Fund on economic approaches used in public health, with specific reference to HIV, TB and Malaria. The two day course covered:

1. Existing approaches to VfM at the Global Fund and Unitaid
2. The theory behind why priority setting in health is important, methods behind conducting economic analysis and practical applications of priority setting in countries
3. How countries are introducing and developing Health Technology Assessment (HTA) processes on the path to Universal Health Coverage

The course was facilitated by Francis Ruiz and Alex Winch (Imperial College London) along with Professor Alec Morton (University of Strathclyde). The training was organised by Ross Leach from Unitaid and Shufang Zhang from the Global Fund.
Attendees from the Unitaid strategy, results and finance teams joined staff from the Global Fund’s Technical Advice & Partnerships, Health Product Management and Grant Management divisions.

Ongoing iDSI projects in the Philippines and Kenya were referenced, along with practical examples of integrating the STAR (Socio-Technical Allocation of Resources) tool in countries; and a deep dive on how VfM is considered in published literature around Malaria, HIV and Hepatitis C.

At the national level, countries are increasingly developing formalised HTA processes to support evidence-based trade-offs in health, across a range of diseases and for the adoption of innovative health technologies.

At the international level, countries are looking to the development community more and more for guidance and support on incorporating HTA, as expressed in World Health Assembly resolution 67.23 on HTA. iDSI hopes to harness more opportunities to further engage with multi-lateral financing organisations such as the Global Fund, Unitaid and normative technical agencies such as the World Health Organization on the robust use of economic evidence in resource allocation and decision making.

The 22 delegates, from both clinical and non-clinical backgrounds, visited London and Cambridge to develop their understanding of the UK healthcare system, including health-related legislation and regulatory mechanisms, policy development and health reforms.

Along with visits to St Thomas’ Hospital, Boots Pharmacy’s corporate office and AstraZeneca, the group received talks on the role and function of National Institute for Health and Care Excellence and the Medicines and Healthcare Products Regulatory Agency in protecting and improving public health; the pricing of branded and generic pharmaceuticals in the UK; vaccine evaluation; the development of evidence-based clinical pathways and integrated care pathways; and how to best to make use of electronic health record systems.

Members of the delegation from China with iDSI staff in Queen’s Gate

Yu Ou’yang from the Division of Medical Administration within the Hunan Provincial Health Commission in China said: “Over the last two weeks we have had presentations from almost 30 experts, even though the context of the UK and China is very different there has been so much for us to learn here. During the study tour I have realised healthcare management and delivery in the UK is very detailed and precise to ensure all goes as smoothly as possible, the UK also takes into account the balance between cost and effectiveness in healthcare which is extremely important. It has been great to learn more about standardised operations such as Clinical Commissioning Groups and NICE and their responsibilities. I would like to extend my thanks to all the presenters and those that facilitated our practical days.”

Ying Peng, who is based in Beijing but also carrying out a PhD in Health Economics at the University of Sheffield, said: “The range of presentations we received will really help my own PhD studies, I’ve definitely developed my understanding of how new interventions are appraised in the UK and how evidence is the pinnacle of decision-making. It was really important for me to learn more about the UK health system, which organisations underpin it and how this could be adapted for China.”

The group was made up of officials from iDSI core partner the China National Health and Development Research Center (CNHDRC) and the Chinese Ministry of Health (National Health Commission); along with policy makers and academics from Huazong, Beijing and Shanghai universities.

Liu Jianan, from the Division of the Essential Medicines List, within China’s National Health Commission, said: “Our delegation is diverse but between us all we have rich experience and knowledge. Our learning over the last two weeks has been delivered in such a systematic way; there is still much more we can learn from the UK healthcare system however for now I am pleased we will all be able to bring back our experiences from this trip, especially for matters such as pricing for medicines, which is of broad and current interest in China.”

Chen Bo, a PhD student from Peking University’s School of Public Health, said: “I feel very lucky to be here. The talks have inspired me a lot, particularly as my current area of study is public hospital reform at county-level in China. For me the most valuable part of the study tour has been expanding my knowledge of the ways in which hospital reforms could be made more efficient; and learning so much about Cost Effective Analysis exercises and ways we could push forward with this in China.”

Francis Ruiz, iDSI Senior Advisor, said: “The Global Health & Development Team at Imperial and iDSI have been delighted to organise study tours to the UK for senior Chinese officials since 2014. The talks from various presenters, including representatives from The Nuffield Trust, NHS England, NHS Benchmarking and feedback on their own workstreams from the delegates themselves has been a fantastic complement to off-site days where the group observed the delivery of health care first-hand and attended a workshop focused on primary care. We hope the visit was valuable and will have positive impact on them as individuals; and help develop the UK-China partnership in Health Technology Assessment.”

