NICE hosts senior delegation from Indonesia
From 28 – 30 September 2015, NICE hosted a delegation of senior health policy makers and academics from Indonesia on a 3-day study visit. The delegation was led by Dr Untung Suseno Sutarjo, Secretary General, Ministry of Health of Indonesia. The aim of the study visit was for the delegates to learn about the UK’s approach to using evidence and social values to inform healthcare decision making and to explore how NICE can work in partnership with Indonesia as they continue their progress towards universal health coverage.
The visit was supported by USAID and iDSI, working in partnership with the Indonesian Ministry of Health and the WHO country office. It was part of a continued series of engagements between Indonesia, NICE and iDSI partners, including HITAP, which is working with the Indonesian Ministry of Health to develop HTA to support health policy decision making.
The agenda included presentations on the National Health Service, its organisation and key guiding principles. The delegation also learnt about the history and background of NICE during discussions with Sir Andrew Dillon and Professor David Haslam, and how NICE has managed to remain a useful institution within the National Health Service over the years.
NICE staff introduced the delegation to key NICE outputs including Technology Appraisal recommendations, Clinical Guidelines, Public Health Guidance and Quality standards. The delegation also visited the NIHR Evaluation, Trials and Studies Coordinating Centre, University of Southampton to learn about the key role of health research in informing health decision making in the UK. On the final day of the visit, Professor John Cairns chaired a session at NICE offices to discuss the proposed roadmap for HTA institutionalisation in Indonesia and how NICE and partners can support this initiative.
The visit was highly successful and has laid the groundwork for continued partnership between NICE and the Ministry of Health in Indonesia over 2016-2018. Read the study visit report here.
Supporting the development of HTA processes in Indonesia
NICE International joined the HITAP team, senior officials from the Ministry of Health (MOH), the National Health Security Office (NHSO) and Mahidol University in Jakarta for two days of meetings on the strategy around establishing and sustaining a HTA process in support of Universal Health Coverage (UHC) in Indonesia.
The events were coordinated by the WHO country office and major funding and delivery partners including PATH, USAID and DFAT also joined, as did different stakeholders from government, including the recently set up HTA Committee; representatives from Badan Penyelenggara Jaminan Sosial (BPJS), the health insurance agency; different MOH departments including P2JK which is serving as the Secretariat for the HTA committee; managers from major hospitals and community involvement leaders.
In parallel, Carleigh Crubiner, who is leading on the ethics stream for iDSI, conducted a series of interviews with key stakeholders in preparation of applying for a Wellcome Trust grant to support this work-stream going forward.
The Secretary General of the MOH joined the discussions and reiterated the government’s commitment to high quality services and the relevance of accountable HTA processes to achieving the objectives of UHC. During their presentations, the HTA Committee chair and Committee members raised issues of capacity, data and institutional coordination across major players such as the Indonesian FDA and the MOH, as potential challenges. Strengths included the existing legal framework setting out HTA as a requirement in the decision making process for technology adoption decisions, and the HTA committee with dedicated, though part-time support staff and a broad and supportive international network. A HTA roadmap is being drafted with a mission and vision already well-articulated (see slide 1 of PowerPoint presentation below) and setting the authorities achieving a clear HTA process and structure with over 100 staff in place by 2026. The vision also sets out that 0.05% of the Jaminan Kesehatan Nasional (JKN) budget should be used to support HTA activities.
One of the major take home messages was the need to connect HTA results with the way the health benefits package is designed and updated and in particular aligning payment mechanisms with HTA decisions through for example introducing national level value-based prices for individual drugs and devices especially those paid for through Fee For Service and adjusting the bundle price for care episodes to reflect the cost of cost effective technologies.
During the second day, a comprehensive list of activities was presented by the MOH leadership (see slides 2 and 3) and a donor coordination meeting was held to agree on priority areas and responsibilities. iDSI will coordinate with existing players both local and international to make sure our activities contribute towards the government’s vision. The leadership of the MOH and BPJS will also be hosted at NICE the week of 28 September 2015, as part of our ongoing collaboration with the Indonesian authorities.
Visiting HITAP for latest on economic evaluation of the Package of Essential Non-Communicable Disease Interventions (PEN)
In August 2015, Laura Morris visited the Health Intervention and Technology Assessment Program (HITAP) for two weeks as part of the partnership between NICE and HITAP. The purpose of the visit was to better understand HITAP’s role in providing evidence in the Thai health system and delivering practical support to other countries in the region.
Laura shadowed HITAP researchers leading on an economic evaluation of the Package of Essential Non-Communicable Disease Interventions (PEN), conducted as part of iDSI practical support in Indonesia. This study aimed to examine the value-for-money and budget impact of different options for implementing the PEN. It was completed in collaboration with the Indonesian Ministry of Health and WHO country and regional offices.
The study demonstrated that screening for diabetes and hypertension is highly cost-effective and leads to greater health gains at population-level (versus no screening). The current programme was estimated to:
- Reduce healthcare costs by 14.22 million IDR (around £675 or $1031) for every disability adjusted life year (DALY) averted
- Yield 7.10 more DALYs averted than no screening
Analysis also showed that cost-effectiveness could be improved (and coverage of the intervention increased) by targeting the screening at high-risk groups (Rattanavipapong et al., in press). This targeted option has the potential for significant savings, which can be re‐allocated to other programs to improve overall treatment.
During her time in Bangkok, Laura also participated in a study visit to HITAP by a delegation from Vietnam. The delegates will be responsible for forming a Council for the Basic Health Service Package (BHSP), due to be submitted in 2017. They visited HITAP to present their progress so far and discuss the appropriate role and membership of the council. As part of the study visit, HITAP presented on the Thai Sub-committee for Benefit Package and Laura presented on the role of NICE’s Technology Appraisals Committees, providing the Vietnamese colleagues with an overview of the experiences from Thailand and the UK in this area.
HTA workshop in Indonesia
Francis Ruiz joined colleagues from HITAP at a stakeholder workshop in Jakarta to highlight the role of HTA and priority-setting in supporting UHC .
In support of ongoing iDSI activities in Indonesia, at the end of April 2015, Francis Ruiz, Senior Adviser, NICE International participated in a stakeholder workshop organised by the WHO on HTA, held in Jakarta.
Attendees at the workshop included representatives from multiple stakeholder groups including local academics and clinicians, the MOH (Centre for Health Insurance, Pusat Pembiayaan dan Jaminan Kesehatan or PPJK) and the social health insurer Badan Penyelenggara Jaminan Sosial (BPJS). The workshop began with presentations from Francis Ruiz and Dr Yot Teerawattananon on the role of explicit priority setting and HTA in support of UHC, drawing examples from the UK and Thai experience. There was also a presentation from Prof Dr Sudigdo Sastroasmoro, Chair of the recently established HTA committee, on the current status of HTA in Indonesia and the work of the committee.
The second half of the workshop focussed on the HITAP supported economic evaluation of an MOH adapted version of the WHO PEN programme. (PEN stands for “Package of Essential Non-Communicable disease”). HITAP presented preliminary results of an analysis of alternative screening policies that could be adopted.
Francis Ruiz also participated in training workshops for the technical secretariat supporting the HTA committee and selected topic experts, as part of capacity building work by HITAP to enable an evaluation of two future topics: treatments for pulmonary arterial hypertension, and a comparison of peritoneal and renal dialysis.
Supporting Health Technology Assessment development in Indonesia