Industry wants broader health technology assessments for drugs, says global report
This article was originally published in SRA
Health technology assessments for medicines should be broader, says an international report commissioned by R&D-based pharmaceutical industry associations from Europe, the US and Australia1,2.
Assessments that take on the views of wider stakeholder groups or incorporate more technologies, for example, would provide a wider evidence base to support the use of drugs under scrutiny, said Edith Frénoy, director of market access at the European Federation of Pharmaceutical Industry Associations3.
The report – A comparative analysis of the role and impact of Health Technology Assessment –was prepared by Charles Rivers Associates, who was commissioned by EFPIA, EuropaBio, PhRMA and Medicines Australia to conduct a comparative assessment of the role of HTA across the world. It looked at systems in Australia, Brazil, Canada, England, France, Germany, Italy, the Netherlands, New Zealand, Poland, Scotland, South Korea, Spain, Sweden and Turkey.
According to the report, industry would like to see HTA incorporate other technologies in their assessments, including devices and surgical procedures. "This could show drugs to be cost-effective compared to surgery. For example, a drug could replace a procedure, which would mean patients do not have to come into hospital," said Ms Frénoy.
All HTA systems studied, except for those in Italy and New Zealand, allow for this, albeit to differing degrees, says the report. For example, consideration of all other technologies is routine for some authorities, while for others it is not. In many cases, the standards demanded of pharmaceuticals are more stringent than those required for other technologies, says the report.
The report recommends that HTA would benefit from broader stakeholder involvement. The wider the pool of stakeholders, for example, inclusion of patients, the better the opportunity for providing more evidence, said Ms Frénoy. Of the countries studied, Brazil, France, Italy and Turkey have the lowest levels of stakeholder involvement. France's Transparency Commission, for example, only invites the manufacturer to take part in the evaluation process, although clinical experts may be consulted for specific advice.
In particular, there was room for better interaction with manufacturers, said Ms Frénoy. Some systems offer scientific advice, but others offer no formal opportunity for dialogue. "Stronger dialogue is important so that industry can meet the agency's needs and give it what it wants in terms of showing value," she said.
Ms Frénoy highlighted another of the report's recommendations, that "a full societal perspective should be considered when undertaking HTAs". Of the countries studied, only the Netherlands and Sweden fully incorporate societal benefits in to their assessments. Other countries, for example Poland, take societal perspective into account in some way, although it appears to have "considerably less impact" on decisions than evidence relating to health benefits or the cost to the health system.
Meanwhile, many HTA authorities – including England (under the current system), New Zealand, South Korea, Spain and Turkey – do not take societal benefits into account. Many believe that such costs or benefits fall outside of their remit and that they should be counted elsewhere.
The report also called for a cost-benefit analysis of HTA processes in order to assess their impact on drug reimbursement decisions. Ms Frénoy said she hoped authorities would take note of the study's findings.
References
1. Joint EFPIA, EuropaBio, Medicines Australia and PhRMA press release, 13 July 2011
2. A comparative analysis of the role and impact of Health Technology Assessment, Final report, May 2011, http://codex.uk.corplan.net/kms/Download?id=46ef6d84-b1e8-11e0-b701-4f12144b74c2
3. Personal communication, 14 July 2011