HTA in Asia: Momentum Continues to Build
1. Participants at the 5th Asia Policy Forum
Sometimes, small things can make a huge difference (an idea borrowed from “The God of Small Things” by Arundhati Roy).
In this case, and on a less sublime level, I am referring to the small “i” in “HTAi.” For many years, our organization has benefited from the great work being done in Europe, North America, Latin America and Oceania, with more limited (but meaningful) participation from other parts of the world. This is not to say that there has not been substantial HTA work happening all over, it has just not been consistently reflected in the meetings, programs and activities of our society.
HTA on the rise in Asia
All of this has changed noticeably over the past five years, and before long, it may be necessary to consider whether it is time to capitalize the “i” in HTAi. For evidence to support this, here are a few reflections based on the recent HTAi Asia Policy Forum, held in Beijing in early November 2017, as well as the second annual meeting of the China Health Policy and Technology Assessment Network, held in Wuhan, China on November 6, 2017.
To put it simply, HTA is taking off in Asia, and that is probably a serious understatement. This observation is unlikely to be breaking news for many members of the HTA community, who have been active in Asia for years, but for me, it became crystal clear over the course of this recent week-long visit.
2. Mr. Liu Dengfeng
The 5th Asia Policy Forum
The HTAi Asia Policy Forum brought together nearly 50 individuals from public and private sector organizations, with representatives from 11 countries, including China, Thailand, South Korea, Malaysia, Vietnam, Japan, Taiwan, Singapore, Philippines, Indonesia, and Iran. For the latter three countries, it was the first time they had participated in the HTAi Asia Policy Forum. We also had active participation from the World Health Organization global and regional offices, along with staff from 11 pharmaceutical and device companies. Several senior officials from the Chinese government also attended and spoke at the Forum, including Liu Dengfeng from the Department of Science and Education and Dr. Zhang Feng from the Drug Policy and Essential Drugs Department of the National Health and Family Planning Commission (NHFPC). Each speaker emphasized the essential role that they see for HTA as a part of their efforts to expand access to health care across their population of 1.34 billion people.
3. Mrs. Kun Zhao
4. Shift of China population from rural to urban
over the past 20 years
At a very high level, the two-day conversation explored the role of HTA in the context of progress toward Universal Health Coverage (UHC) in Asia. Healthcare systems in Asia are experiencing tremendous pressures exerted, in part, by increasing urbanization, aging populations and a dramatic increase in chronic non-communicable disease.
Asia are experiencing tremendous pressures exerted, in part, by increasing urbanization, aging populations and a dramatic increase in chronic non-communicable disease.
Most health systems in the region are striving to achieve UHC and need to find ways to strike the right balance in providing essential health care services, while increasing access to care, and also reducing health inequalities and out-of-pocket expenditure. The overarching theme of the meeting was to discuss what role health technology assessment (HTA) can play in overcoming barriers to achieving UHC. There was a particular focus on the potential role that real-world data (RWD) can play in this context.
There were a remarkable number of insightful comments made by presenters and during the plenary discussions, many of which have been summarized in the latest Policy Forum series newsletter, and further detail will be available in journal publications in the next several months. A selection of a few particularly noteworthy comments included:
HTA is one priority setting tool that can be used to overcome some of the barriers to achieving UHC, but it must be used appropriately to the local context while also taking account of the budget impact and affordability within the Asia region. Simple adoption of HTA systems from other parts of the world is unlikely to work.
- Countries in the region need to define their healthcare priorities, identify technologies that address these priorities and then conduct HTA. HTA should be used to prioritize and evaluate services of all technologies in a pathway of care, rather than focus on single technologies in isolation.
- There is a disconnect between what RWD the HTA agencies collect, and what industry and academics have knowledge of, and access to, in the Asia region. This could be improved by greater collaboration and trust between agencies, private sector experts and stakeholders.
By the end of the second day, there was a palpable appetite in the room to find ways to move from dialogue to action on some of the ideas discussed. People were energized to “make something happen”, which was a great outcome to observe. Specific ideas were raised such as developing guidance to support a greater convergence of HTA methods in Asia, and exploring ways to share RWD across public and private organizations. HTAi is currently reviewing options to move this forward.
It is probably clear from the description above that I found the HTAi Asia Policy Forum to be a rewarding, fascinating, and enjoyable experience. The success of the meeting is mostly due to the extraordinary efforts of our two main Beijing hosts, Kun Zhao and Michelle Li. For HTAi, the heavy lifting was done by the Asia Policy Forum Chair Brendon Kearney, HTAi’s Policy Forum Manager Rebecca Trowman, and the APF Scientific Secretary Linda Mundy.
Enriching meeting with faculty members and students at Fudan University in China
5. Faculty and students from Fudan University, China
Following the meeting in Beijing, I was able to spend a lovely weekend in Shanghai, as the guest of Yingyao Chen, a member of the HTAi Board, and Director of the Key Lab of Health Technology Assessment, Ministry of Health (Fudan University). Having the opportunity to meet with members of the Fudan faculty and their enthusiastic students, it is undeniable that China has the talent, energy and inclination to contribute significantly to the field of HTA for many years to come.
My last event in China was the second annual meeting of the China Health Policy and Technology Assessment Network (CHPTAN), an impressive gathering of HTA experts, policy makers, health economists, and other experts. Meeting participants shared an interest in expanding the capacity for HTA in China, developing standard methods, and promoting collaboration within and outside of China. The talks and informal discussions were both substantive and spirited.
I wanted to finish up this note with a few more general, and perhaps personal thoughts, that occurred to me during my visit to China. First, people’s health and well-being are impacted by the degree to which we succeed. This work really matters, and it is reassuring to see how much energy is being devoted to it. Second, this work is best done through collaboration, which requires a lot of dialogue and the development of trust. Participants in the HTAi Asia Policy Forum meeting underscored how much the public and private sector participants learned from each other. They also expressed hope that there would be opportunities to work together building on the ideas and relationships emerging from the discussion.
6. Sean Tunis, President of HTAi, speaking
at the 2nd Annual Meeting of the CHPTAN
Finally, HTAi is eager to continue its engagement with our Asian HTA colleagues, and we believe that a lot can be accomplished by increasing the connection between the longstanding HTA community and our colleagues in Asia. We also hope that HTAi can continue to contribute by providing a neutral platform for dialogue and collaboration. It is clear that we have much to learn from each other, and that our ability to do this offers much potential benefit for global public health.
Comments and suggestions welcome!
In order to advance our messaging to the HTAi community, I would welcome your feedback on this message. Comments or suggestions for future topics, or highlights of noteworthy activity within the wide world of HTA that you feel deserve additional visibility are also welcome. Please send me a note at firstname.lastname@example.org.
I look forward to hearing from you.
Sean Tunis, MD, MSc
President and CEO, Center for Medical Technology Policy