Health Technology Assessment Roundtables

2024 HTA Roundtable - Asia Pacific

VIRTUAL | 5 MARCH 2024

The ISPOR HTA Roundtable - Asia Pacific, will take place virtually on 5 March 2024 and will focus the discussion on the successes and challenges in assessing innovative technologies such as advanted therapy medicinal products (AMTPs) and genetic testing.

2023 HTA Roundtable - Asia Pacific

VIRTUAL | 8 MARCH 2023

On 8 March 2023, ISPOR virtually held the Health Technology Assessment (HTA) Roundtable – Asia Pacific. 32 attendees from 13 different Asia Pacific countries or jurisdictions met to discuss "the role of HTA in digital healthcare transformations and technologies."

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.

Prior to the Roundtable start, a survey was sent to all participants asking about the status of HTA of digital health therapies (DHTs) in their country or jurisdiction. 8 people responded and all respondents do not have a framework to assess digital health technologies; one country/region is in the process of developing a framework and another is in the process of adapting the NICE framework.

The HTA Roundtable – Asia Pacific had 3 presentations, one from the CEO of CureApp from Japan, presenting on the differences of cost-effectiveness for DHTs versus pharmaceuticals, one from South Korea on their experience assessing DHTs, and finally a presentation from the National Institute for Health and Care Excellence (NICE) on their Evidence Standards Framework, which includes DHTs in its framework.

Everyone was then divided into 3 breakout groups to discuss the challenges and opportunities of HTA for DHTs. A main theme that emerged in all breakout groups as a challenge was the topic of health equity. For example, smoking cessation apps are very helpful, but the Māori female population have the highest rate of smoking in the world, yet this population will never have access to smoking cessation apps due to their culture. Other issues also include remote islands without internet connectivity which is often required for DHT use. Questions about the implementation costs of DHTs were also raised, as some cost hundreds of thousands of US Dollars to implement; how are these costs included into an HTA? Staff capacity was also acknowledged as a challenge because many staff who are brought in to work on DHTs have a biomedical engineering or information technology background and not a background in economics or HTA. There is a large need for HTA and economic evaluation training in the region.

Opportunities to assessing DHTs were all related to evidence and experience sharing. It was asked for more case studies on how DHTs were assessed and information sharing among the region. In addition to cross-border or cross-regional information sharing, requests were made for more information sharing among regulators, HTA bodies, payers, and digital health technology developers. Sharing of information and evidence will lead to better decision making for patients in the end.

The roundtable was chaired by Dr. Izzuna Mudla Mohamed Ghazali of Malaysia and a webinar focusing on its content took place in June 2023. You can watch the webinar here.

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.

Previous HTA Roundtables - Asia Pacific

• 2021 - Virtual
• 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

BARCELONA, SPAIN | 17 NOVEMBER 2024

The ISPOR HTA Roundtable - Europe will be held on 17 November 2024 during ISPOR Europe 2024 in Barcelona, Spain. This roundtable will focus on discussing the EU HTA Regulation, as the regulation will fully be implemented on 1 January 2025.

2023 HTA Roundtable - Europe

COPENHAGEN, DENMARK | 12 NOVEMBER 2023

The ISPOR HTA Roundtable - Europe was held on 12 November 2023 during ISPOR Europe 2023 in Copenhagen, Denmark. The topic of discussion focused on the better use of evidence generation methods in HTA, capacity building, and stakeholder engagement. Discussion summary is to follow.

2022 HTA Roundtable - Europe

VIENNA, AUSTRIA | 6 NOVEMBER 2022

On 6 November 2022, ISPOR held the first in-person Health Technology Assessment (HTA) Roundtable since the start of the COVID-19 pandemic. The HTA Roundtable focused on Europe and took place in Vienna, Austria. 52 attendees from 30 European countries convened to discuss HTA and public health in a time of crisis (eg, pandemic or war) and how to properly assess technologies with speed without compromising quality.

