Deliverables From 10 Years' Implementation of a National Health Technology Assessment System: Outcomes Sustainability Efficiency, Access, and Equity
Author(s)
Jorge Felix Parreia, MSc1, Bruno Pires, MSc2, Catarina Gomes Rocha Carujo Carreteiro, BSc3, Inês Faria, PharmD3, Jessica Fernandes, MSc3, João Rocha, MSc2, Jorge Campilho Fragoso, MSc3, José Madeira, MSc3, José Marques, MSc2, Mafalda Girão, BSc3, Márcio Silva, MSc3, Melina Mota, MSc3, Valeska Andreozzi, PhD4.
1Director, Exigo Consultores LDA, Lisboa, Portugal, 2Exigo Consultores LDA, Lisbon, Portugal, 3Exigo Consultores LDA, Lisboa, Portugal, 4Exigo Consultores, Lisbon, Portugal.
1Director, Exigo Consultores LDA, Lisboa, Portugal, 2Exigo Consultores LDA, Lisbon, Portugal, 3Exigo Consultores LDA, Lisboa, Portugal, 4Exigo Consultores, Lisbon, Portugal.
OBJECTIVES: Decisions from National Health Technology Assessment (HTA) Systems can affect virtually all the citizens in the country. The Portuguese national HTA system (SiNATS) was established in 2015. We follow the European Commission recommendations on evaluating laws, policies and funding programmes to assess the effectiveness of SiNATS in fulfilling expectations and meeting its objectives.
METHODS: Data was retrieved from public sources, favoring transparency and reproducibility. Effectiveness measures were. Health outcomes: life-expectancy at birth and at 65 years (LY), healthy life years (HLY) and health status Self-assessment. Sustainability: public health and medicines expenditure as a share of GDP. Waste and inefficiency: rate of reimbursement decisions implementation. Innovation adoption: Reimbursement propensity to priority and accelerated medicines and advanced therapy medicinal products (European Medicines Agency definition). Equity of access: Inequality in access within and between pharmacotherapeutic groups of medicines. 5% significance level was adopted.
RESULTS: Population health status increased substantially since 2015: life-expectancy (+0.7 LY), and 65+ (+0.5 LY); +2.6 HLY, +1.8 HLY 65+. People rating their health status as “good” or “very good” increased 15%. From 2015 to 2023 total public health expenditure remained stable at 6.5% of the GDP. Public expenditure in medicines varied between 19% to 21% of the total public expenditure. SiNATS was 75% efficient in implementing non-reimbursement decisions at public hospitals. Innovative medicines were more likely to be reimbursed (odds ratio=1.94, 95%CI: 0.44-8.45), but time-to-reimbursement did not differ from other medicines (hazard ratio=1.1 95%CI: 0.77-1.57). Gini coefficient estimation revealed 10% reduction in inequality in access to innovative, orphan and oncology medicines from 2020 onwards. Between 2020 and 2025 orphan medicines were the most accessible and oncology medicines the less ones.
CONCLUSIONS: There is evidence favoring the Portuguese National Health Technology Assessment Systems contribution to better health population outcomes, sustainability in public health expenditures and equity of access especially to orphan medicines.
METHODS: Data was retrieved from public sources, favoring transparency and reproducibility. Effectiveness measures were. Health outcomes: life-expectancy at birth and at 65 years (LY), healthy life years (HLY) and health status Self-assessment. Sustainability: public health and medicines expenditure as a share of GDP. Waste and inefficiency: rate of reimbursement decisions implementation. Innovation adoption: Reimbursement propensity to priority and accelerated medicines and advanced therapy medicinal products (European Medicines Agency definition). Equity of access: Inequality in access within and between pharmacotherapeutic groups of medicines. 5% significance level was adopted.
RESULTS: Population health status increased substantially since 2015: life-expectancy (+0.7 LY), and 65+ (+0.5 LY); +2.6 HLY, +1.8 HLY 65+. People rating their health status as “good” or “very good” increased 15%. From 2015 to 2023 total public health expenditure remained stable at 6.5% of the GDP. Public expenditure in medicines varied between 19% to 21% of the total public expenditure. SiNATS was 75% efficient in implementing non-reimbursement decisions at public hospitals. Innovative medicines were more likely to be reimbursed (odds ratio=1.94, 95%CI: 0.44-8.45), but time-to-reimbursement did not differ from other medicines (hazard ratio=1.1 95%CI: 0.77-1.57). Gini coefficient estimation revealed 10% reduction in inequality in access to innovative, orphan and oncology medicines from 2020 onwards. Between 2020 and 2025 orphan medicines were the most accessible and oncology medicines the less ones.
CONCLUSIONS: There is evidence favoring the Portuguese National Health Technology Assessment Systems contribution to better health population outcomes, sustainability in public health expenditures and equity of access especially to orphan medicines.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HPR53
Topic
Health Policy & Regulatory, Health Technology Assessment, Organizational Practices
Topic Subcategory
Reimbursement & Access Policy
Disease
Oncology, Pediatrics, Rare & Orphan Diseases