Bridging HTA Assessment and Policy Appraisal and Decision

Problem Statement: Since 2017 a HTA unit was established within the Swiss Federal Office of Public Health. The unit produces full, short and customized HTA reports. The reports present evidence of effectiveness/safety, cost-effectiveness, budget impact and possible ethical, legal, social or organizational issues related to the technology.

The reports inform federal commissions when making coverage decisions. Coverage is recommended when the technology meets the by-law defined effectiveness, appropriateness and economic efficiency (EAE) criteria.

Description: After approximately 9 years, the HTA unit evaluated whether and to what extent the results of the HTA assessments mirrored the recommendations by the federal commissions and the final implementation of the recommendations.

It was shown that:

1. HTA findings and the federal commission recommendations most often, but not always align
2. Implementation of new or revised coverage recommendations in daily medical practice is often complicated.

Reasons for the findings are 1) commission recommendations may diverge from HTA assessment findings, as a result of strong societal or cultural patterns, fast evolving field of technology or non-clinical negative consequences of coverage changes for patients, and 2) implementation of the coverage decision may face resistance to change in general or absence of awareness of necessity among patients or practitioners and lack of monitoring tools.

Lessons Learned: The HTA reports have limited effect on coverage recommendations and implementation. However, the unit can optimize alignment through 1) exploring and discussing regulation options earlier in the HTA process, 2) anticipate more on consequences of reimbursement changes in the society and 3) involve patients and practitioners earlier in the process of implementing recommendations.

Stakeholder Perspective: The HTA unit is a governmental agency, which is responsible for the HTA assessment, but not for the coverage recommendation and decision.