Self-Sustainability in HTA: Is a Proportionate Approach Really Proportionate?

OBJECTIVES: Increasing demand for health technology assessment (HTA) in recent years has highlighted the need for efficiencies within appraisal processes to ensure patients have fast access to new treatments. HTA agencies are modifying their approach to ensure that they are able to, independently and continuously, conduct and fund evaluations of treatments, ensuring efficient, evidence-based decision making and long-term viability. One such approach is proportionate review, which enables a streamlined process to be used when a detailed review is not required. This study aimed to evaluate the proportionate approach to HTA in the United Kingdom (UK) and Canada and understand the potential future impact this approach may have on self-sustainability of healthcare systems.

METHODS: HTA methods were identified via government organization websites, including the National Institute of Health and Care Excellence (NICE) for the UK and Canada’s Drug Agency (CDA). The methods were reviewed for their approach to proportionate HTA. In addition, web-crawling was used to determine the impact of proportionate review on HTA timelines.

RESULTS: NICE introduced a proportionate approach in 2022. During the pilot period, NICE recommended 6 treatments under the proportionate approach, benefitting around 175,000 patients. The proportionate approach helped speed up the technology appraisals process by up to 20 weeks (45%), as well as increasing the capacity for guidance on more complex treatments. In January 2024, CDA announced the implementation of a proportionate approach to some of their HTA processes and is in the process of developing a comprehensive plan to address the proportionate approach initiative later this year.

CONCLUSIONS: A sustainable HTA approach can streamline the assessment process, reduce the time needed to evaluate new treatments and ensure long-term efficiency in healthcare decision-making. The UK and Canadian healthcare systems are introducing self-sustainability through a proportionate approach to HTAs to meet the growing demand for appraisals.