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 Europe is comprised of HTA bodies (including committees), national insurance organizations, the World Health Organization regional office, the European Commission, EUnetHTA, 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 Europe.

The meeting started with several high-level updates from the European Commission, EUnetHTA21, Heads of HTA Agencies Group (HAG), International Horizon Scanning Initiative (IHSI), and an update on new tools relating to real-world evidence (RWE). A theme that was raised in all presentations was the importance of stakeholder engagement in the entire HTA process and how can clinical societies and clinicians be brought into the HTA process earlier.

The first discussion topic focused on HTA in a time of public health crisis. The WHO/Europe presented their perspective on how HTA can help ensure timely access to medicines and provided examples of how WHO/Europe helped to provide access to vaccines during the height of the COVID-19 pandemic. However, it was recognized that HTA is often institutionalized in high-income countries and that low- and middle-income countries do not always have a formal HTA process. To make up for the disparity, thinking needs to focus on how to get HTA into the procurement system of a country and how to provide the proper funds so countries can utilize HTA in their decision making.

Hungary then provided an overview of the challenges that they faced when assessing new technologies during the height of the COVID-19 pandemic. They have now streamlined their process and have tried to find new value frameworks to assess technologies due to what they learned from performing HTA on COVID-19 technologies.

An open discussion then took place. A quick survey of hands showed that very few countries assessed public health interventions during the height of the COVID-19 pandemic, and it was recognized that HTA for public health is very different due to evidence sources. Many public health interventions only have real-world data (RWD) available, which is considered low on the hierarchy of evidence. In times of crisis where things have to move very, very quickly, HTA bodies are increasingly relying on expert opinion and then are at the mercy of the stakeholders who are around the table. This makes it very difficult to navigate, especially with the quality of evidence. There was an evidence hurdle during the pandemic, where the null hypothesis was almost “this works, we should do it”, and the question to answer was “is there any evidence to show that we shouldn’t do it?”

Some other key points in this section included the realization that no cost-effectiveness analyses that we are aware of were done on the health impacts of lockdown measures vs non-lockdown measures. It was also discussed how countries can learn from one another so they can be prepared for next time. However, to do an ecologic study of what worked in which countries, to try to help inform what should be done next time, is not really feasible because there are so many confounders that cannot really be measured in any reasonable way. Ultimately, what was learned from the pandemic in terms of rapid HTA is an imperfect process of assessment, but this process can be refined and could be valuable later.

Topic 2 focused on how one can assess products in a timely manner without sacrificing the quality of the assessment. An overview of the topic was presented from England and then an open discussion took place. The differences between large and small countries were discussed and the importance of data sharing and collaboration between small countries were highlighted (BeNeLuxAI, FINOSE, etc). Discussions took place as to why early assessments are challenging, including the relatively few breakthrough technologies approved in recent years and how randomized controlled trials (RCTs) provide reliable evidence for efficacy but not safety. Ultimately it was decided that the speed of assessments should be towards the needs of the health system and not other players, eg, industry or patients.

Previous HTA Roundtables - Europe

2024 HTA Roundtable - Latin America 

CARTAGENA, COLOMBIA | 15 AUGUST 2024

The ISPOR HTA Roundtable - Latin America will take place on 15 August 2024 alongside the ISPOR Colombia Chapter conference in Cartagena, Colombia. The topic of discussion is TBD.

2023 HTA Roundtable - Latin America 

VIRTUAL | 2 AUGUST 2023

On 2 August 2023, the ISPOR 2023 Health Technology Assessment (HTA) Roundtable – Latin America convened over 35 stakeholders from Latin America representing HTA bodies, public and private payers, other governmental decision makers, and academia when no HTA body exists in a country. The discussions focused on deliberative and unique approaches to patient-inclusive HTA practices, as well as critical equity considerations, highlighting the collaborative pursuit of advancements in healthcare decision making across Latin America.

