Identification and selection of health technologies for assessment by agencies in support of reimbursement decisions in Latin America

Abstract

Objective There is no health system that has the resources to evaluate all technologies. The presence of a clear process to prioritize health technologies for assessment by health technology assessment (HTA) agencies is a good practice principle recognized at the international level. The objective of Health Technology Assessment International's 2020 Latin American Policy Forum (LatamPF) was to explore how to improve the way HTA agencies in Latin America identify and prioritize technologies for assessment. Methods This paper is based on a background document, a survey, and the deliberations of the members of the LatamPF (forty-six participants from eleven countries) using a design thinking methodology. Results Participants agreed that a lack of clear prioritization mechanisms results in HTA processes and decisions that are perceived to be of low transparency and overly exposed to political or interest group pressures. The LatamPF identified barriers and recommended actions to improve HTA prioritization mechanisms in Latin America. The criteria identified as the most important to be taken into consideration by HTA agencies in the region when prioritizing a technology for assessment were: the burden of illness, the potential clinical benefit, the alignment with national health priorities, the potential impact on equity, a lack of treatment alternatives for patients, and the potential economic impact. Conclusions Forum participants agreed that the establishment of transparent prioritization processes is a key element for all health systems. Improvements in these processes will strengthen HTA and provide greater legitimacy to decision making.

Topic identification, selection, and prioritization for health technology assessment in selected countries: a mixed study design

“…The need to establish priorities for which technologies are to be assessed is a long-standing important issue for the HTA community [ 4 , 24 ]. We found variation in TISP approaches, similar to previous findings [ 5 , 25 – 27 ] with TISP being very closed in some counties (e.g., limited to policy makers and expert involvement), with the potential for being much more inclusive and participatory (e.g., involving all or most relevant stakeholders). At a strategic level, political awareness and governance supported through institutional frameworks were raised as important to TISP.…”

“…Horizon scanning and early awareness typically is based on a mixture of approaches [ 14 , 46 , 47 ]. Although horizon scanning has been advocated to support collaborative HTA in Europe [ 7 ], several countries with experience in HTA such as Thailand [ 26 ], most countries in Latin America [ 25 ], and many in Europe [ 48 ] use simplified approaches to identifying topics Topic selection (or filtration) Identified topics are checked for alignment with the aims of the HTA system For example, if the HTA system has a narrow scope such as childhood vaccination, then vaccines not suitable for children will be excluded. Selection processes may involve technical advice from clinical experts and industry [ 7 , 27 ] Topic Prioritization A decision is made to initiate, reject, or postpone an assessment While selection ensures that identified topics are aligned with the aims of the HTA system, prioritization is needed when not all identified and selected topics may be assessed at the same depth or through the same process due to limited available resources.…”