Health and the Wealth of Evidence: A workshop on using Health technology Assessment (HTA) for priority setting in Indonesia

Thailand’s HITAP, one of iDSI’s core partners, along with the Indonesian Ministry of Health and the  WHO country office in Indonesia, organised and led an HTA capacity building workshop in Jakarta, from  April 25 to 29, 2016. Delegates included clinicians from four academic institutions in Indonesia (University of Gadjah Mada, University of Airlangga, University of Hassanuddin, and the University of Indonesia), HTA committee members and representatives from the Ministry of Health. The workshop was opened by Dr. Donald Pardede, Director of the Centre for Health Financing and Health Insurance (Pusat Pembiayaan dan Jaminan Kesehatan, PPJK), MoH. The PPJK is the secretariat of Indonesia’s HTA committee.

The workshop provided an introduction to HTA and economic evaluation, and included highly interactive practical exercises and the development of HTA proposals over the course of 4 days on topics identified by the participants themselves. These proposals were then presented to senior MOH staff and HTA committee members on the last day. Delegates learnt how:

Health technology assessments are conducted to generate evidence for decision makers

How HTA evidence is used in policy making

How other countries around the world use HTA

Formal training presentations were delivered by HITAP experts, led by Dr, Yot Teerawattanon and Drs. Usa Chaikledkaew and Montarat Thavorncharoensap from Mahidol University from Thailand. Dr. Raymond Hutubessy, Health Economist at the WHO, gave a discussion on HTA as applied to vaccines; and Dr Andrew Mirelman from the University of York, also discussed decision rules in economic evaluation. Dr. Hutubessy highlighted a number of challenges in the application of HTA techniques to vaccines, particularly when evaluating the newer generation of technologies in this area, since they demand a flexible, comprehensive approach that also includes consideration of different delivery platforms such as school settings.

University of York researchers, supported by iDSI, are seeking to embark on research to support the estimation of the opportunity cost of health interventions in Indonesia using local data, in order to contribute to the development of appropriate decision rules that can be used by Indonesian policy makers and local HTA researchers. This research would represent the first ever in-country estimation of health opportunity costs in a non high-income setting. Participants at the workshop heard how opportunity costs can serve as useful ‘benchmarks’ for investment decisions in health, alongside ethical considerations and other social objectives a decision maker may have.

In a presentation by Dr Carleigh Krubiner (Berman Institute of Bioethics, John Hopkins University), attendees at the workshop heard about ethical frameworks for promoting justice and equity that could applied to priority setting, and the important role of implementing HTA processes that are seen to be fair and participatory. The issue of HTA process was also highlighted by Francis Ruiz of NICE International in his presentation, which also provided examples of where ‘poor’ and opaque approaches to priority setting can have negative impacts on health system resources and population health.

Building HTA capacity requires the development of appropriate skills within local academic institutions. This iDSI supported workshop, by bringing together Indonesian academics and policy maker representatives,  helps build this mutual understanding and contributes to the Indonesian government’s aim of building a sustainable HTA framework to inform coverage decisions as part of that country’s UHC agenda.