Factors Conducive to the Development of Health Technology Assessment in Asia

Overview

Health technology assessment (HTA) is an important priority setting process for countries that are working to achieve Universal Health Care. In settings where HTA is well-established, the use of evidence supports transparent and evidence-based decision making.

Although the Asia Pacific region has HTA institutions and networks operating successfully in Organisation for Economic Co-operation and Development (OECD) countries and a few of the middle-income countries (MICs), many of the low- and middle-income countries (LMICs) have HTA systems that are still at a very early stage of development. Factors that have constrained the development of national HTA capacity range from a shortage of skilled HTA researchers to limited information technology infrastructure and low political support. In such a context, benefits packages can become too broad, ill-defined and/or experience problems in establishing benefit packages and procurement of new medical technologies and medicines. Weak priority setting process in the absence of HTA also lead to providers having increased incentives to utilize high-cost technology and medicines resulting in higher healthcare costs and inefficient use of resources.

Despite recognition by the governments in the region to support HTA, HTA institutionalization faces several impediments in the LMICs, such as silo-based decision-making process, lack of adequate decision-making capacity in policy-makers, strict controls on research dissemination, and according to more value to opinions of seniors and authorities than evidence-based research. 

This Policy Brief reviews experience from well-established HTA settings and draws out six contextual factors that are conducive to the establishments of HTA agencies and their contribution to evidence-informed coverage policies. These factors are: (i) a high proportion of public investment and strategic purchasing in health care, (ii) political will, leadership and legislation, (iii) a good health information technology infrastructure, (iv) local training on HTA-related discipline, (v) effective collaboration between HTA agencies or programmes and local stakeholders, and (vi) a country’s independence from external support or international aid.

The Asia Pacific Observatory on Health Systems and Policies (the APO) developed the Policy Brief on Factors Conducive to The Development of Health Technology Assessment in Asia in collaboration with the Prince Mahidol Award Foundation, as written by staff at the Health Intervention and Technology Assessment Program (HITAP) in Thailand. Its evidence is based on the experience from six HTA settings – China, Indonesia, the Republic of Korea, Malaysia, Thailand and Viet Nam. The Policy Brief describes the historical development and current practice of HTA systems and identifies supportive policies and operational practices that were conducive to the introduction and maturation of HTA in these settings. The Policy brief also includes a practical step-by-step guide that provides recommendations on how to effectively develop HTA systems and a checklist to monitor the progress of the introduction and development of HTA.