Enabling access through technology

Achieving the goals of universal health coverage (UHC) in low- and middle-income countries requires a structured, collaborative effort that ensures health systems use resources effectively and efficiently.

In this regard, governments, payers, and clinicians need to consider a range of decision-making tools to prioritize healthcare interventions and ensure patients have access to quality healthcare products and services to prevent, diagnose, and treat diseases, the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) said.

According to the IFPMA, international and national agencies should consider several key policy principles in considering how to make evidence-based decisions on healthcare.

Evaluation systems should be holistic and consider all impacts of medical technologies, including medicines, assessing both the benefits as well as costs; consider national health systems and circumstances and tailor the use of medical technologies to local circumstances; have transparent processes that involve all stakeholders; have as an objective to increase access to new medical technologies; inform and promote patient choice; and encourage innovation and experimentation.

While there are many evidence-informed decision-making tools available, some governments and payers use health technology assessment (HTA) to help inform health policy decisions.

The World Health Organization (WHO) defines HTA as a systematic, multidisciplinary and transparent evaluation of the properties of health technologies and interventions covering both their direct and indirect consequences. It aims to determine the value of a health technology and to inform guidance on how these technologies can be used in health systems around the world.

According to the WHO 2015 Global Survey on Health Technology Assessment by National Authorities, high-income countries are much more likely than low-income countries to use HTA for determining reimbursement or to decide what to include in a benefits package. Middle-income countries tend to use HTA to inform clinical practice guidelines and protocols more often (85%) than high- and low-income countries (46% and 50%, respectively). Less than 60% of countries in any income category used HTA for pricing of health products.

The most conventional form of HTA is at the “micro-level,” which focuses on the assessment of individual health technologies such as drugs and medical devices. However, “micro-level” HTA of individual technologies is unlikely to address the systemic challenges faced by healthcare systems in low- and middle-income countries.

In contrast, “macro-level” HTA specifically addresses patient access to high quality medical care by assessing the effectiveness and efficiency of interventions within the whole health system and informing the prioritization of healthcare services.

“Macro-level” HTA can inform payers’ decisions on what products and services to cover in benefits packages as countries progress towards UHC and expand beyond basic benefits packages toward comprehensive coverage.

The innovative biopharmaceutical industry believes evidence-informed benefits design that is patient-centered and takes into account the healthcare delivery system as a whole can help promote long-term sustainability and flexibility in meeting UHC objectives. This, at the same time, while ensuring that priority setting reflects social values and preferences for investment in healthcare.

The Universal Health Care Act of 2019 created the Health Technology Assessment Council (HTAC), an independent advisory body with the overall role of providing guidance to the Department of Health (DoH) and the Philippine Health Insurance Corp. (PhilHealth) on the coverage of health interventions and technologies to be funded by the government.

HTAC is mandated to undertake technology appraisals by determining their clinical and economic values in the Philippine healthcare system, with the aim to improve overall health outcomes and ensure fairness, equity, and sustainability of coverage for all Filipino citizens. Ethical, legal, social and health system implications are also considered in the assessments.

The HTAC Core Committee is responsible for the development and submission of final recommendations to policy- and decision-makers, based on the evidence appraisal of the different subcommittees.

As the country’s HTA works toward assessing medicines and technologies, it is important to consider the patient perspective and overall impact to improving health outcomes of the individual, and in the healthcare system. An ideal HTA is one which enables access to life-saving medicines and technologies for each and every patient who urgently needs them.

Teodoro B. Padilla is the executive director of the Pharmaceutical and Healthcare Association of the Philippines (PHAP), which represents the biopharmaceutical medicines and vaccines industry in the country. Its members are at the forefront of research and development efforts for COVID-19 and other diseases that affect Filipinos.