The musings of a NICE International intern from when a Vietnamese delegation came to visit

Ashok Manandhar Nov. 27, 2015

On the 19th of December 2015, NICE International host a 21-strong Vietnamese delegation headed by Professor Phạm Lê Tuấn, Vice Minister of Health, and as a young intern the whole experience was fascinating for me. The delegation comprised a number of heads of departments, directors and senior officials who formed a broad spectrum of Vietnamese health policy makers, seeking to increase their understanding Health Technology Assessment (HTA) methods and application; its potential for application in Vietnam; and the role of research and other organisations in the HTA process.

NICE International Director Kalipso Chalkidou offered an overview of NICE and its core principles and practices. During this she emphasised how important it is to not only measure the cost-effectiveness of a particular drug or intervention, but then comparing it to the existing standard practice. Economic evaluations of these sorts are what the delegation is keen to bring to the Vietnamese health system.

The following presentation was probably of the most interest, both to the delegation and to me, as it outlined the nature of and the methods underlying Health Technology Assessment (HTA). NICE International’s Tommy Wilkinson went into detail on a plethora of topics encompassing: HTA and its workings, from assessment to technology appraisal, and then subsequently to recommendations; regulatory approval, oversight and accountability; the two drug pricing mechanisms in the UK; the Patient Access Scheme (PAS) and reference pricing; pharmacist’s pay; medical device pricing and procurement; deliberate misalignment of the main stakeholders’ incentives; and the Incremental cost-effectiveness ratio (ICER) and QALYs. Predictably, after covering so many areas, the delegation had numerous questions, especially seeing as economic evaluation has great significance to the Vietnamese setting as with many health systems in emerging economies. For someone who is about to study Economics at university these discussions really captured my attention; most significantly how QALYs and the ICER allow for multiple health interventions to be simultaneously compared and graphically illustrated in terms of both health gain and economic impact. This can help decision makers make a better, more informed healthcare decision for the population.

However, HTA methods obviously cannot be taught solely through a short study tour, which raises the question: how much can the delegates take from this? This, in my opinion, is a greater understanding of the fundamental benefits of HTA and possessing an evidence-based policy making ethos. Therefore, Francoise Cluzeau and Ryan Li referenced NICE International’s work in Vietnam itself developing Quality Standards for the Hospital Management of Acute Stroke, demonstrating the application of HTA in that setting. They drew in many features of the project, including identification of problems, creation of innovative, evidence-based solutions, the systematic implementation of the quality standards and their impact on health outcomes. This was well received by the delegation, yet what became evident was how their understanding developed most when explanations were applicable to a familiar setting. Despite being a highly distilled version of the projects, simply referring to a practical real-life example made HTA more relatable to the delegates. This was the most valuable lesson I drew: that clear explanation is vital, but making what you are saying applicable to the audience is even more so. In this case NICE International’s previous work in Vietnam enabled an easier explanation to the Vietnamese delegation

The last presentation came from Steven Edwards representing the British Medical Journal Technology Assessment Group (BMJ-TAG), which is one of the organisations who conduct HTAs for NICE. A much deeper understanding of what is practically involved with doing frequent and large HTAs for NICE was provided, and – coming from an external source – was couched in different terms, creating a good balance. This covered the different types of HTA, the time constraints and the significant work put into analysing manufacturers submissions. The delegates’ questions seemed to focus on identifying where accountability lay, and how legal issues relating to malpractice are handled. Admittedly a sensitive topic, it was clearly important to members of the delegation.

Events were preceded by a one-to-one discussion between Professor Phạm Lê Tuấn and Kalipso Chalkidou. Apparently productive, it felt like it set the tone and thrust of the rest of the day, as well as providing an agreement for NICE International to continue its collaboration with Vietnam under the international Decision Support Initiative (iDSI), specifically developing Quality Standards on Antimicrobial Resistance. For NICE International and the Vietnamese delegation this was considered a productive event, but it was also personally valuable to me, as I am now considering a career in health economics!