How does Australia’s HTA stack up?

A new report delves into the evolving landscape of Health Technology Assessment (HTA), documenting key reforms, identifying driving factors, and analysing the influences that shape HTA guidelines across 14 countries, including Australia.

This first-of-its-kind analysis uncovers how HTA agencies have shaped and been shaped by each other in the ongoing development and review of their HTA Methods and Processes (M&P) guidelines.

HTA plays a pivotal role in the decision-making processes that govern access to cutting-edge health technologies. The report evaluates how HTA agencies, across diverse geographies, address five core methodological themes: discount rates, modifiers, patient involvement, real-world evidence (RWE), and surrogate endpoints.

The findings illustrate a clear trend toward greater adaptability and pragmatism among HTA agencies in their evaluation of new treatments, though notable variation remains between agencies. However, the absence of harmonisation across M&P guidelines is creating discrepancies in the evidence requirements imposed by different stakeholders.

When examining discount rates, the report reveals a striking range from 1.5% to 5%, with most agencies setting rates between 2.5% and 3.5%. Yet, Australia stands as a stark outlier, clinging to the highest discount rate of 5% – a rate it has maintained since before 2010.

While discounting future costs and benefits is widely accepted in economic evaluations, there remains no consensus on the appropriate rate. The choice of discount rate profoundly impacts the economic evaluations of interventions, especially for those like gene therapy, where costs are incurred upfront but benefits unfold over a prolonged period.

The inclusion of patient perspectives in HTA decision-making is critical to ensure that voices and evidence not captured through clinical or economic analysis are incorporated into evaluations. By prioritising patient involvement, HTA agencies can enhance the legitimacy and credibility of their decisions.

The majority of HTA agencies have explicit guidelines on patient involvement, though the report reveals that Australia’s PBAC, along with four other agencies, lack clear guidance on this issue. Despite this, the PBAC has demonstrated a ‘willingness’ to incorporate patient input into its decision-making, though it ranks lower compared to agencies like ACE (Singapore), CADTH (Canada), IQWiG (Germany), and NICE (UK) in terms of patient involvement.

HTA agencies identified as ‘catalysts’ lead the charge in reforming M&P processes and their influence often extends beyond national borders. NICE, in particular, stands out as a leader, with over four revisions of its M&P guidelines and references in the guidelines of ten other agencies. Similarly, the PBAC is also recognised as a highly influential body, cited in the guidelines of six other agencies.

“Our research identified variations amongst agencies in how formal and structured their M&P reform processes are. NICE is an example where there is a process with clear steps, including stakeholder involvement and opportunities for their input. Other agencies have less transparent or well-defined processes, which might make it challenging for external parties to anticipate, get involved, and contribute. This could represent a key priority for HTA agencies to address to ensure inclusivity and broad endorsement among local stakeholders,” the authors said.

The drivers of reform primarily reflect the perspectives of various stakeholders, such as academics, patients, and HTA experts. The authors argue that “robust empirical evidence”, including “societal preference studies” and advances in methods development, should form the foundation of any evidence-based reforms.

Additionally, international collaboration has the potential to accelerate the evolution of HTA systems and streamline the implementation of reforms by enabling agencies to collectively anticipate and address shared challenges. An example of this is a collaboration between eight agencies across Australia, Canada, and the UK, which focuses on improving work-sharing, horizon scanning, and methods development.

“To be fully successful, collaborations should ensure full and early involvement of stakeholders, to increase the legitimacy of changes, improve evidence generation, and facilitate implementation of reforms at the national level,” the authors emphasised.

In reimagining healthcare across the entire patient journey, Health Industry Hub^TM is the only one-stop-hub uniting the diversity of the Pharma, MedTech, Diagnostics & Biotech sectors to inspire meaningful change.

The Health Industry Hub^TM content is copyright protected. Access is available under individual user licenses. Please click here to subscribe and visit T&Cs here.