Health Technology Assessment Roundtables

2023 HTA Roundtable - Asia Pacific

VIRTUAL | 8 MARCH 2023

The ISPOR HTA Roundtable - Asia Pacific will take place on 8 March 2023. The topic of discussion for this meeting will be "the role of HTA in digital healthcare transformations and technologies."

2022 HTA Roundtable - Asia Pacific

VIRTUAL | 27 SEPTEMBER 2022

On 27 September 2022, ISPOR virtually held the 2022 ISPOR Health Technology Assessment (HTA) Roundtable – Asia Pacific. 30 participants from the Asia Pacific region convened to discuss how the use of HTA can help rebuild healthcare systems after the emergence of COVID-19. The results of a study creating an HTA Implementation Scorecard for Asia was also presented and discussed.

ISPOR has been convening annual Health Technology Assessment (HTA) Roundtables since 2007 with Roundtables now held in Asia Pacific, Europe, Latin America, Middle East and Africa, and North America. These Roundtables are closed-door, invitation only meetings between HTA bodies, public and private payers, other governmental decision makers, and academics when no HTA body exists in a country. They provide an unbiased platform to advance scientific methods; facilitate information-sharing about the current state of HTA, its development, and its role in optimizing healthcare decisions; and bridge the gap between technology assessors, private and public payers, regulators, and patients to improve health globally.

The HTA Roundtable in Asia Pacific is comprised of HTA bodies (including committees), national insurance organizations, the World Health Organization regional offices in the Asia Pacific region, and academics when no HTA body exists in a country. The organizations in attendance are involved in the access to, pricing of, and reimbursement of healthcare technologies, as well as health system strengthening in Asia Pacific.

The first topic of discussion focused on how countries used HTA to rebuild their healthcare system after the emergence of COVID-19. Presentations were from China, the Philippines, and Australia. There were some common themes amongst the discussions. It was important for everyone to recognize that COVID-19 is not over and that while we have made many advancements in 2.5 years, there is still a lot that we do not know about the disease. Many countries in Asia Pacific used telehealth/telemedicine/teleconsults to provide access to healthcare for patients. This was especially important in rural areas, where there are few physicians. However, there are some places in island nations like the Philippines, who do not have access to internet, and thus telehealth cannot be provided. Despite the increasing use of telehealth in Asia Pacific, there are still a number of questions surrounding how to assess this kind of service. The assessment of digital technologies (including telehealth/telemedicine/teleconsults) will be the topic of the 2023 ISPOR HTA Roundtable – Asia Pacific.

There was a short discussion about how different countries are using HTA to evaluate the use of traditional Chinese medicine (TCM). Several attendees of the Roundtable had mentioned that when they contracted COVID-19, their physician chose to use TCM (or whatever traditional medicine was present in their country), however they were unsure about how to assess treatments due to lack of evidence. TCM provided a lot of additional opportunities to treat COVID-19. The most important thing when assessing TCM is to look at the impact. What is the impact of the treatment on the patient and others? This applies not only to COVID-19, but other areas such as oncology as well. It was mentioned that there is a traditional formula in China of treatments that patients can take. Some hospitals were approved to provide TCM as a supplement to other COVID-19 treatments. Participants of the roundtable asked if the Chinese assessments of TCM were publicly available, and if so, could attendees from China please share the assessments to help other countries in the region.

Finally, an overview of a paper published by Management Sciences for Health (MSH) in the International Journal of Technology Assessment in Health Care (IJTAHC) was presented by Dr. Christian Suharlim and Dr. Ana Amaris Caruso. The United States Agency for International Development (USAID) commissioned MSH to conduct a review of barriers or facilitators of HTA using articles up to April 2020. A roadmap was published on the MSH website describing the barriers and facilitators that can be used to compare different HTA systems against one another.