A deliberative HTA process involves evaluating a problem, assessing stakeholder perspectives, and critically analyzing evidence to guide decision-making. It aims to address specific interests by considering diverse opinions from all stakeholders to increase the legitimacy and perception of the process. This also ensures that decisions consider the public's best interests.

HTAs utilize deliberative processes at three pivotal stages:

1. Prioritization of topics selection for evaluation: Prioritization is necessary since resources are often limited.

2. Development and communication of recommendations: All recommendations should be based on sufficient evidence and communicated to all stakeholders.

3. Contextualization: Deliberative processes provide context by incorporating various stakeholder perspectives to add a comprehensive understanding of the evidence tailored to the needs of a particular society.

Stakeholders include patients, citizens, providers, financiers, technology producers, researchers, and decision-makers. It can also include fields such as medicine, law, economics, health administration, and epidemiology.

During the 2021 HTAi Latin American Policy Forum, a survey examined the deliberative processes of HTA in 11 Latin American countries. The results showed that 50% of these countries have formal deliberative processes in the technology selection phase. This is followed by 70% in the assessment phase and 80% in the recommendation and/or decision-making phase. The survey revealed that there is limited institutionalization of HTA processes, insufficient education and knowledge about HTA, unclear mandates for institutions, excessive influence from stakeholders, and inadequate public trust.

Deliberative processes should be adopted to offer a means to making well-informed decisions, incorporating diverse societal perspectives, and enhancing decision-making quality and legitimacy.

During the roundtable, the Brazilian Ministry of Health (MoH) presented an overview of Brazil's National Committee for Health Technology Incorporation (CONITEC). CONITEC advises the MoH in decisions related to the incorporation, exclusion, or change of medicines, products, and procedures in the Unified Health System (SUS). It also advises the MoH on developing clinical guidelines.

The structure of CONITEC includes three main areas: products and procedures, guidelines, and an executive secretariat, along with the Department of Management and Incorporation of Health Technologies. The Brazilian Public Health System actively includes patients and the public in the decision-making process. Patients, their families, and patient association representatives can participate in evaluations and share their experiences with various health technologies.

The process involves several stages, starting with demand and concluding with the final decision. These stages include the initial recommendation, the presentation of topics, patient perspectives, discussions, and public consolidation of recommendations. Citizens can submit their suggestions, comments, and initial recommendations electronically. The process has received a substantial number of contributions. Qualitative analysis is performed on the content of contributions, allowing for a comprehensive understanding of public input. Guest participants, including representatives of public defenders and clinical professionals are also invited to provide input.

Public hearings allow various segments of society to engage in the evaluation process. CONITEC maintains a database of patient specialists and managers to enhance collaboration and stakeholder engagement. Key challenges include expanding engagement in social movements, improving dialogue with health managers, and enhancing HTA literacy in scientific communication strategies.

A patient contributor to Argentina's National Commission for the Evaluation of Health Technologies (CONETEC), then introduced the innovative "health cube" concept. It highlights the finite nature of public health spending, emphasizing the importance of informed decision making in allocating healthcare resources. It was encouraged to systematically integrate novel health technologies to ensure the long-term sustainability of the healthcare system.

In Argentina, presenting a new health technology is open to the public. Patients and the public can contribute to formulating key questions and participate in technical meetings. Patient organizations are summoned to provide their input, which involves collecting online forms and testimonials. However, there have been challenges in gathering patient testimonials effectively. Their experience also highlighted the importance of facilitators from CONETEC in enhancing the patient testimony process.

The patient perspective is primarily incorporated in the initial recommendation meeting, and there is limited involvement in other process phases. Patient organizations are encouraged to participate in HTAs, but it is recognized that some patient groups face challenges due to HTAs targeting specific populations, necessitating well-organized testimonies and evidence.

