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HTA in India: Overview and Update

Authors:  Genpro Medical Writing & HEOR consulting group, mw.info@genproresearch.com

 

Background and Need

Health technology assessment (HTA) is in discussion for quite some time in India as it has far-reaching implications on the healthcare system. The Current healthcare system of India could be characterized by excessive uptake of sophisticated technologies, ever-increasing burden of out of pocket expenditure and simultaneous change in disease profile of the population. Moreover, there is an onus on government and healthcare administrators to prioritize the healthcare resources for optimal treatment outcomes while safeguarding the public health and socio-economical quality of life. Moreover, the extensive availability of biomedical research literature has blurred the knowledge and clinical acumen driven approach in healthcare delivery. Thus, it becomes imperative for a healthcare decision-maker to provide quality through affordable solutions in public benefit with judicious use of both scientific and non-scientific data, which could be partially resolved by a systematic and scientific process ubiquitously known as “Health Technology Assessment(HTA)”.

What is an HTA and what does its report contain?

Health Technology Assessment (HTA) is a multidisciplinary field of policy analysis, studying the medical, economic, social and ethical implications of development, diffusion and use of health technology (INAHTA 2009). It is a tool for assessing and comparing various health technologies using the same unit of cost. HTA helps in informing the policymakers for making evidence-based policies. There are different reasons for conducting health technology assessments such as qualifying the product in terms of its applicability in common public, designing mechanism for healthcare reimbursement,  finding a pathway to integrate health technology in the current health system or acquiring health technology for a hospital.

Global Status

Given the intense advocacy for universal health coverage by the World Health Organization, most of the countries have tried to evolve their health system with partial or comprehensive adoption of HTA in their system. Several international bodies like the International Society of Pharmacoeconomics and Outcomes Research (ISPOR), International Network of Agencies for Health Technology Assessment (INAHTA), Health Technology Assessment International (HTAi) and allied organizations have provided a multitude of platforms to share and exchange insights regarding HTA and its utility from healthcare providers and payers’ perspective. Depending on the health system of the country and scope of applicability of an HTA for health technologies of public interest, governments of various countries have established their own HTA infrastructure and framework. These include National Institute of Health and Care Excellence (NICE), Canadian Agency for Drugs and Technologies in Health (CADTH), Health Intervention and Technology Assessment Programme (HITAP), Thailand, just to name a few. Though terminology for all these HTA bodies may sound similar, their context might differ. For example, NICE provides recommendations for reimbursement with a statutory role, whereas HITAP could serve as an advisory body with recommendations of policy influence but not decision making itself (HITAP 2016).

Status of HTA in India

India has taken naïve steps in the direction of establishing an HTA eco-system with proactive involvement of Indian Council of Medical Research (ICMR), eminent academic research institutes, pharma and medical device manufacturers associations as well as Govt. bodies. Moreover, private organisations have also come up with proactive initiatives giving thrust to overall HTA landscape in the country.

Institutionalized model of HTA in India is formally known as “HTAIn” which is governed by the Department of Health Research, Ministry of Health and Family Welfare since 2008. Though it is being continually evolved as per the voice of stakeholders and political priorities, HTAIn has released its process manual in March 2018, which includes general details about steps to be followed for conducting HTA via HTAIn with Indian context (ICMR HTAIn 2018).  Moreover, establishment of the National Health Innovation Portal has resulted in the beginning of HTA driven approach for the uptake of innovations. Introduction of Largest National Healthcare Protection Scheme-Ayushman Bharat has also given impetus to efforts towards achieving Universal Health Coverage and thereby increasing use of HTA methodologies to inform policy decision making. Out of several HTA outcome reports released by HTAIn in past, use of safety syringes and cardiac stents had become a tool for informing policy decisions.

Another major development could be seen in form of capacity building programmes across the country by various academia and industry professionals in the name of Health Economics and Outcomes Research (HEOR) and HTA. However, there seems to exist the know-do-gap reflecting in limited frequency of HTA reports as well as sub-optimal data analyses and early inferences without in-depth strategies for conduct and/or interpret HTA.  This could also be partially attributed to paucity of several data and limited knowledge about pragmatic HTA methodologies.

Way Forward:

Here are our suggestions for stronger and robust HTA ecosystem in India::

  1. Domain Specific HTA and HEOR Trainings.
  2. Establishment of National Report Writing Body though joint venture of Govt and Clinical Research and Medical Writing Industry.
  3. Multidisciplinary Taskforce for Deriving Health System Integration Strategies.
  4. Increased public access to epidemiological database with funding of very large scale data collection projects so as to create a robust data repository.

Genpro Medical Writing team can provide various services in authoring & conceptualising HEOR modalities besides statistical & programming support for customised economic modelling. Reach out to mw.info@genproresearch.com or visit MSW page for more details.

Useful Resources to Read:

  1. http://www.globalhitap.net/wp-content/uploads/2017/08/South-South-Collaboration_Mission-Report.pdf
  2. https://htain.icmr.org.in/index.php/documents/publications/htain-manual
  3. https://www.tandfonline.com/doi/pdf/10.1080/16549716.2018.1527556?needAccess=true
  4. https://www.sciencedirect.com/science/article/pii/S2590229620300022
  5. https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)
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