The study published in IJTAHC by MSH is based off of a publication from Chootipongchaivat et al in 2015 by the Asia Pacific Observatory on Health Systems and Policies. In that study, 18 milestones to implementation of HTA were identified. MSH then adapted these 18 milestones and rated countries on the 18 milestones, with 1 being the lowest and 5 being the highest. 9 territories were examined for this study: South Korea, Malaysia, Indonesia, China, India, the Philippines, Thailand, Taiwan, and Vietnam. It is important to note that the names used in this report do not represent the view of MSH, the US Government, or ISPOR on the legal status of any territory. The names are used to better clarify what area was being examined.

Results based on the usage of HTA for benefits coverage and reimbursement decisions are Advanced HTA includes Thailand and South Korea. Established HTA includes Taiwan and Malaysia. Growing HTA includes China, India, Indonesia, the Philippines, and Vietnam. Several factors have contributed to the growth of HTA in the Asia Region: global and regional entities raising awareness of HTA, ISPOR’s Asia Consortium and country chapters help promote the use of pharmacoeconomic evidence (ISPOR was not involved in the development or conduct of this study), a number of non-government organizations (NGOs) are engaged in supporting HTA development in the region, and HTAsiaLink has promoted regional collaboration and capacity building in the region.

Two participants of the Roundtable were then asked to reflect on the results of the study, one from South Korea and one from Malaysia. Both participants agreed with the results of the study but also had some feedback for the authors. They agreed that there are some key principles such as manpower, financial support, and regulation which are more important than others to the implementation of HTA in a country. It was also recommended to ask local experts next time, rather than regional experts, because local experts can tell them in detail what is happening in a country. In addition, some challenges to implementing HTA were mentioned by those reflecting on the results. These challenges include decision confidence with uncertain evidence; the inclusion of public assessments into HTA; and the increasing price and environmental impact of new technologies.

Overall, the final discussion led to a number of participants agreeing that there is a need to possibly update some seminal articles that address different milestones or benchmarks used to assess the level of HTA regionally and globally. Discussions were had about how different organizations can work together to further advance HTA not just in Asia Pacific, but globally, and participants were committed to participating in future studies benchmarking HTA in the region.

The roundtable was chaired by Dr. Izzuna Mudla Mohamed Ghazali of Malaysia.

2021 HTA Roundtable - Asia Pacific

VIRTUAL | 9 NOVEMBER 2021

Twenty participants representing Health Technology Assessment (HTA) bodies from 18 countries in Asia Pacific attended the ISPOR HTA Roundtable - Asia Pacific. This year, the roundtable focused on two main topics: 1) The Lifecycle HTA Approach and 2) Best Practices on Contracting. Participants had the opportunity to learn from some HTA bodies in their region about the use of the lifecycle approach in their processes, from horizon scanning to scientific advice until disinvestment decisions. Attendees listened to some of the regional best practices on contracting, learned about new ways to provide access for new therapies, including the development of Managed Entry Agreements (MEA) and the implementation of tendering system as a potential solution. 

Previous HTA Roundtables - Asia Pacific

• 2020 - Virtual
• 2019 - Beijing, China
• 2018 - Tokyo, Japan
• 2017 - Taipei, Taiwan
• 2016 - Singapore
• 2015 - Astana, Kazakhstan
• 2014 - Beijing, China
• 2013 - Manila, The Philippines
• 2012 - Taipei, Taiwan
• 2010 - Phuket, Thailand
• 2008 - Seoul, South Korea

2023 HTA Roundtable - Europe

COPENHAGEN, DENMARK | 12 NOVEMBER 2023

The ISPOR HTA Roundtable - Europe will be held on 12 November 2023 during ISPOR Europe 2023 in Copenhagen, Denmark. Topics of discussion are TBD.

2022 HTA Roundtable - Europe

VIENNA, AUSTRIA | 6 NOVEMBER 2022

Nearly 55 attendees from 30 European countries met on 6 November 2022 for the ISPOR HTA Roundtable - Europe. This year the Roundtable focused on how can we use HTA to help with public health emergencies, speed versus accuracy in HTA, and plenary session on hot trends.

