ISPOR HTA Roundtable – Latin America – Summary Summary developed by Sebastian Garcia Marti, Chair of ISPOR HTA Roundtable Latin America
On 28 July 2022, ISPOR virtually held the ISPOR Health Technology Assessment (HTA) Roundtable – Latin America where 30 participants from different countries around the region convened to discuss how to incorporate economic evidence into health technologies assessment process and the challenges of HTA in pluralistic societies.
ISPOR has been convening annual Health Technology Assessment (HTA) Roundtables since 2007 with Roundtables now held in Asia Pacific, Europe, North America, Middle East and Africa, and Latin America. These Roundtables are closed-door, invitation only meetings between HTA bodies, public and private payers, other governmental decision makers, and academics when no HTA body exists in a country. They provide an unbiased platform to advance scientific methods; facilitate information-sharing about the current state of HTA, its development, and its role in optimizing healthcare decisions; and bridge the gap between technology assessors, private and public payers, regulators, and patients to improve health globally.
More specifically, the HTA Roundtable in Latin America is comprised of HTA bodies and other governmental organizations involved in pricing and reimbursement of healthcare technologies in Latin America.
During the meeting on 28 July, Andrés Pichon-Riviere from the Institute for Clinical Effectives and Health Policy (IECS) in Argentina, Adriana Robayo from the Instituto de Evaluación Tecnologica en Salud (IETS), and Aurelio Mejía from Ministerio de Comercio, Industria y Turismo (MINCIT) in Colombia presented some concepts around the incorporation of economic evidence in health technology assessments review, the experience in measuring a cost-effectiveness threshold for Colombia, and concepts on HTA process in pluralistic societies.
Andrés Pichon Riviere presented some of the results of the Inter-American Development Bank (IADB) Project report “Application of economic evidence in health technology assessment and decision-making for the allocation of health resources in Latin America: Seven key topics and a preliminary proposal for implementation” (1). He mentioned that two common regional barriers at the moment to incorporate economic evidence are lack of local economic evidence and countries not having a cost-effectiveness threshold defined. Regarding the cost-effectiveness thresholds, he presented some work on the estimation of local thresholds derived from country level life expectancy and GDP per capita. Results were similar to other studies’ results with general values around or less 1 GDP per capita for the different countries in the region. He also presented some approximation for the incorporation of economic evidence from other countries that rely on the comparison of GDP per capita of the country where the economic evidence was generated and the country where it needs to be incorporated, by relating the benefit and cost of the technology in both countries, the original and the application one.
Adriana Robayo presented a project done in Colombia to estimate the cost-effectiveness threshold. Based on mortality individual level data national vital health statistics, general life expectancy and national healthcare expenditure they estimate a threshold for Colombia of around 0.86 GDP per capita per QALY and 0.75 per life year gained, similar to the estimations in other studies (2). She also proposed some potential applications of this threshold as HTA price regulation and incorporation into the national health system.
During the second half of the Roundtable, Aurelio Mejía presented the work done by the ISPOR HTA Council Working Group on the Challenges of HTA in Pluralistic Healthcare Systems (3). It was highlighted that the challenges that this kind of health system face are multiple payers or funders with different requirements of information, different budgets, and different responsibilities regarding the provision of care.
He proposed some suggestions to overcome these challenges that includes the development of some core methods shared by the different payers or funders, the promotion of local adaptation of HTAs to facilitate its application, the generation of HTAs timely in accordance with the decisions to be made and to develop and maintain a collaborative framework that generates and promotes transparency among the different actors in the health system.
The roundtable concluded with HTA Council Chair and ISPOR President-Elect 2022-2023, Brian O’Rourke inviting the participation to the next ISPOR HTA Roundtable to be held virtually in July 2023.
(1) Application of economic evidence in health technology assessment and decision-making for the allocation of health resources in Latin America: Seven key topics and a preliminary proposal for implementation. A report for the Inter-American Development Bank. Pichon-Riviere A, Drummond M, García Marti S, Augustovski F. July 2021. IDB-TN-2286. July 2021. DOI http://dx.doi.org/10.18235/0003649. Available in eprints from: https://eprints.whiterose.ac.uk/178985/
(2) Espinosa O, Rodríguez-Lesmes P, Orozco L, Ávila D, Enríquez H, Romano G, Ceballos M. Estimating cost-effectiveness thresholds under a managed healthcare system: experiences from Colombia. Health Policy Plan. 2022 Mar 4;37(3):359-368.
(3) Drummond MF, Augustovski F, Bhattacharyya D, Campbell J, Chaiyakanapruk N, Chen Y, Galindo-Suarez RM, Guerino J, Mejía A, Mujoomdar M, Ollendorf D, Ronquest N, Torbica A, Tsiao E, Watkins J, Yeung K; ISPOR HTA Council Working Group on HTA in Pluralistic Healthcare Systems collaborators. Challenges of Health Technology Assessment in Pluralistic Healthcare Systems: An ISPOR Council Report. Value Health. 2022 Aug;25(8):1257-1267.
The ISPOR Virtual Payer Summit 2022 was hosted on Thursday, September 15. The theme of this year’s Summit was “Value Interpretation: Do We Need to Expand the Concept of Value for High-Cost Innovations?”. This discussion was coupled with breakout sessions that discussed avoided vs avoidable costs, incorporating patient-centered research and endpoints into value assessment, and how to incorporate broader societal value into clinical and economic assessments.
This event was moderated by Carole Longson, PhD of Carole Longson Consulting. Panelists included Peter Neumann, ScD of Tufts Medical Center, Alan J. Balch, PhD, of the Patient Advocate Foundation and National Patient Advocate Foundation, and Iga Lipska, MD, PhD, MPH of the Medical University of Gdańsk.
The topics featured at the Payer Summit were identified and led by experts from payers, industry, and academia who follow emerging trends and challenges in healthcare decision making. This meeting convened over 30 participants from payers, HTA bodies, patient organizations, and the biopharmaceutical industry to share lessons learned, solutions, and priorities for moving forward.
Additional information on the ISPOR Payer Summits is available here: https://www.ispor.org/strategic-initiatives/payer-engagement-in-heor