December 18, 2013 - In budget-constrained times, adopting new drugs or medical technology is a high-stakes challenge that requires a comprehensive, balanced approach, according to a report released today by the C.D. Howe Institute. In “Capturing Value from Health Technologies in Lean Times,” authors Ake Blomqvist, Colin Busby and Don Husereau argue healthcare policymakers should make greater use of Health Technology Assessment (HTA), a policy tool that can help them balance demand and supply pressures for new technologies within a health-system budget.
“While making decisions to adopt new technologies is a highly politicized process, these decisions must nonetheless strive to make use of all available evidence,” said Ake Blomqvist, Health Policy Scholar.
This is a complex challenge, involving many stakeholders, note the authors. Individuals and firms, who have developed a new technology, want it to work well and be widely used. Most of them – pharmaceutical firms and manufacturers of diagnostic and medical devices – have a strong financial interest in seeing this happen. On the consumer side, patients and their doctors want to know the technology’s health benefits. And third-party payers, such as provincial governments or private insurers, are particularly interested in the technology’s costs in relation to health outcomes when deciding whether they will agree to pay for using it.
Decisions should include evaluations of the costs and consequences of new technologies for society as a whole, including medical, ethical, legal, social and cultural. HTA provides a framework for doing that. These decisions can be very difficult. Even in cases where a technology does have additional health benefits compared to existing ones, it may not be worth using it if the cost is too high. For example, with limited budgets, deciding to spend more on treating patients with a new technology means less money for treating others with older technologies, even though the latter may produce more health benefits per dollar spent.
The overarching objective of HTA is to get the greatest health gains, in a constrained fiscal world, by grounding decisions in clear, transparent and coordinated processes.
“The number of entities engaged in various forms of HTA has been growing in Canada, and more and more people in healthcare are intricately involved in the decisions,” commented Colin Busby. “This progress and capacity growth is encouraging. However, there is a lack of coordination among provinces when it comes to sharing evidence and avoiding duplication.”
The authors look at examples of HTA experience outside Canada and highlight lessons for Ottawa and the provinces. At present, the National Institute for Health and Care Excellence in the UK is the most advanced example of a consistent framework for technology adoption in a government-funded system. The UK’s current transition toward “value-based pricing” is a positive example of how HTA economic evaluation can be used in a more constructive way than can traditional “yes” or “no” recommendations. The UK has adopted a £30,000 ($52,000) threshold per quality-adjusted life-year, a widely accepted measure of health. An established threshold can help system administrators decide whether, at a given price, to purchase an available technology. The authors recommend:
- Greater use of HTA, with close links to budgets, in technology adoption decisions;
- More interprovincial coordination and collaboration;
- That Canadian HTA agencies draw as much as possible on existing international evidence – from randomized clinical trials, post-market assessments, clinical guidelines, etc. – and maintain close relationships with their international and domestic counterparts;
- That HTA frameworks aim for more stakeholder participation and relationship development with a broader range of actors, such as patient and industry umbrella groups, along with other key stakeholders such as providers and taxpayers.
“To be effective, HTA must be conducted in a neutral manner and be reasonably immune from politics, public pressure and media advocacy,” added co-author Don Husereau.
Click here for the full report.
For more information contact: Ake Blomqvist, Professor at Carleton University and Health Policy Scholar at the C.D. Howe Institute. Don Husereau, Senior Associate with the Institute of Health Economics and Adjunct Professor of Medicine at the University of Ottawa; or Colin Busby, Senior Policy Analyst at the C.D. Howe Institute. 1-416-865-1904; email: cdhowe@cdhowe.org.