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Liu GG, Guan H, Peng N, Xie S, Wang K, Liu LZ, Zhou Y, Jin H. Key Issues of Economic Evaluations for Health Technology Assessment in China: A Nationwide Expert Survey. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02759-1. [PMID: 38977183 DOI: 10.1016/j.jval.2024.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES Health technology assessment (HTA) is increasingly crucial in medicine price negotiations in China, yet previous appraisals revealed national discrepancies on key economic evaluation issues: willingness-to-pay threshold, pricing models for multi-indication medicines, and comparator selection principles. This study aimed to collect expert opinions on these issues for future HTA evaluations. METHODS A nationwide anonymous web-based survey encompassing experts across academia, HTA, consultancy/contract research organization/industry, service provider, and payer. In 2023, a generic invitation containing a web link to the questionnaire was disseminated via WeChat using convenience and snowball sampling. Agreement rates for questionnaire views were analyzed using descriptive statistics. The relationship between participants' responses and demographics was examined using appropriate logistic models. RESULTS A total of 303 responses were received from experts in 34 cities. Key expert views include a suggested base willingness-to-pay threshold ranging from 0.5 to 1.5 times gross domestic product (52.1% agreement); elevated thresholds for childhood diseases, rare diseases, end-of-life diseases, and first-in-class medicines (>78.0% agreement); a single pricing model for multi-indication medicines (60.4% agreement); consideration of multiple medicines as comparators (79.9% agreement); and avoiding the use of centrally procured medicines as comparators for medicines with a time to market of less than 3 years (71.0% agreement). Participants who are service provider had lower odds of selecting higher thresholds (odds ratio 0.26; P < .01) than responders from consultancy/contract research organization/industry. CONCLUSIONS Expert views indicate the need for substantial changes in China's current HTA methods, highlighting the need for increased investment in HTA processes and expertise cultivation.
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Affiliation(s)
- Gordon G Liu
- Institute for Global Health and Development, Peking University, Beijing, China; National School of Development, Peking University, Beijing, China
| | - Haijing Guan
- China Center for Health Economic Research, Peking University, Beijing, China; Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Nan Peng
- China Center for Health Economic Research, Peking University, Beijing, China; School of International Pharmaceutical Business, China Pharmaceutical University, Jiangsu Province, Nanjing City, China
| | - Shitong Xie
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Kang Wang
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, England, UK
| | - Larry Z Liu
- Center for Observational and Real-world Evidence, Merck & Co, Inc, Rahway, NJ, USA; Weill Cornell Medical College, New York, NY, USA
| | - Yanbing Zhou
- Center for Observational and Real-world Evidence, Merck & Co, Inc, Rahway, NJ, USA
| | - Huajie Jin
- Institute for Global Health and Development, Peking University, Beijing, China; King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, England, UK.
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Liu S, Xia Y, Yang Y, Ming J, Sun H, Wei Y, Chen Y. Mapping of health technology assessment in China: a comparative study between 2016 and 2021. Glob Health Res Policy 2024; 9:4. [PMID: 38229176 PMCID: PMC10790493 DOI: 10.1186/s41256-023-00339-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/09/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Health Technology Assessment (HTA) in China has recently expanded from purely academic research to include policy or decision-oriented practice, especially after HTA evidence was used to update the National Reimbursement Drug List for the first time in 2017. This study aims to identify the progress and challenges of HTA development from 2016 to 2021 and inform policies and decisions to promote further HTA development in China. METHODS We conducted a cross-sectional web-based survey with policy makers, researchers and industry-providers in China in 2016 and 2021 respectively. The 'Mapping of HTA Instrument', was utilized to assess the HTA development across eight domains: Institutionalization, Identification, Priority setting, Assessment, Appraisal, Reporting, Dissemination of findings and conclusions, and Implementation in policy and practice. To reduce the influence of confounders and compare the mapping outcomes between the 2016 and 2021 groups, we conducted 1:1 Propensity Score Matching (PSM). Univariate analysis was conducted to compare the differences between the two groups. The overall results were further compared with those of a mapping study that included ten countries. RESULTS In total, 212 and 255 respondents completed the survey in 2016 and 2021, respectively. The total score of the HTA development level in China in 2021 was higher than that in 2016 before PSM (89.38 versus 83.96). Following PSM, 183 respondents from the 2016 and 2021 groups were matched. Overall, the mean scores for most indicators in the Institutionalization domain and Dissemination domain in 2021 were higher than those in 2016 (P < 0.05). The Appraisal domain in 2021 was more explicit, transparent and replicable than that in 2016 (t = -3.279, P < 0.05). However, the mean scores of most indicators in the Assessment domain were higher in 2016 than those in 2021 (P < 0.05). CONCLUSIONS Our study suggest that the level of HTA development in China progressed significantly from 2016 to 2021. However, before engaging in HTA activities, further efforts are required to enhance the assessment process. For instance, it is important to establish a clear goal and scope for HTA; adapt standardized methodologies for evaluating the performance of systematic reviews or meta-analyses; and provide comprehensive descriptions of the safety, clinical effectiveness, cost, and cost-effectiveness of the assessed technologies, thus improving the development of HTA in China.
