Evolving National Health Technology Assessment (HTA) Frameworks in Theory Versus Practice in the Asia-Pacific (APAC) Region: A Targeted Literature & HTA Review Focusing on Australia, Japan, and Taiwan

OBJECTIVES: Recent years have seen health systems deliberate various definitions of value, extending beyond cost-effectiveness, and including multi-stakeholder perspectives. This research evaluates HTA frameworks across APAC markets, comparing theoretical and practical use of value determinants in HTA decision-making.

METHODS: A targeted review consisting of national pharmacoeconomic guidelines in 11 APAC markets identified theoretical value determinants in HTA. A case-study deep-dive in Australia, Japan and Taiwan evaluated these in practice using ten asset-indication examples from post-2018 HTA reports, selected based on inclusion in UK’s NHS high-cost list or for having novel value elements cited as important in global evaluations.

RESULTS: Beyond traditional payer value determinants of cost and QALYs, APAC guidelines referenced multiple non-traditional elements including productivity, equity, disease severity and family spillover. Most markets (except Thailand with a formal threshold) had informal cost-effectiveness thresholds. Eight of 11 guidelines recommended adopting a societal or healthcare system perspective for analysis.

In the 25 HTA evaluations reviewed, elements of cost (24/25), disease severity (24/25), QALYs (18/25), patient voice (12/25), productivity (8/25), healthcare system impact (7/25), value of hope (6/25), family spillover (5/25), equity (3/25), and time to access (2/25) were considered. A higher ICER threshold was considered acceptable in Australia when targeting high unmet need (conditional to risk-sharing measures), and in Japan for rare and pediatric diseases, or cancer.

CONCLUSIONS: APAC guidelines theoretically acknowledge a broader definition of value (seen in the preference for societal perspective); HTAs have reflected this in practice, yet the weight of non-traditional determinants in decision making is not explicitly defined. Net costs, with or without QALYs, remain a driver of determining value across assessments, with a possible implicit severity modifier allowed on a case-by-case basis.

Increasing inclusion of novel value determinants by APAC HTA bodies – particularly patient voice in Australia and Taiwan – is a promising move towards enabling patient access.