Health costs are already swallowing up 10% of GDP in the OECD countries, with a 4% year-on-year increase in the EU. The already aged European population has a life expectancy that is growing by a year every four years. And there is an economic crisis. Small wonder that Health Technology Assessment (HTA) is becoming a key tool for determining the safety, efficiency, and cost-effectiveness of therapies and technologies. Such assessments can be pivotal to decisions about whether diagnostic/ treatment costs are reimbursed. And a growing number of stakeholders want a say, experts told today’s session on Benchmarking Health Technology Assessments.

Bad Hofgastein, October 7, 2011 - Health Technology Assessment (HTA) has become a key policy instrument in the development and management of health care systems. The challenge of Europe’s ageing population, with a life expectancy growing by a year every four years, was compounded by health costs (rising in the EU by an annual 4%), topped by the current economic crisis, have all added urgency to getting good value, for patients but also to balance the needs and priorities of providers, innovators, and also payers. A broad, system-wide healthcare approach, involving all stakeholders, was the most promising approach, Prof. Bengt Jönssen of Stockholm School of Economics, told the European Health Forum Gastein (EHFG) today.

The economic crisis had brought public health spending to a standstill, he said. “On the other hand, a situation like this offers opportunities for improving the efficiency of healthcare delivery – quality care as well as cost-saving. And HTA is a good tool for finding a balance of interests in the healthcare system, and making better use of dwindling resources”. Average health costs in the OECD had now risen to 10% of GDP, he said. Something had to be done. But there was often a lack of evidence about both patient benefit and cost-effectiveness, Prof Jönssen said. HTA could help by guiding medical innovation and decisions about market access.

An advantage of HTA, he said, was that data were  analyzed and evaluated in an open and rational way which made decisions very transparent. "Of course an HTA cannot satisfy everyone all the time,” he said. “You cannot do everything for everyone. But I think everyone has the right to know how decisions are made."

Patients demand participation 

One of the interest groups demanding increased involvement in the HTA processes is affected patients themselves. But as Dr. Gisela Kobelt, president of a French polyarthritis patient union, noted, there could be problems associated with this. HTAs were necessarily very  quantitatively oriented, in terms of cost-effectiveness, for example. “But the interests of the patients and their representatives, are usually more focussed on quality.” It was also difficult to define who should represent the interests of the public - patients had a different perspective to the general public in terms of new therapies.

"Public and patient involvement will gain ground,” said Dr Kobelt. But, noting a recent survey of HTA-experts from Canada and the UK, she said: “The HTA community wants to move cautiously and incrementally." 

Common HTAs were now being implemented at EU level, reported Wim Goettsch (NL), lead partner of the EUnetHTA. "Technologies are becoming more international, not only for pharmaceuticals – the European market authorisation - but also for medical devices, surgical procedures and so on. Patients are becoming more ‘European,’ and the EU Directive on cross-border healthcare specifically mentions HTA as a tool.”  

Another reason for EU collaboration, he said, was to reduce  duplication: “Some technologies, like drugs in oncology assessments, are performed simultaneously by different national and regional organisations.” The same was true of HTAs. “Variety in types of assessments seems to be common, but does this lead to different assessment results"? 

Goettsch emphasized that European health insurance was not the goal: “Decisions about reimbursement should continue to be made on a national level.” 

The focus of EUnetHTA, Joint Action 2010-12 HTA, is to facilitate efficient use of resources available for HTA in Europe; to create a sustainable system of HTA knowledge sharing, to promote good practice in HTA methods and processes and to develop a business plan for a continuous European network for HTA.

The EHFG is the most important conference on health care policy in the EU. This year it attracted more than 600 decision-makers from 45 countries for discussions on the latest developments in health care policy.   

EHFG Forum 6, Session 1 “Health Technology Assessment.” 6 October 2011

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