Developing an Approach for Using Health Technology Assessments in Reimbursement Systems for Medical Products. Geneva, Switzerland, July 20-21, 2015
(2015; 31 pages)

Abstract

A two day meeting was held to discuss the use of health technology assessment (HTA) in low and middle income countries (LMIC), including aspects of its use in relation to medicine and health technologies, pricing policies and reimbursement decisions. The meeting brought together experts in HTA and pharmaceutical economics from academia; WHO regional advisors from Europe (EURO), Africa (AFRO), Eastern Mediterranean (EMRO) and the Americas (PAHO), as well as representatives from LMIC that have started using elements of HTA, or are working towards doing so. (Annex 1). In addition, the meeting discussed possible follow-up actions, including a proposed larger consultation to be held late in 2015. A key discussion point was to identify the future role for WHO in supporting the development of HTA, particularly given the WHA resolution from 2014 (67.23) on the topic that called on WHO to develop global guidance on methods and processes for health intervention and technology assessment in support of universal health coverage.

As has been well described in extant literature, currently HTA is used as a tool in many high income countries as part of a process of selecting pharmaceuticals, clinical procedures and medical devices for reimbursement, budgeting, and insurance programs as well as public health interventions. A wide variety of different organizations and structures have been set up in order to use aspects of HTA, ranging from large institutions to small advisory committees and secretariats in ministries of health. Common elements in advanced systems are staff or personnel with capacity to critically appraise clinical and economic evidence, availability of data on cost and resource utilization, integration in some way with decision-making processes about budgeting, benefit packages, or reimbursement lists. In some countries, pricing of pharmaceuticals or technologies is explicitly linked to HTA (most often narrowed down to economic evaluations), but in combination with other policies such as reference pricing, generic substitution, and control of supply chain mark-ups. Meeting participants discussed some of the current work of the WHO relating to aspects of HTA. This includes the work on health financing, guidance on cost-effectiveness of interventions and the selection of essential medicines and devices. Results of a large WHO survey of countries with respect to their reported use of and capacity for HTA were presented.

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