2021 HTA Roundtable - Europe

VIRTUAL | 23 NOVEMBER 2021

Nearly 25 attendees from 20 European countries convened for the Virtual ISPOR HTA Roundtable - Europe. This year the Roundtable focused on two relevant topics: 1) The Role of HTA in Assessing Digital Technologies and Virtual Care and 2) HTA of Potentially Curative Therapies (ATMP). Presentations from HTA Bodies and Academicians (National Health Fund HQ, INFARMED, IQWiG, Gdańsk Medical University, AIFA) among others, discussed the needs to adapt and organize HTA activities around emerging trends. 

Previous HTA Roundtables - Europe

2022 HTA Roundtable - Latin America 

VIRTUAL | 28 JULY 2022

On 28 July 2022, ISPOR virtually held the ISPOR Health Technology Assessment (HTA) Roundtable – Latin America where 30 participants from different countries around the region convened to discuss how to incorporate economic evidence into health technologies assessment process and the challenges of HTA in pluralistic societies. 

ISPOR has been convening annual Health Technology Assessment (HTA) Roundtables since 2007 with Roundtables now held in Asia Pacific, Europe, North America, Middle East and Africa, and Latin America. These Roundtables are closed-door, invitation only meetings between HTA bodies, public and private payers, other governmental decision makers, and academics when no HTA body exists in a country. They provide an unbiased platform to advance scientific methods; facilitate information-sharing about the current state of HTA, its development, and its role in optimizing healthcare decisions; and bridge the gap between technology assessors, private and public payers, regulators, and patients to improve health globally. 

More specifically, the HTA Roundtable in Latin America is comprised of HTA bodies and other governmental organizations involved in pricing and reimbursement of healthcare technologies in Latin America. 

During the meeting on 28 July, Andrés Pichon-Riviere from the Institute for Clinical Effectives and Health Policy (IECS) in Argentina, Adriana Robayo from the Instituto de Evaluación Tecnologica en Salud (IETS), and Aurelio Mejía from Ministerio de Comercio, Industria y Turismo (MINCIT) in Colombia presented some concepts around the incorporation of economic evidence in health technology assessments review, the experience in measuring a cost-effectiveness threshold for Colombia, and concepts on HTA process in pluralistic societies. 

Andrés Pichon Riviere presented some of the results of the Inter-American Development Bank (IADB) Project report “Application of economic evidence in health technology assessment and decision-making for the allocation of health resources in Latin America: Seven key topics and a preliminary proposal for implementation” (1). He mentioned that two common regional barriers at the moment to incorporate economic evidence are lack of local economic evidence and countries not having a cost-effectiveness threshold defined. Regarding the cost-effectiveness thresholds, he presented some work on the estimation of local thresholds derived from country level life expectancy and GDP per capita. Results were similar to other studies’ results with general values around or less 1 GDP per capita for the different countries in the region. He also presented some approximation for the incorporation of economic evidence from other countries that rely on the comparison of GDP per capita of the country where the economic evidence was generated and the country where it needs to be incorporated, by relating the benefit and cost of the technology in both countries, the original and the application one. 

Adriana Robayo presented a project done in Colombia to estimate the cost-effectiveness threshold. Based on mortality individual level data national vital health statistics, general life expectancy and national healthcare expenditure they estimate a threshold for Colombia of around 0.86 GDP per capita per QALY and 0.75 per life year gained, similar to the estimations in other studies (2).  She also proposed some potential applications of this threshold as HTA price regulation and incorporation into the national health system. 

During the second half of the Roundtable, Aurelio Mejía presented the work done by the ISPOR HTA Council Working Group on the Challenges of HTA in Pluralistic Healthcare Systems (3). It was highlighted that the challenges that this kind of health system face are multiple payers or funders with different requirements of information, different budgets, and different responsibilities regarding the provision of care. 

He proposed some suggestions to overcome these challenges that includes the development of some core methods shared by the different payers or funders, the promotion of local adaptation of HTAs to facilitate its application, the generation of HTAs timely in accordance with the decisions to be made and to develop and maintain a collaborative framework that generates and promotes transparency among the different actors in the health system. 

The roundtable concluded with HTA Council Chair and ISPOR President-Elect 2022-2023, Brian O’Rourke inviting the participation to the next ISPOR HTA Roundtable to be held virtually in July 2023. 

