Health technology assessment- Dr. Saraswathy MD, PGIMER
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This document provides an overview of health technology assessment (HTA), including its need, scope, and current status. It discusses: 1. The growing need for priority setting and efficient resource allocation in health systems has led to the rise of HTA globally and in India. 2. HTA involves systematically evaluating medical, economic, social, and ethical aspects of health technologies to inform policy decisions. It aims to maximize health benefits within limited budgets. 3. India has established the Health Technology Assessment Board to conduct HTAs and provide recommendations to guide public health programs and policies. However, developing local evidence and building capacity remains an ongoing challenge.
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Health technology assessment- Dr. Saraswathy MD, PGIMER
- 1. Health Technology Assessment Needs, Scope & Current status Presented by, Dr. Saraswathy M V Junior Resident (2nd Sem.) Deptt. Of Community Medicine School of Public Health PGIMER, Chandigarh Moderator Dr. Shankar Prinja Add. Prof of Health Economics Deptt. Of Community Medicine & School of Public Health PGIMER, Chandigarh 2nd March 2019 Journal Club Seminar presentation, SPH, PGIMER, Chandigarh
- 2. Outline • Background • The Need • Introduction & Definition • History – Global, National • Who does HTA ? • How it is done ? • Applications; Scope (India) • Current Status in India • Barriers & Way forward
- 3. Learning Objectives At the end of session, • Develop an understanding on basic concepts, need and scope of HTA • Gain in knowledge on current status of institutionalization of HTA at the global and national levels • Answer basic questions
- 4. BACKGROUND Global setting • Economic growth – provider competition • Innovation Vs Needs • Third party payments • Untouched concerns on healthcare
- 5. India 4.26 4.12 4.5 4.58 4.36 4.61 4.84 4.77 4.58 4.13 4.03 4.04 3.96 4.01 4.16 3.99 1.22 1.15 1.25 1.3 1.28 1.27 1.31 1.19 1.18 0.93 0.93 1 1.02 1.11 1.26 1.12 3.04 2.97 3.25 3.28 3.08 3.34 3.53 3.58 3.4 3.2 3.1 3.04 2.94 2.9 2.9 2.87 0 1 2 3 4 5 6 % of GDP Financial year (FY) Comparison of Total Health Expenditure (THE), Public and Private Health Expenditures (HE) in India in terms of % of GDP from FY 1994-95 to 2009-10 THE (% of GDP) Public HE (%of GDP) Private HE (% of GDP)
- 6. World turns to UHC … So does India • 2010 World Health Report : Health financing - The path to Universal health coverage • HLEG 2011, Planning Comm. Of India Recommendations ‘India needs to adopt UHC both as a developmental imperative and an ethical commitment to equity in a vital area of human welfare’ • 2015 World Health Report : MDGs to SDGs ‘To promote physical and mental health and well being and to extend life expectancy for all, we must achieve universal health coverage and access to quality health care’ • 12th five year plan (2012-17), Planning Comm. Of India • National Health Policy, India 2017
- 7. 1. ‘More money for health’ – Resource allocation 2. ‘Reduce OOP expenditure’ – Retreat from direct payments 3. ‘More health for money’ – Efficient & equitable use of resources Countries must raise sufficient funds, reduce the reliance on direct payments to finance services, and improve efficiency and equity Strategic recommendations …
- 8. Prepaid private spending Dev. Of health Assisstance Govt. health spending OOP spending PPP : Purchasing power parity ‘Expected’ is future growth treajectory based on past growth How much is spent on health – now and in future – and from what sources in India Source : Financing Global health database 2017
- 9. The Need … To prioritize 3.80% 1.20% 0.00% 0.50% 1.00% 1.50% 2.00% 2.50% 3.00% 3.50% 4.00% % of GDP Budget allocation Disparity in health budgetting Current budget (FY 2018-19) Budget needed
- 10. Examples … National dialysis program Drugs for management of NCDs Breast cancer 1 woman Deworming 20lakh children
- 11. Criteria for priority setting • Burden of disease • Clinical effectiveness of the technology • Cost effectiveness • Budget impact • Reduction in OOP expenditure • Social values • Ethical issues • Legal aspects
- 12. TYPES OF PRIORITISATION • Explicit (adj. stated clearly and in detail leaving no room for confusion or doubt) eg : Cost effectiveness threshold • Implicit (adj. suggested though not directly expressed) eg: Fixed timings of services
- 13. INTRODUCTION TO HTA Aim : Informed decision making regarding health technologies Objective : To inform policy and decision makers in health care on how best to allocate the limited funds to health interventions and technologies Interdisciplinary groups _ Explicit analytical framework _ Evidences _ Inform…
- 14. HTA – DEFINITION HTA is a multidisciplinary approach that summarises information about the medical, economic, social and ethical and legal issues related to the use of health technology, in a systematic, transparent, unbiased and robust manner. Source : EUnetHTA definition
- 15. Technology Any method _ promote _ prevent & treat_rehabilitation_Includes; • Drugs & biologics eg : Chemotherapy, Vaccines, blood products, gene therapy • Devices, equipments & supplies eg: Pacemaker, MRI, gloves, test kits, mosquito nets • Medical & surgical procedures eg: Psychotherapy, nutrition counselling,bariatric surgery • Public health programmes eg: Immunisation, water purification system, smoking prevention • Organisational/ Managerial/ Support systems eg: laboratory, blood bank, e-health records, telemedicine, Medication adherence porgram
- 16. Technology & its Aspects considered in HTA
- 18. History – Global context 1965-75 • TA • OTA 1983-85 • WHO – Consider HTA • ISTAHC 1990s • WHO – HTA in developing countries • INAHTA, 1993 • NICE, 1999 2000-10 • HTAi, 2003 (ISTAHC) • WHA Resolution 60.29, 2007 • DaCeHTA,2005 (EUnetHTA, 2009), Europe 2010- • WHO Publication, 2013 • Global Survey on HTA, 2015
- 19. India’s journey … Government of India. 12th 5-Year Plan (2012–2017), Social Sectors,Volume III. 2017http://planningcommission. gov. in/ plans/ planrel/12thplan/ welcome. html. ‘cost effectiveness studies to frame clinical treatment guidelines’ ‘on the lines of the UK’s National Institute of Clinical Excellence (NICE), DHR would develop expertise to assess available therapies and technologies for their cost-effectiveness and essentiality’ Government of India. National Health Policy (2017), Section2 Goal, Principles and Objectives No.2.3.1 ‘Progressively achieve Universal Health Coverage’ The need to establish such a body was discussed and recommended by 12th Plan Working Group on Health Research. Considering the recommendations, the Government recognized the urgent requirement of Health Technology Assessment body in India and therefore, has decided to set up Health Technology Assessment in India (HTAIn) for evaluation and appropriateness and cost effectiveness of the available and new Health Technologies in India.
