[Event Report] The 58th Breakfast Meeting: Recent Developments in Health Technology Assessment: Cost-effectiveness of Drugs (Jun. 2, 2016)
At this Breakfast Meeting, Dr. Ataru Igarashi, one of the few “Healh Technology Assessment”(HTA) professionals in Japan, joined us to explain what HTA is, how it evaluates the value of medicine, and how HTA outcomes can be reflected in policies, with examples from recent HTA case studies.
Speaker: Dr. Ataru Igarashi (Assistant Professor of Graduate School of Pharmaceutical Sciences at the University of Tokyo)
Date & Time:
Thursday, June 2, 2016 8:00 a.m.-9:15 a.m. (Doors open at 7:45 a.m.)
EGG JAPAN (10th floor, Shin-Marunouchi Building, 1-5-1 Marunouchi, Chiyoda-ku, Tokyo)
What is HTA?
In a general sense, HTA refers to an academic policy analysis field that conducts research into the medical, social, and economical impact of the development, advancement, and utilization of medical technology.
On the other hand, the strict meaning used for this Breakfast Meeting is the evaluation of drug performance and price setting based on cost-effectiveness evaluations leading to the realization of effective medicine through research.
It is important to note that the words “Cost” and “Economics” are not included in the term “Health Technology Assessment “(HTA). HTA is not concerned with only these two areas.
Comparing 800 yen salmon lunch and 1200 yen BBQ lunch
HTA examines effectiveness. If we compare the costs of treatment for a disease today with the costs of treatment in the future assuming that a new drug isn’t introduced, the beginning stage costs are likely to be less in today’s world. However, this kind of comparison is nothing more than a simple price comparison, which is not the right. “Effectiveness” extends beyond mere health benefits – we need to consider the rate of lives saved, the minimization of infections, prognosis improvements, and so on. In addition, the rate of lives saved should not be calculated on a per person basis; it should be calculated based on differences in cost between two possible interventions, divided by the difference in their effects. This is known as an “Incremental Cost-Effectiveness Ratio” (ICER). All of this is fundamental to HTA.
For a simple analogy, let’s make a comparison between a salmon lunch (800 yen) and a BBQ lunch (1200 yen). People may have a tendency to pick up the salmon lunch based solely on its price; however, the content of these two lunches differs greatly. Only once we add to the salmon lunch is it possible to perform a correct comparison and look at measures like the beneficial effects of each lunch (satisfaction and energy intake, etc.).
Adding spice to the quality of life years: Quality Adjusted Life Years
How can we measure effectiveness? First, we need to estimate how much it will cost to increase survivability by 1 year given standard treatments and medicine usage. However, we should not consider only the number of years lived, but also the “Quality Of Life score” (QOL score). “Quality Adjusted Life Years”(QALYs ) are a standard measurement for this. By adding the “Spice” of quality, we are able to measure not only the number of years lived, but also the quality of those years.
HTA around the world
Taking a quick glance at reports from Great Britain, Germany, France, and Australia, it is clear that there is a difference in the systems set up for HTA and the way HTA is practically applied in each country. For example, in Great Britain and Australia, decisions about whether a drug should be covered by insurance are based on the outcome of HTA analyses. In France, medicine prices are determined based on their effectiveness, and HTA is used to test the outcomes of setting high prices for certain medications. In Germany, HTA could supposedly be used to resolve conflicts during negotiations between corporations and the Government, although there has of yet been no such conflicts. It is apparent that the use and status of HTA significantly varies among countries.
Q1: Is it possible to make comparisons in the field of preventative medicine between topics such as therapeutic exercise and healthy food?
A1: It is possible if accurate data exists. I say this based on an evaluation of a smoking cessation clinic that I became involved with when it was still at an early stage. There has been recent data on healthy food but the evidence is still very weak.
Q2: It has been said that there are an insufficient number of HTA experts in Japan.
A2: There actually aren’t very many. But I personally feel that the number of students interested in this topic has increased recently due to focused teaching about it. I look forward to a continued increase in the number of experts.
Q3: How big are the budgets and implementing bodies set up for HTA in each of the countries you mentioned?
A3: The individual organizations in each country do more than just health economics evaluations. In France, as in Japan, evaluations of health service mechanisms are being conducted. In Great Britain, NICE collates diagnostic guidelines. There are about 20-30 people who are experts in economic evaluation in each country. The scales of these organizations are huge; but the budgets for HTA are limited to only a few billion yen. We are actively seeking out cooperation from outside experts because of this. The limited number of experts is also a problem in Japan.