Health Technology Assessment Perspectives and Trends Abdulkadir Keskinaslan, MD, MBA, MPH Market Pricing Director As

1. Health Technology Assessment Perspectives and Trends Abdulkadir Keskinaslan, MD, MBA, MPHMarket Pricing Director Asia Pac

2. 2 Health care spend has reached USD 3.5 trillion in OECDProviders and distributors account for 66% followed by 17% for pharmaceuticals

3. 3 Demographic transition will be the leading cause of growth in health care spend Global population ageing – decreasing fertility along with lengthening life expectancy shifting relative weight from younger to older groups Regional differences in life expectancy at birth are expected to decrease – an interregional gap of about 7 years is expected by 2045-2050, down from approximately 9 years in the period 2025-2030 and from almost 12 years at present

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6. 6 Health care spend has grown above GDP

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8. 8 Health care strategy is all about how you spend your moneyUK is about 5 times more productive than US in managing Type II Diabetes

9. 9 Health Care needs drive changes pricing and value assessment

10. 10 Risk pooling empowers budget holders shifting inelastic demand towards elasticity

11. 11 Value Based – Risk sharing pricing framework

12. 12 Innovative Pricing approach help create win-win solutions Underlying goal of models similar, but differ in reimbursement price and scheme

13. 13 Technology Assessment (TA) is a concept, which embraces different forms of policy analysis on the relation between science and technology on the one hand, and policy, society and the individual on the other hand. Technology Assessment typically includes policy analysis approaches such as foresight; economic analysis; systems analysis; strategic analysis etc. TA could make policy analysis about:

14. 14 1967 - Technology Assessment first used in the Subcommittee on Science, Research, and Development of the House Science and Astronautics Committee of the U.S. Congress 1972 - the U.S. Congress created the The Office of Technology Assessment (OTA) by Public Law 92–484. OTA provide analysis of the complex scientific and technical issues from 1972 to 1995 1987 - Scientific Technology Options Assessment (STOA)-an official organ of the European Parliament – started releasing reports partnering with external experts. 1990 - The European Parliamentary Technology Assessment Network-EPTA was formally established under the patronage of the President of the European Parliament to advise parliaments on the possible social, economic and environmental impact of new sciences and technologies. E.g. Working in future - structures and trends in industrial work , Vaccine capacity in the UK. In 1973-1975 roots of Health Technology was established: the U.S. Academy of Sciences published a report that examined the implications of four health technologies: in vitro fertilization, choosing the sex of children, retardation of aging, and modifying human behavior The National Institutes of Health carried out a rather comprehensive assessment of the totally implantable artificial heart in 1973 The Swedish Organization, Spri, carried out a cost-effectivenessanalysis of the computed tomography (CT) scanner (the first HTA outside of the US)

15. 15 Health Technology Assessment - HTA HTA studies the medical, social, ethical, (legal) and economic implications of development, diffusion and use of technology and informs policy decision Its aim is to improve quality and cost-effectiveness of healthcare Health Technology Health technology covers any method (intervention) used to promote health, prevent and treat disease and improve rehabilitation or long-term care

16. 16 Criteria for HTA varies based on country perspective

17. 17 Increasing interest in HTA across Asia Pacfollowing trends in the US and EuropeFormal HTA programs

18. 18 Key Principles for the Improved Conduct of Health Technology Assessments for Resource Allocation Decisions The goal and scope of the HTA should be explicit and relevant to its use HTA should be an unbiased and transparent exercise HTA should include all relevant technologies A clear system for setting priorities for HTA should exist HTA should incorporate appropriate methods for assessing costs and benefits HTAs should consider a wide range of evidence and outcomes A full societal perspective should be considered when undertaking HTAs HTAs should explicitly characterize uncertainty surrounding estimates

19. 19 Key Principles for the Improved Conduct of Health Technology Assessments for Resource Allocation Decisions HTAs should consider and address issues of generalizability and transferability Those conducting HTAs should actively engage all key stakeholder groups Those undertaking HTAs should actively seek all available data The implementation of HTA findings needs to be monitored HTA should be timely HTA findings need to be communicated appropriately to different decision makers The link between HTA findings and decision making processes needs to be in all transparent and clearly defined

20. 20 Key Principles for Improved Health Technology Assessment: Identify and inform organizational, procedural and methodological best practice

21. 21 HTA systems: room for improvement HTA’s role and utility in decision-making and priority-setting of health care systems and impact on innovation Risk of using HTA as a cost-containment measure HTA governance including transparency, accountability and stakeholder involvement in the HTA process Stakeholder agreement on methods, evidence requirements and cost-effectiveness thresholds employed during the assessment process Delays in the HTA process restricting patient access to treatments

22. 22 Discussion pointsIssues? Resources? Knowledge Networks? Despite the fact that Turkey is advanced on the equity dimension in Health Care, HTA has been relatively slow in gaining much of a foothold. What are the factors that play role in this? Political support? Capacity? Investment? How to speed up capacity building in Turkey? Human resources? Resources in general? Network? What should be the role for stakeholders in capacity building? What is the potential value of Information Centers and Knowledge Networks?

23. 23 Information Centers and knowledge networks for HTAcan accelerate collaboration International Network of Agencies for Health Technology Assessment (INAHTA) Accelerate exchange and collaboration among agencies Promote information sharing and comparison Prevent unnecessary duplication of activities. HTA on the net; A Guide to Internet Sources of Information from Institute of Health Economics is a toolkit with links specialized bibliographic databases relevant to the subject of the assessment; data from government and regulatory agencies; administrative databases; industry studies, and advice from experts in the field NHS Economic Evaluation Database (NHS EED): published economic evaluations of health care interventions