Obstacles emerge in adding new associations to the patient registry due to legal requirements. The lack of legal status for many regional patient organizations complicates their inclusion in participation efforts. A suggested solution is to map and invite unregistered patient groups to participate. Additionally, The Ministry of Health in Argentina intends to launch a patient training program, which will further enhance involvement.

Despite the challenges, Argentina has positive experiences collaborating with authorities even though CONETEC lacks an independent budget and mandatory processes. It is a promising start, but there is much room for improvement.

Concerns arise about using participation merely as a checkbox to fulfill requirements rather than genuinely promoting equity. Common challenges presented by the participants revolved around limited data availability, unequal representation of patient groups, conflict of interest among stakeholders, HTA literacy, inadequate public trust, and clarity in mandates for institutions.

There is a promising start for Latin American countries, but there is still much work and learning to do to improve patient involvement in a deliberative HTA process. Adopting new initiatives will involve staying open to feedback, adapting strategies, and collaborating with stakeholders to enhance the effectiveness of patient participation.

Prioritizing citizen participation is crucial for advancing more equitable healthcare systems. By addressing these points, the HTA process can become more inclusive, transparent, and responsive to the needs and perspectives of patients and other stakeholders.

According to the World Health Organization, equity is defined as “the absence of unfair, avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically or by other dimensions of inequality (eg, sex, gender, ethnicity, disability, or sexual orientation).”

Strategies for incorporating equity in HTA include:

● Describing health inequalities in target populations before decision-making

● Evaluating the impact of interventions on health inequalities

● Assessing the overall impact of interventions on health inequalities at the population level

● Analyzing trade-offs between efficiency and equity

● Evaluating conflicts or trade-offs within equity concerns

During the roundtable, the ECHTA Checklist was showcased. This Checklist was developed to guide HTA practitioners to maximize equity consideration, organized according to each HTA phase.

Participants discussed the distributional analysis of health gains within budget constraints for new technologies. They examined distributions based on factors such as baseline health, quality impacts, technology use patterns, and effectiveness across socioeconomic groups. Actively conducting cost-effective distributional analysis significantly contributes to HTA, necessitating additional guidelines due to the absence of a single approach for incorporating equity. Despite facing challenges in data collection, there is consensus on the importance of incorporating equity actively into HTAs.

It is important to have data available for assessments, and it is suggested to use a qualitative approach or Likert scale in the absence of data. Participants discussed the limitations of the GRADE methodology and the need for a methodological framework for addressing distribution in target populations.

Gender-related disparities in life expectancy and quality-adjusted life expectancy in Chile highlighted the significance of a gender perspective in public health policy.

The meeting concluded with a call for guidance and collective reflection on multifaceted equity challenges. Ongoing efforts were highlighted, and the meeting underscored the importance of prioritizing equity in access before addressing health disparities within benefit plans. The discussion emphasized the intricate nature of actively navigating equity considerations in HTA decision making and the continuous need to refine conceptual frameworks.

The ISPOR 2023 Health Technology Assessment Roundtable in Latin America focused on advancing patient-inclusive and equitable HTA decision-making. Deliberative processes in HTAs, illustrated by Brazil's CONITEC, highlighted prioritization, evidence-based recommendations, and the importance of societal contextualization. Challenges in patient involvement prompted initiatives for streamlined processes and the need for legal revisions.

While Latin American countries show promise, there is a continued need for improvement, requiring open feedback, adaptability, and collaboration. Discussions on equity considerations in HTA and distributional analysis underscored complexity, concluding with a call for ongoing guidance and framework refinement. ISPOR reaffirms its commitment to supporting these initiatives and facilitating collaborative efforts for a more equitable healthcare landscape in Latin America.

Summary by: Alejandra Murillo, Rutgers University, Piscataway, NJ, USA

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. 

