Sustainability of healthcare systems in Asia: exploring the roles of horizon scanning and reassessment in the health technology assessment landscape

Abstract

ObjectivesThe 2019 Health Technology Assessment International (HTAi) Asia Policy Forum (HAPF) discussed the role of horizon scanning (HS) and health technology reassessment (HTR) in supporting sustainable healthcare in Asia.MethodsDiscussions and presentations at the 2019 HAPF, informed by a literature review, results of a premeeting survey, and case studies of HTA agencies from the region form the basis of this paper.ResultsFive of the fourteen HTA agencies surveyed have established or are developing HS systems (HSSs), and six reported some experience with HTR. Although there were many differences in the respective HSSs, all were proactive and identified technologies within a 1–3-year time horizon. Commonalities included the criteria used to prioritize the technologies including burden and rarity of the disease, and cost to the health system and patients. Experience in HTR was not as extensive with most HTR activity being conducted on an ad hoc basis. Challenges for both HS and HTR include a lack of HTA capacity and good quality data, as well as a need for transparency and collaboration with industry.ConclusionsWith developing universal health care and HTA capacity in many countries in Asia, HS and HTR are in their infancy. Whilst several countries in the region are experienced in all facets of HTA, other countries are developing their HTA skill base. As such, there was a clear appetite for setting up a collaborative network in the Asia region to facilitate information sharing around HTA activities, and more specifically, HS and HTR methodologies, experiences, and assessments.

Building a National Reassessment Process for Oncology Drugs: Lessons Learned by the Canadian Real-World Evidence for Value of Cancer Drugs (CanREValue) Collaboration through a Simulated Reassessment Exercise

“…Insights from this simulation exercise may be valuable to international HTA agencies that have adopted, or are in the process of adopting, reassessment processes [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. Since 2004, new drugs approved by the Health Ministry in France received a registration for reimbursement for 5 years, after which drugs are systematically re-evaluated by the Haute Authorite de Sante (HAS) [ 25 ].…”

“…In 2006, the National Institute of Health and Clinical Excellence (NICE) in the UK attempted to pilot the ineffective treatments program to appraise health procedures in order to identify those of low value that may be suitable for disinvestment; however, it was later felt that this program was not necessary as NICE has been consistently producing “do not do” recommendations in collaboration with Cochrane Review during the existing HTA process [ 25 ]. Finally, several countries in Asia are also refining and/or developing HTA processes which include exploring reassessment procedures and developing frameworks to integrate reassessment into the HTA processes [ 21 , 23 ]. In Canada, CADTH has outlined a reassessment process in its recent procedural update and the lessons from this simulation exercise may inform the future refinement of CADTH’s reassessment processes [ 13 ].…”