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HTA Principles Survey Questionnaire

I. Introduction

This survey aims to inform health care decision makers in their rational and efficacious applications of health technology assessment (HTA) in Asia, while adhering to key established benchmarks. These benchmarks may be referred to as the 15 key principles of HTA [1, 2, 3]. The principles strive to outline the “best practices” for HTA application, following the organizational structure, methodology, process of implementation, and the use of information in health care decision making. Through this survey, it is hoped that data may be captured to accurately reflect the current HTA situation across Asia and ultimately generate evidence for better-informed health care decisions.

II. Questionnaire Instructions

1. This questionnaire is designed to evaluate the HTA system at the level of your country/jurisdiction. HTA processes may include (1) HTA organization (such as the department who manage the health insurance coverage decision process within the Ministry of Health or Health Insurance Scheme, or an independent organization assigned by the government; (2) HTA appraisal committee; or (3) agencies who conduct HTA assessment and generate the report.

2. There are 15 key principles of HTA, with corresponding questions. For each principle 1-15, first indicate by highlighting the relevance (usefulness) of the principle to your particular country’s context, rating from “Extremely relevant” to “Not Relevant.”

3. After rating the relevancy, please include any specific comments pertaining to the principle’s relevancy in your country.

4. For each principle’s corresponding question, highlight the appropriate box (yes, no or unsure)

5. Please send the completed survey (saved word doc.) to [email protected].

mailto:[email protected]


III. Responder Information

1. Your Country or Region:

2. Your Organization name:

3. How would you classify your organization? (Highlight appropriate box)

□ a. Central/Federal Government

□ b. Local/Provincial/State Government

□ c. Professional (e.g. medical-related society)

□ d. Pharmaceutical/Medical Device Industry

□ e. Academic/Not for profit Research Institution

□ f. Hospital

□ g. Private insurer/managed care

□ h. Other (Please state in the text field provided)

4. Does your organization do any of the following: (Highlight appropriate box)

□ a. Coordinate HTA activities (in the country concerned)

□ b. Make reimbursement decisions, or issue guidance based on HTAs

□ c. Assess HTAs (e.g. Industry submissions)

□ d. Undertake HTAs

□ e. None of the above

5. Your Name (optional)

6. Your Contact Information (optional)

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E-mail: Phone: Address:


IV. QuestionnaireStructure of HTA

1. The goal and scope of the HTA should be explicit and relevant to its use.

Please indicate the relevance of Principle # 1 to your country’s HTA processes

□ Extremely Relevant

□ Fairly Relevant

□ Somewhat Relevant

□ Barely Relevant

□ Not Relevant

1.1 Is the remit of the HTA organization clearly defined?

□ Yes

□ No

□ Unsure

1.2 Is a scoping document drawn up prior to an HTA, containing information on the specific decision problem to be addressed, the relevant patient populations to be considered, the intervention of interest, the relevant alternatives (comparators), and the outcomes (PICOs) to be assessed?

□ Yes

□ No

□ Unsure

2. HTA should be an unbiased and transparent exercise.



□ Fairly Relevant


□ Barely Relevant

□ Not Relevant

2.1 Is the HTA assessment agency independent of the body making the reimbursement or coverage decision?

□ Yes

□ No

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Comments:

Comments:

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□ Unsure

2.2 Are the recommendations of the HTA organization made by an independent expert advisory committee?□ Yes

□ No

□ Unsure

2.3 Are any conflicts of interest of committee members documented and made public?

□ Yes

□ No

□ Unsure

2.4 Are the meetings of the committee held in public?

□ Yes

□ No

□ Unsure

2.5 Is the supporting information and the basis of the recommendations made publicly available?

□ Yes

□ No

□ Unsure

2.6 Does the organization normally commission outside groups to undertake the health technology

assessment?

□ Yes

□ No

□ Unsure

2.7 Are the reports produced subjected to independent peer-review prior to final determination?

□ Yes

□ No

□ Unsure

2.8 Are the draft conclusions subject to review by stakeholders and the public, with rationale underlying final determinations of contentious issues?

