Monday, July 15, 2024

Transforming China’s Health Technology Assessment: Expert Insights and Future Directions

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Health technology assessment (HTA) has played a key role in price negotiations for medicines seeking coverage under China’s national Social Health Insurance program. However, past HTA appraisals have revealed a lack of national consensus on various issues relating to economic evaluation, particularly focusing on three key areas: willingness-to-pay (WTP) thresholds, pricing models for multi-indication medicines, and comparator selection principles.

To address these gaps, we conducted a pioneering nationwide survey to gather perspectives from diverse stakeholders on these three key issues. Our study, one of the earliest global initiatives to systematically collect views on economic evaluations for HTA, received 303 responses from experts across 34 cities. This diverse sample, including participants from academia, health technology assessment, consultancy, industry, service providers, and payers, ensures comprehensive insights into the current challenges and potential improvements for health technology assessment in China.

Key expert views derived from this survey included a suggested base WTP threshold ranging from 0.5 to 1.5 times GDP. Experts advocated for elevated thresholds for specific categories such as childhood diseases, rare diseases, end-of-life diseases, and first-in-class (FIC) medicines. Additionally, a single pricing model for multi-indication medicines was favored, along with the consideration of multiple medicines as comparators. Implementing these recommendations would require substantial changes to China’s HTA methods, highlighting the need for increased investment in health technology assessment processes and expertise cultivation.

Survey Methodology and Results

The nationwide anonymous web-based survey encompassed experts across various fields including academia, health technology assessment, consultancy/contract research organizations (CROs), industry, service providers, and payers. In 2023, a generic invitation containing a web link to the questionnaire was disseminated via WeChat using convenience and snowball sampling methods. Agreement rates for questionnaire views were analyzed using descriptive statistics, and the relationship between participants’ responses and demographics was examined using appropriate logistic models.

From the 303 responses received, key findings included a suggested base WTP threshold ranging from 0.5 to 1.5 times GDP, with 52.1% agreement. Elevated thresholds for childhood diseases, rare diseases, end-of-life diseases, and FIC medicines garnered over 78.0% agreement. A single pricing model for multi-indication medicines received 60.4% agreement, while the consideration of multiple medicines as comparators saw 79.9% agreement. Notably, 71.0% of participants agreed on avoiding the use of centrally procured medicines as comparators for medicines with a time-to-market under three years. Interestingly, participants who are service providers had lower odds of selecting higher thresholds (OR: 0.26; P<0.01) compared with responders from consultancy/CRO/industry.

Health Technology Assessment

Implications and Future Directions on Health Technology Assessment

The survey results indicate the need for substantial changes in China’s current HTA methods. Experts highlighted the importance of increasing investment in health technology assessment processes and cultivating expertise to support these necessary modifications. Additionally, they emphasized the need for continuous training and development programs to ensure that HTA practitioners remain updated with the latest methodologies and global standards.

By aligning on key issues such as WTP thresholds, pricing models, and comparator selection principles, China’s health technology assessment framework can become more robust, transparent, and aligned with international best practices. Implementing these changes will not only enhance the quality of HTA in China but also improve the efficiency and fairness of medicine price negotiations, ultimately benefiting patients and the healthcare system as a whole.


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Resource: Value in Health Journal, July 05, 2024

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