Development of Health Technology Assessment and Management in China

1. Development of Health Technology Assessment and Managementin China Professor JIE CHEN Key Lab of HTA, MOH (Fudan University)

2. Overview of Health Technology & HTA

3. to formulate as appropriate national strategies and plans for the establishment of systems for the assessment, planning, procurement and management of health technologies …… to draw up national or regional guidelines for good manufacturing and regulatory practices, to establish surveillance systems and other measures to ensure the quality, safety and efficacy of medical devices…… Resolution of WHA (2007)Health Technology (1)

4. Resolution of WHA (2007) Health Technology (2) to collect, verify, update and exchange information on health technologies …… to establish where necessary regional and national institutions of health technology, and to collaborate and build partnerships …… to collect information that interrelates medical devices, which deal with priority public-health conditions at different levels of care……

5. Medical Device Procedure Knowledge Drugs Support system Components of Health Technology Equipment

6. Why HTA is necessary? Visibility of new technologies High expenditures for health care Necessity to begin to rationalize health care technology

7. Why HTA is necessary? Echnical information needed by policymakers is frequently not available, or not in the right form. A policymaker cannot judge the merits or consequences of a technological program within a strictly technical context. He has to consider social, economic, and legal implications of any course of action (US Congress, House of Representatives 1967).

8. The careful evaluation of a medical technology for evidence of its safety, efficacy, cost, cost-effectiveness and ethical and legal implications…… HTA is performed for the purpose of providing input to a policy decision [HTA] is a multidisciplinary field of policy analysis. It studies the medical, social, ethical, and economic implications of development, diffusion, and use of health technology HTA Definition

9. Technical properties Safety Efficacy and/or effectiveness Economic attributes or impacts Social, legal, ethical and/or political impacts Properties and Impacts Assessed

10. Application of HTA

11. Rising expenditures related to incentives for technological intervention Rising expenditures addressed by prospective fixed budgets Fixed budgets can control costs and technology， but not assure cost-effectiveness or efficiency Every system is characterized by incentives and disincentives HTA and Cost containment

12. Traditionally the “package” is defined by medical doctors New technology not admitted to package until shown to be effective (and possibly cost-effectiveness) Old technology removed from the package when shown to be ineffective or very expensive for the benefit gained Benefit Package of Health Insurance

13. Wide range of activities, including Routine statistics (for example, health outcome) Audits Licensing Accreditation Certification Informational strategies Clinical practice guidelines Quality assurance

14. The stages of pharmaceutical R&D

15. Challenge to HTA in China

16. Contrary with developed countries, HTA in China made its first step relatively later Developed rapidly, but not enough The Ministry of Health (MOH) pay consistently great attention to HTA Characteristics of HTA in China

17. MOH is positively involved in HTA development HTA development in China • A special group organized by the MOH went to European countries, aiming to learn HTA experience (1991) • Two national workshop on HTA (April and September 1992) • National symposium on HTA, Professor Jie Chen made a report entitled as “HTA and policy research” (November 1992)

18. 3 phases • 3 phases in last decades: • to develop HTA units (1994-) • to promote HTA (1994-) • to merge HTA with policy making(1999-)

19. The first HTA Research Center in China was established in the former Shanghai Medical University in January Other two HTA units were established in Zhejiang University and the former Beijing Medical University respectively The evidence-based medicine center was established in the former West China University of Medical Sciences (Chengdu) in 1997 Different HTA units have different focuses 1st phase: Develop HTA units

20. A HTA training program developed by HTA Research Center, Fudan University (former Shanghai Medical University) Funded by China Medical Board 5-year program 1997-2001 Participants: faculty and researchers in universities, policy makers at different levels, physicians, pharmacists, etc 2nd phase: promote HTA (example)

21. The early HTA dissemination in China HTA workshop in Shanghai Medical University Dr. Banta and Dr. Jonsson presented HTA theory

22. The Milestone of HTA in China 1st National HTA seminar while hosting the ISTAHC board meeting in Shanghai in 1999

23. Dr. Yu Peng, Vice Minister of MOH, meeting with all board members of ISTAHC in 1999

24. ISTAHC board member presented the HTA theory, methodology and its mechanism in policy making The academic professors in China presented their HTA research results The policy makers realized that HTA is part of policy making in order to improve the quality and efficiency of healthcare Achievements in the seminar

26. MOH sets HTA as priority Established the division of Health Technology Management under the department of Science and Education, MOH More grants to support HTA research Transfer HTA results for policy making 3rd phase: incorporate HTA research with health policy

27. Technology admission mechanism by MOH emerging technology new technology (1st adopter) hi-tech …… Technology admission based on HTA safety efficacy and effectiveness cost-effectiveness social impact How to integrate HTA with health policy?-Mechanism

28. Cases: HTA program on Equipments X-ray, CT, MRI and Gamma knife …… Nation-wide field survey to collect information Experts meeting to develop consensus Assessment in early stage is to determine the efficacy and safety and explore problems in the application of these technologies Assessment in later phase mainly focus on distribution, obsolescence and abandonment issues Suggestions are adopted by all levels of policy makers

29. Case: Experiences from HTA on IVF National regulations on IVF and Sperm Banking issued by the Minister in 2001

30. Case: Experiences from HTA on prenatal diagnosis • HTA • investigation: current situation • technology assessment • Convert TA to policy • focusing on how to manage the technology • technology admission • institution license(accreditation) • professional certification

31. National regulations on Prenatal diagnosis issued by the Minister of MOH in 2002

32. To provide just, scientific and credible results of health technology assessment To promote HTA as the basis and evidence of policy decision Legislative and regulative promotion To widen research areas To improve the knowledge and skills of HTA researchers Prospects (1)

33. To provide more education to policy-makers and health services providers To establish the Journal of Chinese Health Technology Assessment To establish regional or national network in research, education and training of HTA To disseminate the research outcome so that more potential users can reach it Prospects (2)

34. Thank you!