Is There an Adaptive Advantage? Concept for a Simulation Study for Adaptive Health Technology Asessment

OBJECTIVES: Adaptive Health Technology Assessment (aHTA) offers an efficient and context-sensitive alternative to full HTAs, increasingly used in small countries and resource-limited settings. This study aims to evaluate the impact of uncertainty introduced by aHTA on reimbursement decisions and to explore factors contributing to high uncertainties.

METHODS: We conducted simulations to derive an aHTA Incremental Cost-Effectiveness Ratio (ICER) by identifying ICERs from systematic reviews (SRs) of selected technologies. After making pragmatic adjustments, we generated samples of aHTA ICER with a distribution modeled based on ICERs from SRs. Uncertainty in aHTA ICER was assessed using a threshold-based decision rule to evaluate accuracy of reimbursement decisions. This involved comparing aHTA ICER against a baseline ICER derived from studies conducted in Thailand, our reference country. Additionally, we quantified the financial impact associated with implementing an aHTA strategy.

RESULTS: AHTA performance is situationally dependent. An aHTA ICER significantly higher or lower than a country’s willingness-to-pay threshold, along with a lower variability in individual ICERs, reduces the likelihood of incorrect reimbursement decisions. Additionally, for technologies widely considered cost-ineffective across diverse settings, the risk of incorrect reimbursement decisions remains consistently low. ICER adjustment methods, such as price corrections, hold promise in scenarios where they can reduce ICER variability. Moreover, the financial impact of incorrect decisions varies with the disease burden associated with the use of technology. While some technologies may pose a higher risk of incorrect decision-making, the resulting net monetary loss tends to be minimal due to their smaller user base.

CONCLUSIONS: This study contributes to understanding the applicability of aHTA in reimbursement decisions. While interpreting aHTA findings requires caution, it has potential to complement a country’s toolkit for prioritizing technologies for full HTA. Nonetheless, it remains essential for countries to invest in the capability to conduct comprehensive HTAs, particularly for strategically important technologies.