- 21. HTAIn (HTAB) DHR, MoHFW, India, Estd.2017 Dept. of Health Research HTAIn Recommendations TAC Topic selection, Pre analysis, QA of Evidence Secretariat, DHR Research and Analysis MoHFW Indep. TPs
- 23. • Aim : Political-administrative and clinical decisions at all levels • Char : Broad & general approach eg : Complex health problem (viz. Ty2DM) HTA Broad • Aim : Informed decisions in a short time period (1year) • Char : Focus on a single technology eg : Intro of HPV vaccines HTA Focussed • Aim : Informed decisions in very short time (3months) • Char : Focus on a single technology eg : New Cancer drugs HTA Cancer drugs • Aim : Decision making at micro levels (LSG/ Institutions) • Char : Operational oriented tool (HTA based qn) eg: New guidelines, costs Mini HTA • Aim : Planning and decision making at macro and micro levels • Char : Warns on future technologies in its “early life” eg : Technology alerts Early Warning HTA Products
- 24. 3 bases of analysis – Technical, Context, Implementation Implementatio n Context Effectiveness (Absolute & Relative) Performance, safety & Absolute efficacy Technical tests, Clinical evidence : RCTs Stakeholder engagement Economic evaluation : CEA/ CBA/ CUA/ Budget impact analysis Ethical considerations Social values based prioritization Legal aspects Organisational analysis Policy appraisal Clinical trials, Country info & Registries
- 25. The Process in India … •Topic Approval •Allocation of Topic to RRH/TP TAC •Proposal Development •Presentation to TAC and Stakeholders •Conduct of HTA RRH and TP •Technical Appraisal of Methods TAC •Discussion with stakeholders Stakeholders •Review of evidence by Health Technology Assessment Board HTAB •Recommendations presented to user departments. User Departments
- 26. Analysis – Criteria used in HTAIn • Maximisation of healthCost Effectiveness analysis • Equity in healthcare utilization Increase coverage • Reduction in OOP expenditure Reduce direct costs incurred
- 27. Source : The world health report 2008: primary health care – now more than ever. Geneva, World Health Organization, 2008. 10. Busse R, Schlette S, eds. Focus on prevention, health and aging, new health professions. Gütersloh, Verlag Bertelsmann Stiftung, 2007.
- 28. Technology coverage Coding & reimbursemen t Tech. acquisition & management Public health programs & health policies Pricing of healthcare tech Govt. & Comm. payers Std treatment guidelines Evidence gaps & Unmet needs Professional institution for health Marketing permissions Performance & safety of tech Appropriate use of health tech Regulatory agencies Applications of HTA
- 29. Choice of tech based on needs Clinicians & patients Capital funding Acquisitions & transactions Healthcare tech. investors
- 33. Health Technology Assessment of Cervical Cancer Screening Strategies in India • To ascertain incremental cost per QALY gained with cervical cancer screening strategies (VIA, Pap and HPV DNA) at the frequency of every 3 years, 5 years and 10 years among women in the age groups 30-65 years. • To evaluate the extent of reduction in out-of-pocket expenditure as a result of cervical cancer screening. • To undertake a landscape analysis to determine the health system feasibility undertaking cervical cancer screening in India.
- 37. Global Survey on HTA, 2015 (WHO)
- 39. Barriers • Limited awareness among policy makers • Lack of local HTA evidence • Lack of trained human resource • Organisational barriers – Ethics & transparency; Conflicts of interest • Poor dissemination of HTA reports to policy makers • Cost and time restrains for transformation of systems
- 41. Way forward … • Larger public funding than private and public purchasing systems • Political will • Good handholding by national agencies
- 42. Learning points… • What is HTA? • Why do we need it ? • Does India have an HTA agency? What is its role? • Main criteria checked in HTA • Where is HTA more commonly used now ?
- 43. THANK YOU . . .