□ Yes

□ No

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Comments:

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□ Unsure

3. HTA should include all relevant technologies.



□ Fairly Relevant


□ Barely Relevant

□ Not Relevant

3.1 Are all types of technologies (e.g. drugs, devices, diagnostics, procedures, behavioral modification) considered?

□ Yes

□ No

□ Unsure

3.2 Within each category, are both new and existing technologies considered?

□ Yes

□ No

□ Unsure

3.3 In assessments of new technologies, are all relevant alternatives considered?

□ Yes

□ No

□ Unsure

4. A clear system for setting priorities for HTA should exist.



□ Fairly Relevant


□ Barely Relevant

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Comments

Comments

Comments:

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□ Not Relevant

4.1 Does a formal system for prioritizing and selecting topics exist?

□ Yes

□ No

□ Unsure

4.2 Is the priority-setting approach clear and transparent?

□ Yes

□ No

□ Unsure

Methods of HTA

5. HTA should incorporate appropriate methods for assessing costs and benefits.



□ Fairly Relevant


□ Barely Relevant

□ Not Relevant

5.1 Does the HTA organization consider costs as well as benefits and harms?

□ Yes

□ No

□ Unsure

5.2 Does the HTA organization have published methods guidelines for assessing the benefits, harms and costs of health technologies?

□ Yes

□ No

□ Unsure

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Comments

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5.3 Is a full systematic review of clinical evidence required as a basis for economic modeling?

□ Yes

□ No

□ Unsure

5.4 Does the team undertaking HTA assessments on behalf of the organization include individuals with skills in epidemiology/biostatistics, health services research and economics?

□ Yes

□ No

□ Unsure

6. HTAs should consider a wide range of evidence and outcomes.



□ Fairly Relevant


□ Barely Relevant

□ Not Relevant

6.1 Does the relevant clinical evidence include observational and non-randomized studies, as well as RCTs?□ Yes

□ No

□ Unsure

6.2 Does the HTA consider impacts on quality of life and other patient-reported outcomes, as well as clinical events?

□ Yes

□ No

□ Unsure

6.3 Does the HTA consider relevant sub-groups of the patient population (e.g. by baseline risk)?

□ Yes

□ No

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Comments


□ Unsure

7. A full societal perspective should be considered when undertaking HTAs.

Please indicate the relevance of Principle # 7 to your country’s assessment process


□ Fairly Relevant


□ Barely Relevant

□ Not Relevant

7.1 Does the HTA only consider the impact on a specific budget, for example for drugs?

□ Yes

□ No

□ Unsure

7.2. Does the HTA consider all health care costs?

□ Yes

□ No

□ Unsure

7.3. Can other costs be included as extra information?

□ Yes

□ No

□ Unsure

7.4. Are productivity gains and losses (i.e., indirect costs and benefits) considered when relevant?

□ Yes

□ No

□ Unsure

7.5. Are costs for informal care included when relevant?

□ Yes

□ No

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Comments

Comments:

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□ Unsure

7.6. Are costs in added years of life included in the cost-effectiveness ratio?

□ Yes

□ No

□ Unsure

8. HTAs should explicitly characterize uncertainty surrounding estimates.

Please indicate the relevance of Principle # 8 to your country’s assessment process


□ Fairly Relevant


□ Barely Relevant

□ Not Relevant

8.1. Does the HTA include a sensitivity analysis?

□ Yes

□ No

□ Unsure

8.2. Are confidence intervals presented for key estimates?

□ Yes

□ No

□ Unsure

8.3. Have the key deficiencies in available data been identified and discussed?

□ Yes

□ No

□ Unsure

8.4. Is an agenda for key future research proposed?

□ Yes

□ No

□ Unsure

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Comments


9. HTAs should consider and address issues of generalizability and transferability.



□ Fairly Relevant


□ Barely Relevant

□ Not Relevant

9.1. Does the HTA organization have methods guidance for dealing with transferability issues when using data or

analyses from other jurisdictions?

□ Yes

□ No

□ Unsure

9.2. Does the HTA organization consider the generalizability of the results of its studies to other patient

populations, health care delivery systems or practice settings that are relevant for its jurisdiction?

