Coronavirus Disease 2019: Considerations for Health Technology Assessment From the National Centre for Pharmacoeconomics Review Group

Abstract

It is expected that the coronavirus disease 2019 (COVID-19) pandemic will leave large deficits in the budgets of many jurisdictions. Funding for other treatments, in particular new treatments, may become more constrained than previously expected. Therefore, a robust health technology assessment (HTA) system is vital. Many clinical trials carried out during the pandemic may have been temporarily halted, while others may have had to change their protocols. Even trials that continue as normal may experience external changes as other aspects of the healthcare service may not be available to the patients in the trial, or the patients themselves may contract COVID-19. Consequently, many limitations are likely to arise in the provision of robust HTAs, which could have profound consequences on the availability of new treatments. Therefore, the National Centre for Pharmacoeconomics Review Group wishes to discuss these issues and make recommendations for applicants submitting to HTA agencies, in ample time for these HTAs to be prepared and assessed. We discuss how the pandemic may affect the estimation of the treatment effect, costs, life-years, utilities, discontinuation rates, and methods of evidence synthesis and extrapolation. In particular, we note that trials conducted during the pandemic will be subject to a higher degree of uncertainty than before. It is vital that applicants clearly identify any parameters that may be affected by the pandemic. These parameters will require considerably more scenario and sensitivity analyses to account for this increase in uncertainty.

Does a health crisis change how we value health?

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The general population is also impacted, including through increased anxiety and depression (Davillas & Jones, 2020). The economic fallout of the pandemic and its long-term health consequences, including a backlog of demand due to canceled operations, will result in continued pressure on healthcare resources in the future (Leahy et al, 2020). As a consequence, the processes for making decisions about how to allocate scarce healthcare resources will likely become more heavily scrutinized by all stakeholders, including patients and the public at large.Evidence of the cost-effectiveness of healthcare interventions generally incorporates generic measures of health-related quality of life such as EQ-5D (

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

“…Therefore, it is likely that they will be asked to assess novel COVID-19 technologies and potentially review those that bypassed HTA at the height of the pandemic. These assessments are unlikely to be straightforward [ 5 , 6 ] and may require innovative methods or processes to be developed [ 7 ]. It is important to understand the difficulties HTA agencies are likely to face in this intermediate pandemic recovery phase, to help identify how they can add the most value to COVID-19 decision making.…”

Cost-effectiveness evidence on approved cancer drugs in Ireland: the limits of data availability and implications for public accountability

“…This differs by levels of budget impact and cost-effectiveness, with the latter expressed at two thresholds of €20,000/quality-adjusted life-year (QALY) and €45,000/QALY. While the agreement does not articulate how these decision thresholds relate to the task of balancing the cost of new interventions with their opportunity cost, the €20,000/QALY and €45,000/QALY limits are widely interpreted as Ireland's prevailing cost-effectiveness thresholds [7,[11][12][13]. Clearly only the upper threshold will ultimately be relevant if decisions can be escalated to a higher level within the HSE.…”