Assessing Technologies for COVID-19: What are the Challenges for Health Technology Assessment Agencies? Findings From a Survey and Roundtable Workshop

Abstract

Background To date, health technology assessment (HTA) agencies have not been at the forefront of decision making regarding the adoption of interventions for coronavirus disease 2019 (COVID-19). Instead, policymakers have prioritised rapid action in response to the pandemic emergency, with no assessment of value for money. As COVID-19 vaccination coverage increases and healthcare systems begin to recover, HTA agencies will be expected to assess technologies for COVID-19. Objective We aimed to identify the key challenges when assessing therapeutic and diagnostic technologies for COVID-19, from the perspective of HTA agencies, and identify whether there is a case for novel HTA methods and/or processes to address them. Methods We used a mixed-methods approach, by conducting an online survey of HTA agencies, to collect data about the challenges faced when assessing or planning to assess diagnostic and therapeutic technologies for COVID-19. The online survey was followed by a ‘roundtable’ workshop of HTA agencies’ representatives to discuss the results and to elaborate on their responses. Results We received 21 completed surveys (response rate of 45%) and 11 of the respondents joined the roundtable discussion. Five themes emerged from the responses: assessing clinical effectiveness (44%), assessing cost effectiveness (19%), practical (19%), political (11%), and decision making (11%) challenges. At the roundtable, attendees elaborated on the challenges and identified two additional themes: how HTA agencies have responded to the pandemic to date, and how their role might change over time. Conclusion HTA agencies face both methodological and logistical challenges when assessing or planning to assess technologies for COVID-19. An interim best-practice HTA framework to address the key challenges would be valuable. Supplementary Information The online version contains supplementary material available at 10.1007/s40273-021-01097-4.

“What’s Keeping Me Up at Night?” Reflections on the COVID-19 Pandemic in Asia

“…Over the course of the pandemic, HTA agencies have had to adapt to using new and challenging methodologies such as ultra-rapid reviews and "living HTA," synthesizing large volumes of rapidly emerging evidence associated with high levels of uncertainty. Although many HTA practitioners feel that some of these changes will be here to stay post-COVID, others warn against setting methodological precedents, and that COVID-19 technologies should be assessed in the same way as any other healthcare technology (6).…”

“…their processes during COVID, with most reporting a change in methodology when assessing COVID-19 technologies and not conducting cost-effectiveness on these technologies (77 and 62 percent, respectively) (6).…”

“…Unlike full HTA, rapid reviews were conducted along the lines of horizon scanning, using a limited number of databases, artificial intelligence search strategies, and single reviewers, with quality being sacrificed for speed. Some agencies reported that they found the rapid review methodology challenging, dealing with greater pressure, high levels of uncertainty, and rapidly emerging (often changing) evidence (5)(6)(7). Rolling reviews, or "living HTA" of technologies given fast track approval, have also become part of the COVID-HTA landscape, where new evidence and information is incorporated as it becomes available.…”

“…Prior to COVID, one of the greatest challenges in the Asia region was not only the availability and quality of data but also access of industry to data collected by health systems, and vice versa, with data linkage an issue in most countries. COVID has demonstrated the value in having reliable, connected data sources that can be analyzed in real time, which may have implications for health care moving forward (5)(6)(7).…”

“…During the pandemic, COVID-19 technologies have been fast-tracked, given emergency use authorization by regulators using alternative analytical approaches that sidelined normal HTA processes. Policymakers, under pressure to provide rapid solutions, made provisional approvals of COVID public health measures, diagnostics, therapeutics, and vaccines often based on limited safety and efficacy results of clinical trials, with little or no assessment of clinical or cost-effectiveness (6) and value for money was bypassed in favor of direct price negotiation and procurement (5). The existing lack of HTA capacity in the Asia region has been exacerbated by COVID.…”