Summary by: Sebastian Garcia Marti, MD, MSc, Institute for Clinical Effectives and Health Policy (IECS), Buenos Aires, Argentina

(1)   Application of economic evidence in health technology assessment and decision-making for the allocation of health resources in Latin America: Seven key topics and a preliminary proposal for implementation. A report for the Inter-American Development Bank. Pichon-Riviere A, Drummond M, García Marti S, Augustovski F. July 2021. IDB-TN-2286. July 2021. DOI http://dx.doi.org/10.18235/0003649. Available in eprints from: https://eprints.whiterose.ac.uk/178985/ 

(2)   Espinosa O, Rodríguez-Lesmes P, Orozco L, Ávila D, Enríquez H, Romano G, Ceballos M. Estimating cost-effectiveness thresholds under a managed healthcare system: experiences from Colombia. Health Policy Plan. 2022 Mar 4;37(3):359-368. 

(3)   Drummond MF, Augustovski F, Bhattacharyya D, Campbell J, Chaiyakanapruk N, Chen Y, Galindo-Suarez RM, Guerino J, Mejía A, Mujoomdar M, Ollendorf D, Ronquest N, Torbica A, Tsiao E, Watkins J, Yeung K; ISPOR HTA Council Working Group on HTA in Pluralistic Healthcare Systems collaborators. Challenges of Health Technology Assessment in Pluralistic Healthcare Systems: An ISPOR Council Report. Value Health. 2022 Aug;25(8):1257-1267. 

2021 HTA Roundtable - Latin America 

VIRTUAL | 22 September 2021

More than 30 representatives from Health Technology Assessment (HTA) bodies from 18 countries in Latin America virtually met to discuss the challenges and opportunities of integrating evidence from the Real World into the HTA process. Presentations from HTA bodies in the region highlighted the challenges and the needs to develop frameworks to adapt this type of evidence into their current decision-making processes. Attendees also heard presentations from representatives from National Institute for Clinical Excellence (NICE) and CADTH (Canadian Agency for Drugs and Technologies in Health) about Best Practices on the HTA for Medical Devices. 

2020 HTA Roundtable - Latin America

VIRTUAL | 15 October 2020

19 attendees from 13 countries convened for the ISPOR HTA Roundtable—Latin America. A representative from the Institute for Clinical Effectiveness and Health Policy (IECS) discussed how demand for rapid reviews of COVID treatments can be handled, followed by an open discussion. A representative from General Health Council Mexico gave a presentation on the allocation and prioritization of medical devices in the hospital setting. 

Previous HTA Roundtables - Latin America 

• 2019 - Bogotá, Colombia
• 2018 - Lima, Peru
• 2017 - São Paulo, Brazil
• 2016 - Bogotá, Colombia
• 2015 - Santiago, Chile
• 2014 - Santiago, Chile
• 2013 - Buenos Aires
• 2011 - Mexico City, Mexico
• 2009 - Rio de Janeiro, Brazil

2022 HTA Roundtable – Middle East and Africa

VIRTUAL | 4 OCTOBER 2022

On 4 October 2022, ISPOR virtually held the 2022 ISPOR Health Technology Assessment (HTA) Roundtable – Middle East and Africa (MEA). 36 participants from the Middle East and Africa region convened to learn about the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022, an overview of the World Health Organization’s (WHO) 2021 publication on a survey of HTA and benefits packages, an overview of the WHO how to guide on institutionalizing HTA, and the importance of international collaboration when institutionalizing HTA.

ISPOR has been convening annual Health Technology Assessment (HTA) Roundtables since 2007 with Roundtables now held in Asia Pacific, Europe, Latin America, Middle East and Africa, and North America. These Roundtables are closed-door, invitation only meetings between HTA bodies, public and private payers, other governmental decision makers, and academics when no HTA body exists in a country. They provide an unbiased platform to advance scientific methods; facilitate information-sharing about the current state of HTA, its development, and its role in optimizing healthcare decisions; and bridge the gap between technology assessors, private and public payers, regulators, and patients to improve health globally.