Previous HTA Roundtables - Latin America 

• 2021 - Virtual
• 2020 - Virtual
• 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

2023 HTA Roundtable – Middle East and Africa

VIRTUAL | 17 OCTOBER 2023

On 17 October 2023, the ISPOR 2023 Health Technology Assessment (HTA) Roundtable – Middle East and Africa convened 34 stakeholders from Middle East and African countries representing HTA bodies, public and private payers, other governmental decision makers, and academia when no HTA body exists in a country. The discussions focused on assessing non-pharmacological interventions through HTA and overcoming challenges and maximizing the potential of HTA in Middle East and Africa.

The first topic of discussion focused on assessing non-pharmacological interventions through HTA and included 2 case studies, one from Canada and one from Sweden. The first presentation was from the Canadian Agency for Drugs and Technologies in Health (CADTH) and they focused on presenting how they assessed remote monitoring programs for patients. Some key challenges found from funding the remote monitoring programs include understanding that technology alone was not sufficient to foster positive outcomes, it also had to integrate well into a patient’s daily life, some areas had unstable broadband, or the device could have had poor battery life. It was found that these programs were most effective when the patient was motivated and received highly individualized content. It is important to note that these programs were sees as adjuncts to face-to-face care and not replacements.

The Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) then presented their experience assessing psychological treatments for postpartum depression. The Swedish government commissioned this work as a part of a series on women’s health as about 13% of Swedish women suffer postpartum depression. All mothers in Sweden are screened for depression 6-8 weeks after delivery using the Edenborough Post-Natal Depression Scale and an interview. Depending on the severity of the depression, patients are offered patient-centered supportive counseling or cognitive behavioral therapy (CBT). For the HTA, a project group was put together to evaluate the scientific support for the different types of treatment. A Cochrane review of interventions for postpartum depression was published in 2021, so SBU was unable to include it in their review but provided a commentary on the Cochrane review in their final report. In the end it was found that CBT provided a medium-sized decrease in depression symptoms compared to usual treatment and it was found that interpersonal therapy provided a large decrease in depression symptoms compared to usual treatment.

While there were no presentations from the region on the assessment of non-pharmacologic interventions, hearing case studies from countries outside the region allowed for others to learn and ask questions about best practices and how they may be able to implement these types of interventions into their healthcare systems.

After the first discussion topic, the HTA Roundtable was divided into breakout groups to discuss the main challenges and barriers to implementing HTA and how can they maximize the potential for implementation. A pre-event survey was conducted and 56% of respondents indicated that there is a dedicated HTA unit or autonomous agency in their country. Almost all respondents agreed that HTA is useful and valuable for a wide range of decisions, but most agreed that HTA decisions should focus more on coverage decisions and benefits package design.

The breakout groups supported having an official mandate for HTA in each country and agreed that having examples from other countries that successfully use HTA is beneficial in learning best practices and how to apply to their own country. A need for capacity building and formal training was also mentioned in many groups. Discussions also took place around how to engage policy makers to push for and believe in HTA frameworks. This is a common theme we had heard throughout all the HTA Roundtables in 2023, the need for more communication with decision makers about the importance of HTA and how to use the evidence to make decisions.

Once the group came back together, the importance of engaging with patients in the MEA region was discussed. Patients should be engaged as early as possible and often. They should be on advisory committees and groups because if they are not included, they will become resistant and it will be harder to implement HTA. Patients need to be educated on the HTA process and participate in capacity building. It was also mentioned that it is best to focus on umbrella patient organizations instead of individual ones as they have a stronger foothold.

This was the last roundtable for the chair Mouna Jameleddine of Tunisia and the next chair was announced as Abeer Al-Rabayah of Jordan.

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. 

Previous HTA Roundtables - Middle East and Africa

• 2020 - Virtual
• 2019 - Abu Dhabi, UAE
• 2018 - Dubai, UAE
• 2017 - Glasgow, Scotland, UK

2024 HTA Roundtable - North America

ATLANTA, GA, USA | MAY 5, 2024

The ISPOR HTA Roundtable - North America will take place on May 5, 2024 alongside the ISPOR 2024 conference in Atlanta, GA, USA. The topic of discussion is TBD.

