health technology assesment-hta procjene … introduction_t… · africa 1 north america 24 south...

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HEALTH TECHNOLOGY ASSESMENT-HTA PROCJENE ZDRAVSTVENIH TEHNOLOGIJA - HTA

Tarik Čatić, MScPharm ISPOR BH President

Sarajevo, November 23

2nd ISPOR BH CONFERENCE ON PHARMACOECONOMICS AND OUTCOMES RESEARCH with international participation

What is the allocation in health care


5 2 3 14 42 bruto plaće 23 lijekovi 11 ostalo

24 76

Kapitalna ulaganja Rashodi stručnih službi ZZO

Ostali rashodi i naknade ZZO Rashodi u zdr ustanovama (amortizacija, materijalni tr)

Medicinski troškovi

Obračun sredstava u zdravstvu u Federaciji Bosne i Hercegovine za 2010. godinu, ZZOiRFBiH, 2011


4 2 1 1 48 sekund zdr zašt 29 prim zdr zašt 14 lijekovi 1

8 92

Administracija Bolovanja

Poboljšanje uslova rada, certifikacija, reforme, prevencija Ostali oblici zdr zaštite; ostalo

Medicinski troškovi

Saopštenje o ukupnim izdacima za obavezno zdravstveno osiguranje FZO RS za 2010. godinu (http://www.zdravstvo-srpske.org/)

Ortopedska pomagala



Health Care Expenditure

Health Care Expediture


COSTS

OUTCOMES

Pharmaceuticals are in focus in regard to Health Care Expenditure increase but..., during 2000-2008 increase driver was introduction of new technologies and procedures (CT, MRI etc) MRI units per capita more than doubled on average across OECD countries between 2000 and 2008 Pharmacoeconomics is health economics discipline which identifies, measure and compare costs and outcomes of pharmaceutical products Implementation of pharmacoeconomics principles and analysis results should provide more evidence for decision makers to ensure most cost- effective decisions Pharmacoeconomic principles are often applied not only to evaluate pharmaceuticals but also other health care goods/services

HTA

HTA

Evidence

Policy Making


HTA

• Health Technology Assessment is a multi-disciplinary field of policy analysis • Health technology assessment is an active field internationally and has

seen continued growth fostered by the need to support management, clinical, and policy decisions

• Health policy decisions are becoming increasingly important as the opportunity costs from making wrong decisions continue to grow

• The growth of HTA internationally can be seen in the expanding membership of the International Network of Agencies for Health Technology Assessment (INAHTA), a non-profit umbrella organization established in 1993.

• Organizations and individuals involved in HTA research are also affiliated

with societies such as the international societies HTAI and the International Society for Pharmacoeconomics and Outcomes Research (ISPOR)

HTA

International Network of Agencies for Health Technology Assessment) a non-profit organization was established in 1993 and has now grown to 52 member agencies from 29 countries including North and Latin America, Europe, Africa, Asia, Australia, and New Zealand

Technology assessment in health care is a multidisciplinary field of policy analysis. It studies the medical, social, ethical, and economic implications of development, diffusion, and use of health technology. (INAHTA) Healthcare technology is defined as prevention and rehabilitation, vaccines, pharmaceuticals and devices, medical and surgical procedures, and the systems within which health is protected and maintained.


HTA

EUnetHTA Collaboration was launched in November 2008 and is implementing the proposal for a sustainable, permanent collaboration for HTA in Europe

Health technology assessment (HTA) is a multidisciplinary process that summarises information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner. Its aim is to inform the formulation of safe, effective, health policies that are patient focused and seek to achieve best value. (EUnetHTA) Health technology is the application of scientific knowledge in health care and prevention.

HTA Map

Lehoux P, Williams-Jones B. Mapping the integration of social and ethical issues in health technology assessment.Int J Technol Assess Health Care. 2007;23(1):9-16.