The HTA Roundtable in Middle East and Africa is comprised of HTA bodies (including committees), national insurance organizations, the World Health Organization regional offices in the Eastern Mediterranean (EMRO) and African (AFRO) regions, and academics when no HTA body exists in a country. The organizations in attendance are involved in the access to, pricing of, and reimbursement of healthcare technologies, as well as health system strengthening in Middle East and Africa.

An educational session on CHEERS 2022 was presented by Mike Drummond, DPhil of University of York. The first CHEERS report was co-published in 10 journals and endorsed by the EQUATOR Network in 2013 and the update was co-published in 16 journals and endorsed by the EQUATOR Network in January 2022. There were several motivations for updating the 2013 report, which included: (1) CHEERS being perceived as being overly focused on cost-effectiveness analysis or cost-utility analysis and excluding cost-benefit analysis, (2) new checklists have been issued since 2013 which may contain potentially important, update-worthy material, (3) there have been several important, methodological developments in economic evaluation, (4) some confusion on how CHEERS should be used - it is guidance on reporting, not on methodology, and (5) the growth of patient and public involvement and engagement in health services research.

In the 2022 CHEERS report, two items were added related to patients or service recipients, the general public, and community or stakeholder involvement. Other changes include modifying the language slightly to make CHEERS more applicable to all types of economic evaluations. Items were added on equity/distributional cost-effectiveness, reporting if an initial analysis plan was developed for the study, and reporting if the economic model used is publicly available and if so, where could the public find the model. More information, including educational videos on each CHEERS 2022 checklist item can be found at http://CHEERS-STATEMENT.org.

The second session focused on 2021 publications from the WHO on the results of a survey on the status of HTA and benefits package globally, as well as an overview of a how to guide on institutionalizing HTA. There were 3 main motivations for the 2021 survey update: (1) to evaluate the use of HTA principles, (2) to monitor trends in integration and development of HTA, and (3) to develop a database of country profiles. A total of 127 countries responded (out of 193 United Nations [UN] member states) and out of those 127 respondents, 53% reported having a legislative requirement to consider the results of a decision-making process. However only 64% of respondents call this process “health technology assessment”. It was also found that there are 3 main barriers to the use of HTA which includes the low recognition of the importance of HTA, the lack of institutionalization, and the lack of political support.

For future surveys, the WHO is considering how to incorporate sub-national level HTA, for example in countries like Jordan where multiple bodies are performing HTA, or in other countries without national HTA, but who are performing it on a local hospital level. Some questions were raised from roundtable attendees about the use of budget impact analysis (BIA) and if the WHO ever considered asking about country requirements. BIA was not included in the survey because the WHO does not want to dictate what evidence should be used in decision making or what evidence should be reported in the survey. However, the survey did ask about affordability.

The second part of the presentation from the WHO focused on their how to guide on institutionalizing HTA also published in 2021. This short guide focuses on 5 main areas: (1) establishing a mandate; (2) establishing a legal framework; (3) establishing institutional arrangements; (4) establishing procedures for organizing assessment and appraisal processes; and (5) monitoring and evaluating HTA mechanisms. Despite every country being different, this guide is designed to help improve the institutionalization of decision-making processes.

Between these two documents from the WHO, it was found that there are 4 levels of country progress (1) emerging (building awareness and technical capacity; (2) progressing (expanding capacity and clarifying roles; (3) established (sharing knowledge and defining sustainable systems; and (4) advanced (sharing knowledge and continuously improving. There are also 4 key elements necessary to progress: (1) having an enabling environment; (2) inputs; (3) processes; and (4) outputs, outcomes, and impact. Self-assessment of the progress of a country’s HTA process can be done with future versions of the WHO Global Survey on HTA by National Authorities.