2023 HTA Roundtable - North America

BOSTON, MA, USA | MAY 7, 2023

On May 7, 2023, ISPOR held the Health Technology Assessment (HTA) Roundtable – North America during ISPOR 2023 in Boston, MA, USA. While the HTA Roundtable – North America typically focuses on the US and Canada, several European countries were invited to attend in the conversation. 36 attendees from 11 countries (12 of these attendees were from 9 European countries) convened to discuss the assessment of prescription digital therapeutics (PDTs), incorporating environmental factors into HTA, and HTA in a time of scare resources.

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 North America is comprised of HTA bodies, public and private payers (insurers), pharmacy benefit managers (PBMs), the Institute for Clinical and Economic Review (ICER), and other governmental decision makers such as the United States Veteran’s Health Administration and Agency for Healthcare Research and Quality (AHRQ). The organizations in attendance are involved in the access to, pricing of, and reimbursement of healthcare technologies, as well as health system strengthening in the US and Canada.

To start the roundtable discussions and topic 1, England provided an overview of the The National Institute for Health and Care Excellence (NICE) Evidence Standards Framework (ESF) and how it is being used to raise evidence standards for digital health technologies and the challenges that they face. MassHealth (Massachusetts Medicaid) then presented a case study of how they assessed and decided to reimburse for 2 PDTs. Both NICE and MassHealth agreed that evidence standards for assessing PDTs are challenging but that there are learning opportunities from one another to improve healthcare decision making globally.

Some challenges that were raised in assessing PDTs from the attendees of the HTA Roundtable – North America include easy access for patients to free apps (many agreed that by the time they perform an HTA on a PDT, a free app will then be available), patient adherence (clinical trials show a 98% adherence, but in the real-world adherence is closer to 1%), and concerns around safety of PDTs and if there are any unintended consequences.

The second discussion topic focused on how to incorporate environmental sustainability into HTA. England once again started the discussion by presenting an overview of how HTA can support a “greener” National Health Service (NHS). In 2020, NHS England made “net zero commitments” with a goal of carbon emissions being net zero by 2045. The results of a recent NICE Listens session were presented with a focus on the importance of reducing the environmental impact of healthcare, formalizing and publicizing the commitment to environmental sustainability, improving environmental sustainability in healthcare, and ensuring transparency. NHS England has announced the decommissioning of desflurane by early 2024. It is the first medicine to be decommissioned in England due to global warming potential.

A debate then took place during the open discussion about if it is truly the responsibility of HTA and payers to help improve environmental sustainability or if environmental scientists within the government should be relied on more to put legislation in place that will impact manufacturers. It was agreed that there is a disconnect between the two fields and that there may be opportunities for HTA and environmental scientists to work together. A mini Delphi was held at the end of this discussion and it was found that the three most important factors to consider when looking at environmental sustainability are waste, pollution, and packaging.

The final discussion topic of the afternoon discussed how to incorporate resource allocation strategies into HTA. Experiences from both the New Brunswick Department of Health and Veteran’s Health Administration showed similarities in how both governmental organizations handled the stress of COVID-19 from not only a budgetary resource side, but also from a overly stressed human resource side due to new technologies needing to be assessed quickly.

Everyone agreed that to get the best care to patients fast, there must be consideration for the broader healthcare system and the impacts of innovative health technologies beyond cost and clinical effectiveness, as other factors can have unintended consequences for patients and delivery. Healthcare is shifting from looking at single technologies to looking at the systemic impact of technologies. The collective group also discussed how HTA tries to add additional components for consideration, but one thing they do not do well is inform patients and patient groups on why they make decisions. Overall, they should put more emphasis on the education of the public, clinicians, and others in healthcare systems.

2022 HTA Roundtable - North America

 VIRTUAL | MAY 27, 2022

Previous HTA Roundtables - North America

• 2021 - Virtual
• 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