On 4 October 2022, ISPOR virtually held the 2022 ISPOR Health Technology Assessment (HTA) Roundtable – Middle East and Africa (MEA). Thirty six 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.