The final presentation and discussion of the HTA Roundtable – Middle East and Africa focused on the importance of internationally collaboration to institutionalizing and establishing HTA. The section started off with a presentation from William Reuben from the Ministry of Health of Tanzania discussing his experience working with other international organizations to establish HTA. Mr. Reuben said that international collaboration was critical for progress and encourages other countries to reach out to international colleagues for help. Since 2016, HTA has been incorporated into the government medicines policy guidelines, HTA process guidelines have been developed, medicine selection has improved, medicines supply chair for neglected topical diseases has been improved, and communication to relevant stakeholders during quantification and procurement of medicines has improved. The main challenges facing Tanzania today include needing a budget to support HTA initiatives and capacity building for knowledge and skills.

Other participants of the roundtable mentioned that they also participated in international collaboration, most notably Tunisia, who worked with the Institut National d'Excellence en Santé et en Services Sociaux (INESSS) in Quebec, Canada and Instituto de Efectividad Clínica y Sanitaria (IECS) in Argentina. Other mentions of collaborations include multiple countries working together to look at the use of EQ-5D in the Middle East and North Africa region. Despite some countries working together, collaboration between countries in MEA is still developing. Finally, the last comment that was made mentioned how ISPOR is prioritizing this region and highly recommend that all participants participate in the organization through a chapter, regional network, ISPOR Special Interest Group, or even ISPOR meeting attendance.

If you are interested in more information about this HTA Roundtable, an ISPOR HEOR Theater will take place on 23 February 2023 at 10:00am EST (UTC -5:00). Save your seat or watch the recording here.

2021 HTA Roundtable – Middle East and Africa

VIRTUAL | 12 OCTOBER 2021

Nearly 25 attendees from Health Technology Assessment (HTA) bodies across 14 different countries met to discuss and update the status of HTA implementation in their respective countries. Additionally, participants provided their perspectives on managed entry agreements as a potential mechanism to improve patient access. The meeting began with a Short Course training on performance-based risk sharing agreements facilitated by Professor Emeritus Adrian Towse who also moderated the follow-up Q&A and discussion. 

2020 HTA Roundtable - Middle East and Africa

VIRTUAL | 8 October 2020

Eighteen attendees from 13 different countries met to discuss the status of HTA implementation in their respective countries. The roundtable featured open discussion among participants in addition to didactic presentations. Attendees received training on budget impact analysis from representatives of VI Research, followed by a presentation on the use of cost effectiveness thresholds by the National Institute for Health and Care Excellence.  

Previous HTA Roundtables - Middle East and Africa

• 2019 - Abu Dhabi, UAE
• 2018 - Dubai, UAE
• 2017 - Glasgow, Scotland, UK

2023 HTA Roundtable - North America

BOSTON, MA | MAY 7, 2023

The ISPOR HTA Roundtable - North America will take place during ISPOR 2023 in Boston, MA, USA on May 7, 2023. The roundtable will focus on the changing landscape of HTA.

2022 HTA Roundtable - North America

 VIRTUAL | MAY 27, 2022

2021 HTA Roundtable - North America

 VIRTUAL | May 12, 2021

On May 12, more than 37 attendees representing CADTH, ICER, and various US health payers and many other organizations involved in HTA across North America convened for the 2021 ISPOR HTA Roundtable - North America.

The roundtable was divided into two main topics:

Racial disparities and health equity. A panel presentation with participations from Sickle Cell Disease Association of the Midwest, the Canadian Organization for Rare Disorders, and the recent created ISPOR Special Interest Group on Health Disparities followed by open discussion.

The second topic included “The need for a lifecycle approach to HTA” featuring the presentation of Suzanne McGurn, President and CEO CADTH followed by an open discussion.

Previous HTA Roundtables - North America

• 2020 - Virtual
• 2019 - New Orleans, LA, USA
• 2018 - Baltimore, MD, USA
• 2017 - Boston, MA, USA
• 2016 - Washington, DC, USA
• 2015 - Philadelphia, PA, USA
• 2014 - Montreal, ON, Canada
• 2013 - New Orleans, LA, USA
• 2012 - Washington, DC, USA
• 2011 - Baltimore, MD, USA
• 2010 - Atlanta, GA, USA
• 2009 - Orlando, FL, USA
• 2008 - Toronto, ON, Canada
• 2007 - Arlington, VA, USA