Organizacijska načela

Organizational issues

Social issues

Legal issues

Ethical issues

HTA


HTA Agencies Arround the World

• Several groups perform HTA around the world

• Some of them are based in universities, others are operating in arm’s length government agencies or units, and some groups work for the private sector

Region #HTA Agency Africa 1 North America 24 South America 2 Asia 4 Europe 43 Oceania 6

HTA Process Steps

Derived from Panelius et al. 1988, FinOHTA 1997

• HTA Agency ca be organised to: • Conduct full HTA process / evaluation • Asses documentation /evidence submitted by industry


HTA – Value to Different Stakeholders

Summary of Benefits

Optimize health outcomes Increase quality of care Reduce adverse reactions Limit unnecessary/outdated procedures Decrease care spending Improve overall value of investment

HTA in Bosnia and Herzegovina

Survey report on HTA organisations. Moharra M, Kubesch N, Estrada MD, Parada T, Cortés M, Espallargues M on behalf of Work Package 8, EUnetHTA project. CAHTA. 2008.


HTA in Bosnia and Herzegovina – Legal framework

Federation of Bosnia and Herzegovina

• Federal Law on Health care (2010) has recognized HTA (in some way) • HTA body appointed by Minister of Health should conduct HTA for all other

health technologies except drug to be approved for use

• Ordinance on criteria for inclusion and development of list of drugs financed by Solidarity fund (Official Gazzete of FB&H No. 36 of 13.6.2011.)

• Pharmacoeconomic evaluation of expensive medicines (CTx, biologics) • Assesment criteria

• WSP • Cost/patient/duration of treatment (Budget impact) • ICER (New drug vs exsisting therapy covered by HIF) • PE model adopted to local data/epidemiology

Republic of Srpska

• Application for medicines reimbursement consider, among other criteria, price and „pharmacoeconomic parameters“

HTA in Bosnia and Herzegovina - Perspectives

Survey conducted by ISPOR BH

• Objective: skreening of current situation and understanding of HTA principles, process and implementation in decision making proces among key stakeholders

• Methods: A nine-question survey with INAHTA definition of HTA provided has been

distibuted to 50 stakeholders with potential influence on reimbursement decisions. Survey include questions on current practices and process of reimbursement decisions, existance of HTA body/commission, criteria for decisions and reasons for de-listing of reimbursed technologies

• Results:

Response rate 30% MoHs 6 (12) 50% HIFs 5 (12) 42% Hospitals 4 (17) 17%

Use some criteria on drug reimbursement decisions 73% Expert opinions 47% PE studies provided by Industry (Applicant) 40% Price as decision driver 33% Use some criteria on other reimbursement decisions 67%


HTA in Bosnia and Herzegovina - - Perspectives

Initiative of WHO and the World Bank „The Global Alliance on Healthcare Technology „

„The World Bank noted that the impact of it’s US$1.5 billion investment in medical equipment between 1997 and 2001 had not been satisfactory. Nearly a third of

sophisticated equipment remained unused, while over a quarter had a downtime of over 25% due to weak capacity for maintenance.“

Recommendations: • International agencies should help developing countries to strengthen their

regulatory programmes; • Developing countries should access the information available among HTA agencies; • Health Technology Assessment should be an integral part of the medical device life

cycle; • Countries should establish national health policy, clinical/treatment guidelines so

that proper needs assessments can be conducted before acquisition; • Industry could assist by providing manuals and training; • World Bank should explore financing of other modes of acquisition (e.g. turnkey,

consumables, leasing, “up-front warranty” (e.g. 3 years), other recurrent costs).

Conclusions / Issues

HTA can be used and introduced in countries based on their capability, capacity and need

Access to HTA knowledge through the international HTA database → Networking

The appropriate use of HTA in a country matched against its resource capacity - continuum of development:

researchers, scientists and policymakers become familiar with the international scientifi c literature

researchers, scientists and policymakers become familiar with the appraisal, interpretation and potential application(s) of scientific literature in the local settings

a critical mass of professionals is developed so that the country has the capacity and capability to create new knowledge in HTA

formalized mechanisms are established for linking the creation of knowledge to decision-making processes

HTA could be introduced gradually by identifying individuals with a capacity for

accessing and understanding HTAs and making these individuals the “focal points” of HTA and scientific evidence of effectiveness of health-care interventions

HTA Focal points could be located in a national research organization, a national government department, a university or other non-profit agencies concerned with advancing the use of HTA for good governance in policy- and decision making

health technology assesment-hta procjene … introduction_t… · africa 1 north america 24 south...

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