The two-day ‘Setting Priorities Fairly: Sustainable Policies for Effective Resource Allocation’ event, opened Ghana’s Deputy Minister for Health Mr Kingsley Aboagye-Gyedu, set out to address the difficulties LMICs face with Universal Health Coverage (UHC) attainment; and how to navigate inconsistent and dwindling healthcare funding.

Health Technology Assessment (HTA) was a key focus, with presentations including global experiences of HTA from eminent researchers, health economists and medical doctors 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.

Ghana’s Deputy Minister for Health Mr Kingsley Aboagye-Gyedu who opened the event

Under the leadership of Ghana’s Ministry of Health, iDSI has been working with a variety of Ghanaian entities for several years now, providing technical assistance and facilitating capacity building for evidence informed priority-setting, to support the tough decisions and trade-offs government is faced with.

Mr Aboagye-Gyedu also acknowledged iDSI’s support on Ghana’s pilot study on cost-effective management of hypertension, describing the project as “gearing the country into a real policy momentum to entrench HTA into the selection and pricing processes.”

Day one of the event consisted of pre-conference workshops aimed at stakeholders with relevant interest in HTA development in sub-Saharan Africa, intended to provide an overview of HTA, covering core technical components and how HTA could be integrated within a broader decision-making process.

The second day aimed to extend global experiences in HTA to the SSA region and increase the understanding of the use of HTA for resource allocation decisions while coordinating policy priorities of SSA nations. A mix of expert speakers provided international perspectives and thought-provoking presentations in plenary and parallel sessions covering a wide array issues pertinent to HTA in SSA.

iDSI‘s newly released Health Technology Assessment Toolkit was launched at the event, with each delegate receiving the resource pre-loaded onto 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.

Iñaki Gutierrez Ibarluzea, HTAi Vice President, said: “HTAi was proud to join forces with iDSI as well as HTA colleagues from around the world on this ground-breaking initiative. The healthcare challenges sub-Sahara Africa faces are complex and multi-faceted – by leveraging the collective inputs and suggestions from global leaders we hope the ideas and recommendations stemming from this workshop will further spur development and innovation within the region. The collection of knowledge from the delegates that attended the conference was truly remarkable and we are excited to see what some the brightest HTA minds can achieve as a result of this collaboration.” 

Professor Kalipso Chalkidou, iDSI Director, said: “iDSI was delighted to collaborate with HTAi and Ghana’s Ministry of Health to host the event. Bringing together almost 100 policy representatives from across Africa and Europe, our aim was to support countries’ vision to reach Universal Health Coverage in an equitable and sustainable fashion. It was wonderful to be back in Accra, further strengthening our partnership with the Ministry of Health in Ghana, at this event. I would like to extend my thanks to Mr Aboagye-Gyedu for his endorsement and for formally opening and supporting the event.”

Visit the iDSI Knowlege Gateway to read our round up of the event, including key messages and details of external media coverage.

We have made all presentations from the event available on iDSI’s website.

Press coverage:

Ghana News Agency: Ghana hosts conference on sustainable resource allocation
policies (27 September 2018)
Modern Ghana: Conference On Sustainable Resource Allocation Policies (28 September
2018)
Business Ghana: Ghana hosts conference on sustainable resource allocation policies (1
October 2018)

The ‘setting priorities fairly’ event is the first of its kind for Sub Saharan Africa (SSA), with the main event opened by Ghana’s Minister for Health, Kwaku Agyemang-Manu. How important is it for representatives from SSA to share knowledge to optimise the impact of health spending?

The prospect of HTA in SSA is promising, with an increasing number of countries planning to use HTA as a priority-setting tool to promote Universal Health Coverage (UHC). In the light of this, it is crucial that SSA countries share experiences (however little) to learn from each other.

What can attendees to your workshop session on case studies of how Health Technology Assessment can inform decisions on cost-effectiveness expect?

Attendees can expect to learn what has been done already, especially in the case of Ghana and how that applies to their specific country context.

Ghana was the first Sub Saharan African country to introduce a National Health Insurance Scheme (NHIS) and has long standing commitment towards achieving UHC, of course, there is no “one-size-fits-all” approach to UHC, but what is on Ghana’s agenda?

Ghana’s road to UHC through the NHIS has been brave and bumpy, with key challenges relating to financial sustainability. However, given the political support – from all sides of the political divide – the future of the NHIS is bright. A key approach is expanding enrolment through innovative strategies including group enrolment, enrolment of prison inmates etc. In addition, there are efforts to boost the financial status of the NHIS while removing other bottlenecks to promote UHC. A key way forward is re-visiting the Primary Health Care agenda to strengthen close-to-client services and implement provider payment mechanisms that reduce overall service costs and enhance sustainability of the scheme. The overall improvements in the economy could boost fiscal space for health and fast-track attainment of UHC.