□ Yes

□ No

□ Unsure

Processes for Conducting HTA

10. Those conducting HTAs should actively engage all key stakeholder groups.



□ Fairly Relevant


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Comments

Comments


□ Barely Relevant

□ Not Relevant

10.1. Is the HTA organization formally required to engage stakeholders in its activities?

□ Yes

□ No

□ Unsure

10.2. Does the HTA organization involve stakeholders in the scoping of HTAs?

□ Yes

□ No

□ Unsure

10.3. Does the HTA organization have a mechanism for identifying the relevant stakeholders?

□ Yes

□ No

□ Unsure

10.4. Does the HTA organization encourage or require submissions of evidence from stakeholders?

□ Yes

□ No

□ Unsure

10.5. Does the HTA organization allow stakeholders to comment on HTA assessment reports at the draft stage?

□ Yes

□ No

□ Unsure

10.6. Does the HTA organization allow stakeholders to appeal against recommendations/ decisions?

□ Yes

□ No

□ Unsure

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10.7. Do the HTA organization’s appraisal committees include stakeholder representation (e.g. patient groups,

technology manufacturers, clinical specialists)?

□ Yes

□ No

□ Unsure

11. Those undertaking HTAs should actively seek all available data



□ Fairly Relevant


□ Barely Relevant

□ Not Relevant

11.1. Does the systematic review of clinical evidence include the gray literature and unpublished data?

□ Yes

□ No

□ Unsure

11.2. Does the HTA organization have processes for handling confidential data from manufacturers?

□ Yes

□ No

□ Unsure

12. The implementation of HTA findings needs to be monitored.



□ Fairly Relevant

12

Comments

Comments



□ Barely Relevant

□ Not Relevant

12.1. Does the HTA organization develop an implementation plan for its HTAs?

□ Yes

□ No

□ Unsure

12.2. Does the HTA organization monitor the impact of its recommendations?

□ Yes

□ No

□ Unsure

Use of HTA in Decision Making13. HTA should be timely.



□ Fairly Relevant


□ Barely Relevant

□ Not Relevant

13.1. Does the HTA organization have a defined time period for conducting HTAs/producing recommendations?

□ Yes

□ No

□ Unsure

13.2. Does the HTA organization adhere to the agreed timelines?

□ Yes

□ No

□ Unsure

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Comments

Comments:


13.3. Does the organization have a mechanism to update its HTAs/recommendations within a given time period?

□ Yes

□ No

□ Unsure

14. HTA findings need to be communicated appropriately to different decision makers.



□ Fairly Relevant


□ Barely Relevant

□ Not Relevant

14.1. Does the HTA organization develop a communications plan for its recommendations and decisions?

□ Yes

□ No

□ Unsure

14.2. Are separate versions of reports produced for different audiences (e.g. health professionals, decision makers,

general public)?

□ Yes

□ No

□ Unsure

14.3. Is the effectiveness of communication monitored and evaluated?

□ Yes

□ No

□ Unsure

15. The link between health technology assessment and decision-making processes needs to be transparent and clearly defined.



□ Fairly Relevant

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Comments

Comments

Comments:

Comments:



□ Barely Relevant

□ Not Relevant

15.1. Does the organization distinguish between the scientific assessment of the evidence and the appraisal

decision?

□ Yes

□ No

□ Unsure

15.2. Does the organization have an explicit decision rule for acceptance/non-acceptance of health technologies?

□ Yes

□ No

□ Unsure

15.3. Does the organization have a transparent approach for weighing various considerations (e.g. comparative

effectiveness, cost-effectiveness, budget impact, equity)?

□ Yes

□ No

□ Unsure

15.4. Does the organization recommend, or operate, conditional reimbursement/coverage-with-evidence-

development schemes?

□ Yes

□ No

□ Unsure

15.5. Does the organization distinguish between identifiable sub-groups of the patient population when making

decisions?

□ Yes

□ No

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Comments:

Comments:

Comments:

Comments:


□ Unsure

V. References

This survey is compiled by Dr. Yen-Huei (Tony) Tarn on behalf of HTAnetAsia of ISPOR Asia Consortium based on the following articles with the permissions from the authors:

[1] Drummond M, Schwartz JS, Jonsson B, et al. Key principles for the improved conduct of health technology assessments for resource allocation decisions. International Journal of Technology Assessment in Health Care 2008; 24:3 244–258.

[2] Neumann P, Drummond M, Jonsson B, et al. Are Key Principles for improved health technology assessment supported and used by health technology assessment organizations? International Journal of Technology Assessment in Health Care 2010; 26:1 71–78.

[3] Drummond M, Neumann P, Jonsson B, et al. Can We Reliably Benchmark Health Technology Assessment organizations? International Journal of Technology Assessment in Health Care 2012; 28:2, 159–165.

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