Health Technology Assessment in the Americas
This is a joint post with Kate McQueston.
“Every country, no matter how wealthy or how impoverished, cannot afford to waste money in healthcare on health technology that does not contribute to health.”
These words were spoken by Harvey V. Fineberg, the President of the Institute of Medicine, at a recent event co-hosted by CGD and PAHO, which highlighted the importance of supporting health technology assessment (HTA) in the Americas. Low-and middle-income countries are increasingly interested in building capacity for priority setting, particularly in regards to public funding in a time where pressures to incorporate costly new technologies are on the rise and donor contributions are stagnating. Over the past five years Brazil, Chile, Costa Rica, Colombia, Croatia, Estonia, the Republic of Korea, Malaysia, and Uruguay have also added health technology assessment agencies—tasked with varying responsibilities, including the generation or coordination of health technology assessment and budget impact analysis, as well as the creation recommendations for coverage or reimbursement decisions related to public spending.
Of his main key points, Dr. Fineberg pointed out that recent IOM estimates suggest that as much as 750 billion dollars is spent every year within the US health system without contributing to better health. The reasons for this waste are numerous—ranging from under investment in prevention and misuse of technology, to the failure of regulatory systems to detect unsafe technologies soon enough. Dr. Fineberg stated that, as societies, we want health technologies that meet a variety of criteria. Health technologies should be effective, safe (where risks are understood and unnecessary risks are avoided), affordable (both to society as a whole and to the individual), acceptable (to users, regulators, and practitioners), equitable, evaluated, and deployed in a way that reached the people who need them. Dr. Fineberg cited during his remarks that, “Every country, every health system has room for improvement.”
Dr. Fineberg noted two principle dilemmas he viewed as problematic for health systems around the world:
1) While some aspects of technologies are universal, such as how they function at the biological level, countries often face significant differences in the distribution of disease burden, nature of risks, affordability of technologies and their ability to pay. What might be the right decision for one country is not necessarily the right decision for another. Each country needs to interpret available evidence within their own national lens.
2) Technology that may be appropriate for some subset of patients – when approved, regulated, and deployed – is often used in a very different way than for the specific populations for which it would offer benefit. Technologies need to be used with the right patient, in the right way, at the right time and no more. One question that must be addressed is: How do we manage a technology beyond its gross approval to how it is used with specific patients and at specific times?
“The idea of technology is very simple, it’s the idea of knowledge applied to a purpose. But in health care we draw on a lot of knowledge and we have many, many different purposes. And the question for us always in health care is, ‘are we using that knowledge in a way that truly advances health.”
Mirta Roses Periago, Director of the Pan American Health Organization, also spoke at the event, noting a new PAHO resolution to strengthen the Health Technology Assessment Network of the Americas (RedETSA), which was signed in October. Dr. Roses Periago’s comments, which can be viewed below, discussed the current fragmentation and segmentation of health systems in the Americas—which often leaves providers and individual practitioners to determine how specific health technologies will be used. Health technologies generate substantial pressure on budgets, and can ultimately threaten the sustainability of health systems. RedETSA, of which PAHO is the secretariat, is made up of 22 institutions from 13 countries. The network is purposed with promoting the use of HTA, increasing institutional capacity to preform HTA, and to support decision-making processes in the region.
The event highlighted CGD’s recent working group report, Priority-Setting in Health: Building Institutions for Smarter Public Spending. My presentation describing the findings of the report can be found here and viewed below.