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 Christian Suharlim and 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.