Prof Andrés Pichon-Riviere MD MSc PhD

Executive Director and Director of the Health Technology

Assessment and Health Economics Department

Institute for Clinical Effectiveness and Health Policy (IECS)

Professor of Public Health, University of Buenos Aires

HTAi 2018 Annual Meeting

OP09: Summary of the 2018 HTAi Latin America Policy

Forum Background Paper

Contents

• Introduction and background of the 3rd HTAi Latin American

Policy Forum held in Montevideo in April 2018

• Topic selection for this Policy Forum

• Development and contents of the background paper prepared

for this 3rd Policy Forum

Objetives:

• to identify which of the HTA good practice principles proposed at the international level would be the most relevant and of highest priority for application in LAC;

Introduction

First HTAi – Policy Forum

Latin America, 2016

Results and conclusions

• Good practice principles proposed at the international level are valid and potentially applicable in LAC

• The main recommendation was to find appropriate HTA processes and/or methodologies, adapted to the context of each country that would allow for gradual improvements to the links between HTA and decision making.

Pichon-Riviere A, Soto NC, Augustovski FA, Sampietro-Colom L. Stakeholder

involment in health techonolgy assessment process in Latin America. Int J Technol

Assess Health Care, 34:3 (2018), 1-6. doi:10.1017/S0266462318000302

Pichon-Riviere A, Soto NC, Augustovski FA, García Martí S, Sampietro-Colom L.

Evaluación de tecnologías sanitarias para la toma de decisiones en Latinoamérica:

principios de buenas prácticas]. Rev Panam Salud Publica. 2018 Feb 19;41:e138.

Spanish. PubMed PMID: 29466522.

...five principles were identified as high priority and with the greatest potential to be

applied or strengthened in the region in the short term:

Objective:

To debate the best way for HTA agencies in the region to improve stakeholder involvement, both in terms of the conceptual frameworks as well as in the methodological and operational aspects of HTA.

2017

2nd Latin-

American

Policy Forum

3rd Policy ForumDefining the value of health technology in Latin America: developments in value frameworks to inform the allocation of health care resources

Objective: to explore contemporary experiences in the use of value frameworks to

inform the incorporation of health technologies and discuss the potential

implementation of value frameworks in Latin American HTA systems.

2018

3rd Latin-

American

Policy Forum

Background paper

OBJECTIVE

The objective of the Background paper is to offer useful information to

stimulate in-depth discussions during the HTAi’s 2018 Latin America

Policy Forum.

Contents:

• basic information about value frameworks,

• their use in decision-making processes to allocate health resources,

and,

• a series of examples and experiences in the use of value frameworks.

Methods:

The background paper was developed from the 2017 HTAi Global Policy

Forum paper “From theory to action: developments in value frameworks to

inform the allocation of Health care resources”, complemented with a

bibliographic search and an Internet search of the websites of many

organizations involved in the development of value frameworks.

The background paper was prepared by the Institute for Clinical

Effectiveness and Health Policy (IECS) from Argentina, acting as the

Scientific Secretariat of the Latin American Policy Forum.

Results

The background paper summarizes the relevance of value

frameworks around the world and narratively synthetizes the

key findings globally and draw out issues and experiences

relevant to the Latin America region

Wija Oortwijn - HTAi 2017 Annual Meeting Rome, Italy

Reasons for proliferation of frameworks

• Rising health care costs

• More complex health technology

• Perceived disconnect between price and value

• Changes in societal values

• Need for inclusion of additional considerations, such as ethical issues

• Greater empowerment of clinicians and patients

Wija Oortwijn - HTAi 2017 Annual Meeting Rome, Italy

Key topics discussed at 2017 GPF

• Reasons for proliferation of value frameworks

• Content:

- Differences between existing and emerging framework

- Criteria used in value frameworks

- Involvement of different stakeholders

• Use in decision-making:

- Context matters – health system/cultural values

- Value across indications of one technology

- Early access schemes

Conclusions (1 of 2)

Clear consensus over the fact that value frameworks must adhere to principles

such as transparency, predictability, active involvement of stakeholders, and

having clear and consistent processes.

Value Frameworks should not be too rigid or be based solely on numerical

formulas. Deliberative processes are encouraged.

One of the main challenges is the inclusion of other criteria and values beyond

cost and clinical benefit, such as equity and transparency in decision-making

processes

The HTA community plays a decisive role in the use of value frameworks and

the definition of core criteria.

Conclusions (2 of 2)

In Latin America, the formal use of value frameworks is not as developed as in

other regions.

Value frameworks are an important topic for Latin America and can be a

valuable tool to achieve objectives that were already identified as priorities in

the previous Policy Forums:

• Transparency in the production of HTA and the communication of results

• Involvement of relevant stakeholders in the HTA process

• Existence of clear links between the assessment and decision making

VF are not a rigid tool, they are context specific, and it is necessary to

discuss the best way to carry them forward in each country in the region:

• Which are the main dimensions that should be considered?

• Which are the best methodologies to apply?

• Which are the main barriers to their implementation?

Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina (www.iecs.org.ar)

Thanks!

Andres Pichon-Riviere MD MSc PhD

apichon@iecs.org.ar