Article first published by University of Strathclyde

Academics at the University of Strathclyde have produced a simulation tool for assessing the return on investment in Health Technology Assessment Agencies (HTAs) as part of a country’s healthcare system.

The spreadsheet-based tool was produced as part of the Evaluating the Value of a Real-world HTA Agency (EVoRA) project, a collaboration with Thailand’s Health Intervention and Technology Assessment Program (HITAP).

HTAs are bodies that assess and evaluate health technologies. They work with healthcare stakeholders to produce reports and recommendations on which technologies should be adopted as well as producing guidelines for clinical practice.

The simulation-based approach allows policymakers to directly compare health expenditures and outcomes in a scenario where an HTA agency exists and where no such agency exists.

The spreadsheet-based tool was produced as part of the Evaluating the Value of a Real-world HTA Agency (EVoRA) project, a collaboration with Thailand’s Health Intervention and Technology Assessment Program (HITAP).

HTAs are bodies that assess and evaluate health technologies. They work with healthcare stakeholders to produce reports and recommendations on which technologies should be adopted as well as producing guidelines for clinical practice.

The simulation-based approach allows policymakers to directly compare health expenditures and outcomes in a scenario where an HTA agency exists and where no such agency exists.

Practical demonstration

Professor Alec Morton, Head of the Department of Management Science, who created the tool along with Knowledge Exchange Fellow Dr Euan Barlow, said: “As countries develop their health systems on the path to Universal Health Coverage, many are experimenting with the development of a health technology assessment agency in order to set priorities for health benefit packages, make go/no go decisions about innovative new health interventions or to support pricing negotiations.

“Our simulation model is designed to provide users with a practical demonstration of the expected value which could be returned from investment into a health technology assessment (HTA) agency.

The simulation model provides a quantitative comparison of alternative approaches to making decisions on which potential health technology (HT) projects should be allocated funding.

“Comparisons are given in terms of the overall financial impact and anticipated health benefits which could be expected from pursuing the alternative funding approaches.

“Our simulated HTA agency makes decisions on the basis of a cost/quality-adjusted life years rule with a threshold set so that it will accept roughly half of available health technologies.

“We then compare it with a situation where the country accepts technologies on a first-come-first-served basis, without considering cost-effectiveness. Our simulation generates 1,000 random scenarios.

“The threshold rule leads on average to more interventions being funded, higher health benefits for the population and lower costs for payers.

“Inspection of the scenarios shows that in no scenario are costs higher and health benefits lower with the threshold, than with the first-come-first-served approach demonstrating the power of cost-effectiveness analysis.

“Furthermore, the spreadsheet model demonstrates the approach to HT funding decisions which could be expected under an HTA agency, where decisions are transparent and justifiable, and can be tailored to target the priority measures of impact as appropriate to the localised funding situation.”

The EVoRA project generated three separate outputs, each of which is intended to provide an alternative view towards the evaluation of an HTA agency. The outputs along with a policy brief which draws on their findings and a video explaining the project can be found on the HITAP website.

The Health Intervention and Technology Assessment Program (HITAP) is funded by the Thailand Research Fund under a Senior Research Scholar grant.

HITAP’s International Unit is supported by the International Decision Support Initiative (iDSI) to provide technical assistance on health intervention and technology assessment to governments in low- and middle-income countries.

iDSI is funded by the Bill & Melinda Gates Foundation, the UK’s Department for International Development, and the Rockefeller Foundation. Overseas Development Institute Fellows at HITAP support its work in the region.