Diverse stakeholders amplify calls for bold HTA reform

Pharma News: Australians are calling for a revamped Healthcare Technology Assessment (HTA) and medicines reimbursement system that prioritises timeliness, equity, accountability, and accessibility for all citizens. Concerns have arisen as Australian patients contend with staggering delays, waiting three to five times longer on average for access to reimbursed new therapies compared to nations like the United Kingdom (UK), Germany, and Japan. Moreover, the time it takes to secure reimbursed access significantly impacts Australian patient outcomes, with patients dying from their conditions whilst waiting for access.

To address these pressing issues, key stakeholders including Janssen, Cancer Health Services Research, Consumer Health Forum, and ANDHealth, have submitted recommendations to the HTA Review.

Janssen identified several barriers hindering the system’s ability to provide timely reimbursed access to new therapies for Australian patients. These barriers encompass both value assessment and process-related challenges. Notably, managing clinical, economic, and financial uncertainty conservatively, outdated willingness to pay for innovative medicines, selecting comparators based on cost-saving measures, and a growing focus on budget impact have all played a role in prolonging access to life-saving treatments.

In a shared pursuit of transformative change, Janssen emphasised the need for stakeholders to unite in their ambition for bold HTA system reform. The company stressed the urgency of minimising the gap between TGA registration and reimbursed access, aiming for Australia to rank among the top five OECD nations for timely medicines access.

Cancer Health Services Research at the University of Melbourne highlighted critical barriers in their HTA submission, which included the absence of a systematic horizon scanning program, limited guidance on real-world evidence integration, and substantial delays in translating positive recommendations into actual healthcare technology listings.

Another notable issue was the lack of consumer input in HTA decisions. Cancer Health Services Research recommended greater consumer involvement in all decision-making committees, including PBAC/MSAC committees, emphasising the need for patient representatives and direct patient involvement to better align HTA with patient needs and priorities.

“Empowering disease-focused consumers will improve the alignment of HTA with patient needs and goals, ultimately leading to more patient-centred decisions. We need to establish policy to collect real-world evidence directly from patients through patient-reported outcomes, registries, and patient advisory groups,” the organisation said.

Furthermore, there is a growing recognition of the significance of digital health technologies in improving healthcare outcomes. These innovations, including mobile health (mHealth), health information technology (IT), wearable devices, telehealth, and personalised medicine, are transforming the healthcare landscape. However, the current HTA system lacks a dedicated pathway for evaluating ‘digital health’ technologies.

ANDHealth, in its HTA submission, called for the inclusion of digital health within the definition of health technologies. The organisation highlighted the importance of supporting small and medium-sized enterprises (SMEs) to access the HTA system, as these advances in preventative and personalised medicine, remote patient monitoring, and medication management hold the key to the future of the health technology sector.

“In Australia’s case, the ideal solution could combine the best of both the US and German systems to create a new world-leading reimbursement framework which not only incentivises clinicians by reimbursing them to adopt digital health solutions, such as remote monitoring for instance (similar to the US system), but also reimburses digital products directly to drive uptake by end users of apps and other consumer-facing digital health products (similar to the German system),” stated ANDHealth.

Consumer Health Forum’s HTA submission echoed the need for greater consumer involvement from the outset of the decision-making process. Drawing inspiration from the European Union’s approach, the forum advocated for training patient advocates to participate alongside clinicians. They also stressed the importance of considering the social return on investment in healthcare and addressing the barriers posed by co-payments for many Australians.

“The view in the documentation very much subscribes to a ‘dollars and cents’ view of healthcare. This is by nature inequitable. The Review should consider that costs such as co-payments are, for many, a barrier to treatment, and not just an inconvenience. No consumer should ever have to choose between treatment and food. Increasingly this is a choice that many are forced to make. When discussing any change to the system that underlies access to healthcare, the complex relationship between poverty and other kinds of disadvantage and equitable access to health interventions needs to be acknowledged and addressed,” Consumer Health Forum stated in its submission.

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