Coverage decision and medical practices: the role of health technology assessment in Thailand

Transcription

1 Coverage decision and medical practices: the role of health technology assessment in Thailand Pattara Leelahavarong Health Intervention and Technology Assessment Program (HITAP) Fourth Health Policy Decision Makers Forum Asia-Pacific 22 nd October 2016, Beijing, China 1

2 Background Population 67 millions 1% Establishment of the Universal Coverage Scheme (UCS) in 2002 (~1/5 of THE) 12% 13% Total health expenditure (THE): 3.7% of GDP (Public 77%) Sources: National Health Account Report, 2013 GDP per capita: 5,779 USD Sources: World Bank, 2016 Universal Health Coverage 74% Civil Servant Medical Benefit Scheme Social Security Scheme Universal Coverage Scheme Others 2

3 Semi-autonomous, non-profit institute under the MoPH, Thailand UCS Establishment Thai HTA guideline and standard cost list database issued nd Thai HTA process guideline issued 2011 HTA on RRT for ESRD 2004 PD-first policy for UC 2005 HTA-informed benefit package development for UCS and NLEM 2008/2009 Role of HTA in Thailand 3

4 o Value for money o o Incremental cost-effectiveness ratio (ICER) Cost-effectiveness threshold = 160,000 THB/QALY (5,000 USD) o o Budget impact compared current practice and new intervention Feasibility study 4

5 -informed decision making National List of Essential Medicine development (NLEM) Non-pharmaceutical package development (UCS benefit package) Responsible authority National Drug Committee chaired by Deputy Prime Minister National Health Security Board chaired by Health Minister Year of establishment Year of HTA introduction Groups responsible for topic nomination Technical body supporting HTA data Evidence requirement 20 medical specialist groups and the Subcommittee for development of NLEM Health Economic Working Group (HITAP as the secretariat) Cost-utility, budget impact, price negotiation Current capacity HTAs conducted annually by 4-6 public institutes and private firms Implementing agency Three public insurance schemes (UCS, CSMBS, SSS) 7 stakeholder groups (decision makers, academics, professionals, industry, civil society, patients and the public) IHPP, HITAP, and academics Cost-utility, budget impact, feasibility, accessibility 10 HTAs conducted annually by IHPP/HITAP National Health Security Office (for only UCS) 5

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7 Incr. cost 500, ICER 300,000 THB/QALY at current price 2. Negotiated price based on CE threshold -5 Accept the technology if ICER < 160,000 THB/QALY* C 3. Final negotiated price based on budget impact and affordability of 3 schemes 5 Incr.LYs *5,000 USD (1 USD = 35 THB) -500,000 6

8 Appraisal results and decision making Imiglucerase for Gaucher type 1 PD-first policy for ESRD 8

9 Cost-effectiveness of treatment for chronic hepatitis C Peg-interferon alpha 2a,2b plus ribavirin offer cost-saving option. Medicines were included in NLEM in ,000 5,000 Price negotiation of PEG-IFN (180 mcg) Potential saving per year = 600 million THB 0 original price negotiated price New costly treatment (Sofosbuvir) is under consideration. Source: Teerawattananon Y, Tritasavit N, Suchonwanich N, Kingkaew P. The use of economic evaluation for guiding the pharmaceutical reimbursement list in Thailand. Z Evid Fortbild Qual Gesundhwes. 2014;108(7):

10 Hematopoietic stem cell transplantation (HSCT) for severe thalassemia patient Related HSCT was cost-effective. UCS Subcommittee agreed to include the transplantation in the benefit package, but feasibility of the service provision needed to be studied. HLA-B*1502 screening for preventing severe adverse drug reactions Carbamazepine is the first line treatment for epilepsy and neuropathic pain. Cost-effectiveness results are contradict. Sources: 1) Leelahavarong P, Chaikledkaew U, Hongeng S, Kasemsup V, Lubell Y, Teerawattananon Y. A cost-utility and budget impact analysis of allogeneic hematopoietic stem cell transplantation for severe thalassemic patients in Thailand. BMC health services research. 2010;10:209. 2) Rattanavipapong W, Koopitakkajorn T, Praditsitthikorn N, Mahasirimongkol S, Teerawattananon Y. Economic evaluation of HLA B* 15: 02 screening for carbamazepine induced severe adverse drug reactions in Thailand. Epilepsia Sep 1;54(9): ) Kieslich K, Bump JB, Norheim OF, Tantivess S, Littlejohns P. Accounting for Technical, Ethical, and Political Factors in Priority Setting. Health Systems & Reform Jan 2;2(1):

11 Barriers to the development of HTA systems Silo-based decisionmaking process Respect for expert opinions or authorities HTA low quality decisionmaking criteria Source: Policy brief and working paper: Conductive factors to the development of HTA in Asia. PMAC 2016 Strict control on research disseminat ion 11

12 Six contextual factors of the establishment of HTA systems Settings independence from external support high proportion of public investment Political will, leadership, and legislation HTA Source: Policy brief and working paper: Conductive factors to the development of HTA in Asia. PMAC 2016 Effective collaboration between HTA agencies and local stakeholders Local training on HTA-related disciplines good health information infrastructure 12

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