• iDSI has cultivated the growth of Bhutan’s nascent health technology assessment (HTA) system and capacity. Since graduating from Gavi support in 2016, Bhutan has implemented national vaccine provision through their Bhutan Trust Fund. The government has designated the Essential Medicines and Technology Division (EMTD) under the Department of Medical Services of the Ministry of Health to conduct HTA to inform decision-making on new vaccine provision.

Our Impact

iDSI has:

Developed HTA capacity leading to national rollout of PCV-13 vaccine

Supported development of HTA processes and guidelines

Facilitated knowledge sharing at HTAsiaLink and the Prince Mahidol Award Conference

iDSI, through HITAP, has facilitated the HTA movement through providing technical assistance on conducting HTA studies, developing HTA policy processes and stakeholder capacities, and facilitating knowledge sharing with partners in the region and beyond. These activities have generated much local investment in HTA, with Bhutanese colleagues looking to strengthen their HTA systems and apply the principles of evidence-informed priority-setting widely across the health system beyond vaccines.

Using HTA evidence to inform vaccine rollout

Since graduating from Gavi support, the Bhutanese has required new vaccines to be evaluated for their cost-effectiveness and financial sustainability prior to introduction. In 2016, two vaccines were being considered for national provision: the pneumococcal conjugate vaccine (PCV) and the rotavirus vaccine for children under 5 years. With WHO and iDSI support on HTA training and stakeholder consultations, the EMTD conducted a cost-effectiveness analysis of introducing 10 and 13 valent PCVs compared to a no vaccination scenario.

"If introduced, treatment costs of pneumococcal bacterial diseases are expected to decline by 8.5 percent and 13.6 percent respectively for PCV10 or PCV13. "

National newspaper of Bhutan



PCV prevents the transmission of pneumococcal bacterial diseases such as pneumonia, otitis media, bacteraemia and meningitis, some of the major causes of morbidity and death among Bhutanese children. The findings showed that both PCV10 and PCV13 offer good value for money in Bhutan but PCV13 yields better health outcomes and has a lower five-year budget impact.

Stakeholders including Bhutan’s High-Level Committee supported the results of the study; subsequently, cabinet members approved the introduction of the vaccine which was introduced into national routine immunization services in 2018.

Following this successful collaboration, Bhutanese stakeholders are now increasingly using HTA in resource allocation decisions.

In 2017, EMTD began an economic evaluation of the rotavirus vaccine (which prevents the rotavirus infection, a leading cause of severe diarrhoea in children) with support from PATH and iDSI. The study found that, at the current cost-effectiveness threshold in Bhutan, the available vaccines are unlikely to be cost-effective, though ROTASIIL and ROTAVAC would provide the best value-for-money.

These activities have led to a study with EMTD, Hitotsubashi University Institute for Advanced Studies or HIAS and HITAP, with the support of IDSI and the Access and Delivery Partnership (ADP), on an empirically derived, locally relevant cost-effectiveness threshold in Bhutan. In addition, as part of this collaboration, the team will be conducting a willingness-to-pay study alongside a household survey.

Key reads

Strengthening institutional capacity and networks for HTA

iDSI has supported HTA institutional development in Bhutan in parallel to the vaccine evaluation work. This includes introducing HTA processes and methods based on Thai experiences, with Bhutanese partners developing context-specific HTA process guidelines with input from iDSI HTA experts; and iDSI-supported training for Bhutan’s medical professionals and technical researchers to increase awareness of and support of HTA and its usefulness. In order to build the network and credibility of EMTD, iDSI also facilitated their membership in the HTAsiaLink network and participation in the Prince Mahidol Award Conference (PMAC) and Access and Delivery Partnership (ADP) meetings, allowing them to disseminate the results of their work and be exposed to international expertise and knowledge about HTA. In addition, the EMTD team has been part of the Working Group to develop a guidance document on the “Use of Real-World Data and Real-World Evidence to Support Drug Reimbursement Decision-Making in Asia”.