You have led on a number of research projects on health economics and policy in Ghana, Botwsana, Kenya, Malawi and Nigeria – what has been your biggest achievement?

My joyous moments (which I see as achievements) are when I see that recommendations from a previous study I was involved in are evaluated and implemented. A typical example was when the Ministry of Health and World Health Organization in Botswana accepted the findings and recommendations of our study on efficiency and begun planning to implement.

What do you enjoy most about your role?

I enjoy seeing my former students in decision-making roles, applying some of the things they learnt. I also enjoy being involved in discussions and networking (with networks such as the platform that iDSI provides) that are directly relevant for evidence-informed policy making in low- and middle-income countries, particularly efforts that benefit Ministries of Health.

If you weren’t a health economist, what would you be doing instead?

I would have been a geomorphologist, studying earth formations.

Registered delegates can attend the workshop Justice will feature in, ‘Introduction to Health Technology Assessment’, from 1pm on 26 September 2018, as part of Setting priorities fairly: sustainable policies for effective resource allocation in Africa.

The workshop was attended by 23 delegates representing NACC and NASCOP, as well partners from the Global Fund to fight against AIDS, Tuberculosis and Malaria; the Centre for Disease Control; USAID, Kenya Institute for Public Policy Research and Analysis; and the National Treasury.

The first day kicked off with presentations and case study exercises by the iDSI team, including an introduction to economic evaluation and to fundamentals of costing; as well as a session on valuing and measuring costs. The HIV programmes in the country highlighted the need to develop a standard framework for costing work in Kenya, given that several costing studies are on-going in the country.

Participants spent the morning of day two discussing the evidence needs for the HIV programme. NASCOP presented the on-going work on the piloting of differentiated care pathways coupled with a quality improvement intervention (DCM+QI) in seven counties. DCM+QI recognises that the change from a single guideline to a differentiated pathways requires up-front investment and training to support providers. As a result, NASCOP has worked for almost two years with facilities in the intervention counties to develop locally relevant solutions to support DCM implementation.

In-country partners, the Global Fund and iDSI, will form a technical working group to support NASCOP and NACC in generating the evidence relating to the pilot. This workshop demonstrated the importance of consultation, especially between external partners and local partners working on the ground in Kenya.

The workshop was the first in a series that are designed to help build capacity for undertaking HTA in India; and come as the Global Health and Development team at Imperial College London have signed a Letter of Understanding with the Department of Health Research (DHR) within the Government of India, who are leading on an exciting initiative to institutionalise HTA.

Over 30 attendees gathered in Delhi for the workshop which focused on introducing participants to the key concepts of evidence-based priority setting and HTA, how to frame an economic evaluation, and how to identify key stakeholders for consultation throughout the HTA process.

Senior Scientist Dr Kavitha Rajsekar discussed the importance of HTA for India and gave an update on the latest developments on HTA in India. Ensuring that an evidence-based, inclusive, and transparent system is put in place via the HTAIN will aid health resource allocation decisions across the country.

Associate Prof Shankar Prinja presented the results of the cost effectiveness of auto disposable syringes, one of the first studies to be approved by the HTAIN Technical Appraisal Committee which has resulted in the government of Andra Pradesh using results to inform their decision to invest in autodisposible syringes to reduce rates of infection due to needle re-use in the state.

Alex Winch discussed what UHC means for India and how establishing fully functioning HTAIN centers will provide a sound basis upon which health resource allocation decisions can be made in India, to ensure that every rupee spent buys the maximum health possible.

Dr Laura Downey and Dr Pankaj Bhaguna outlined what evidence is required to undertake HTA analyses, drawing from their own experience of conducting HTA in India; and their recent publication on identifying publicly available data sources for HTA in India.

Dr Oshima Sachin presented on how evidence for health costs is being collected by the HTAIN and a network of partners from across India to form a common costing database, which iDSI is providing technical advice and assistance with.
Dr Aamir Sohail introduced the concept of equity and ethics in informing HTA in India; and shared his experience of conducting a literature review on equity to inform the intraocular lens HTA undertaken by the HTAIN secretariat at DHR.

Juliet Eames and Saudamini Dabak of HITAP Thailand introduced the concept burden of disease and measuring quality of life to estimate Quality Adjusted Life Years (QALYs), as well as Disability Adjusted Life years (DALYs).
The presentations stimulated lengthy discussions amongst participants as to the challenges of conducing HTA in India, when such evidence is often not available and not routinely collected.

A follow up workshop will be held in three months’ time and iDSI is pleased to report feedback received from participants to this workshop was overwhelmingly positive, with 75% of participants reporting they plan to use the skills and knowledge that they had learned during the course towards undertaking a policy-relevant HTA study.

This was one of the key take-home messages from the first in a series of workshops designed to build capacity for undertaking HTA analyses in India.

Participants from technical institutions across the country travelled to Thiruvananthapuram in Kerala to join this workshop. The workshop focused on supporting India in the transition towards a formalized system of using evidence to inform health resource allocation. The Department of Health Research, Government of India are leading on this by establishing a medical technology assessment board (MTAB). Building capacity to undertake health economic analyses in India will be an imperative foundation for the success of the HTA program under MTAB.

Key take-home messages from the workshop:

HTA is an important tool for prioritizing health resources in India’s journey towards UHC: Dr Soumya Swaminathan, Secretary DHR and Director General of the Indian Council of Medical Research (ICMR) discussed the importance of HTA for India. Ensuring that an evidence-based, inclusive, and transparent system is put in place via the MTAB will aid health resource allocation decisions. As a result, healthcare decisions will be made on the basis of best value for money for the Indian people.

Sri Rajeev Sadanandan, Principle Secretary for the State of Kerala, further reiterated this sentiment and expressed his commitment to establishing a center for HTA in Kerala.

Dr Laura Downey lead a discussion on what UHC means for India, and how establishing a fully functioning MTAB centers on utilizing the best available evidence. This will provide a sound basis upon which health resource allocation decisions can be made in India, to ensure that every rupee spent buys the maximum health possible.

Economic analysis requires a lot of evidence, some of which isn’t always easily available: Discussions relating to evidence were a common theme throughout the workshop. Dr Miqdad Asaria outlined the kinds of evidence that is required to undertake a HTA analyses. Dr Akashdeep Chauhan presented on how evidence for health costs is being collected from across India to form a common costing database. Dr Laura Downey also introduced the concept of utility tariffs for measuring quality of life to estimate Quality Adjusted Life Years (QALYs) or Disability Adjusted Life years. Together these presentations stimulated lengthy discussions amongst participants as to the difficulties of conducing HTA in India, when such evidence is often not available and not routinely collected.

Dr Yot Teerawattanon shared his experience from Thailand, where HITAP conducted primary research to fill these gaps to inform Thai analyses. This included collecting an EQ5D dataset to build a Thai value set for quality of life utility tariffs. Dr Kavitha Rajshekar from DHR highlighted that in order to address some of these data gaps in India, the MTAB will collaborate with the National Institute of Medical Statistics (NIMS) to build a National data repository to inform HTA analyses.

A mechanism for identifying and addressing data gaps will also be put into place through capitalizing on the partnership between the DHR (government policy-making body) and the ICMR (a scientific primary medical research body).

A reference case for economic evaluation is essential to guide structured, transparent, and technically sound analysis: The necessity for a reference case for Indian health technology assessment was highlighted throughout the workshop.

Dr Deepshikha Sharma lead a discussion regarding the different dimensions a reference case must cover, such as whether DALY or QALY should be used, and at what level a threshold for cost effectiveness must be set.

Dr Miqdad Asaria lead further discussion regarding the importance of setting a threshold at the right level for India to limit the opportunity cost of where resources could potentially be better spent.

Dr Laura Downey and Dr Kavitha Rajshekar shared plans for the development of the Indian reference case under MTAB. They explained that a reference case for economic evaluation will be collaboratively developed, and that all technical institutions whom undertake HTA as part of the MTAB program of work will be required to follow this guide.

Want to know more about HTA?

Health Technology Assessment in Universal Health Coverage

WHO resolution on Health Technology Assessment

National Institute of Health: “HTA 101”

Organizer’s information:

iDSI

The Department of Health Research Government of India

The Post Graduate Institute of Medical Education and Research Chandigarh

The Sree Chitra Tirunal Institute for Medical Sciences and Technology

Useful links:

iDSI reference case for economic evaluation

Informing global health decision making: Cost per DALY thresholds and health opportunity costs

Country-level cost effectiveness thresholds : Initial estimates and need for further research

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.

From 25th – 27th July 2016, a workshop was jointly convened by DHR, Government of India, The Indian Council of Medical Research (ICMR), and iDSI partners: Imperial College’s Global Health and Development Group and HITAP, to raise awareness of this initiative to institutionalise HTA in India.

• The first day of the workshop brought policy makers, academics, health practitioners, and public and private health insurance providers together to discuss the initiative and how it can be best implemented to support India’s Universal Health Coverage Agenda. Read the HTA workshop report here.
• Days two and three were run as a participatory workshop exploring the process for topic selection for HTA in India. Participants generated ideas on how topics could be identified and prioritised, how different stakeholders could be involved and the process for final topic selection. Read the topic selection workshop report here.