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Affiliation(s)
- Shimeng Liu
- School of Public Health, Fudan University, Shanghai, 200032, China
- National Health Commission Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, 200032, China
| | - Yu Xia
- School of Public Health, Fudan University, Shanghai, 200032, China
- National Health Commission Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, 200032, China
| | - Yi Yang
- School of Public Health, Fudan University, Shanghai, 200032, China
- National Health Commission Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, 200032, China
| | - Jian Ming
- School of Public Health, Fudan University, Shanghai, 200032, China
- National Health Commission Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, 200032, China
| | - Hui Sun
- School of Public Health, Fudan University, Shanghai, 200032, China
- National Health Commission Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, 200032, China
- Shanghai Health Development Research Center, Shanghai, 201199, China
| | - Yan Wei
- School of Public Health, Fudan University, Shanghai, 200032, China.
- National Health Commission Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, 200032, China.
| | - Yingyao Chen
- School of Public Health, Fudan University, Shanghai, 200032, China.
- National Health Commission Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, 200032, China.
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Mbau R, Vassall A, Gilson L, Barasa E. Factors Influencing the Institutionalization of Health Technology Assessment: A Scoping Literature Review. Health Syst Reform 2023; 9:2360315. [PMID: 39158224 DOI: 10.1080/23288604.2024.2360315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/24/2024] [Accepted: 05/22/2024] [Indexed: 08/20/2024] Open
Abstract
There is global interest in institutionalizing Health Technology Assessment (HTA) to inform resource allocation decisions. However, institutionalization of HTA remains limited particularly in low- and lower-middle-income countries. We conducted this scoping review to synthesize evidence on factors that influence the institutionalization of HTA at the macro (national)-level across countries globally. We searched for relevant literature in six databases namely PubMed, Embase, CINAHL, Scopus, EconLit, and Google Scholar. We conducted the last search on December 31, 2021. We identified 77 articles that described factors that influence institutionalization of HTA across 135 high-, middle-, and low-income countries. We analyzed these articles thematically. We identified five sets of factors that influence the institutionalization of HTA across countries of different income levels. These factors include: (1) organizational resources such as organizational structures, and skilled human, financial, and information resources; (2) legal frameworks, policies, and guidelines for HTA; (3) learning and advocacy for HTA; (4) stakeholder-related factors such as stakeholders' interests, awareness, and understanding; and (5) collaborative support for HTA through international networks and non-governmental and multi-lateral organizations. Countries seeking to institutionalize HTA should map the availability of the factors identified in this review. Developing these factors wherever necessary can influence a country's capacity to institutionalize the conduct and use of HTA.
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Affiliation(s)
- Rahab Mbau
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Lucy Gilson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
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Chen Y, Zhao K, Liu G, Chen W. Health technology assessment to inform decision making in China: progress, challenges, and sustainability. BMJ 2023; 381:e068910. [PMID: 37321607 PMCID: PMC10266481 DOI: 10.1136/bmj-2021-068910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Yingyao Chen
- School of Public Health, Fudan University, Shanghai 200032, P R China
- National Health Commission Key Laboratory of Health Technology Assessment, Fudan University
| | - Kun Zhao
- China National Health Development Research Center, Beijing 100044, P R China
| | - Gordon Liu
- National School of Development, Peking University, Beijing 100871, P R China
| | - Wen Chen
- School of Public Health, Fudan University, Shanghai 200032, P R China
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Xia Y, Lian D, Yang Y, Si L, Ming J, Wei Y, Chen Y. The quality of published health economic evaluations on screening programs in China: a systematic review and quantitative appraisal. Expert Rev Pharmacoecon Outcomes Res 2022; 22:1277-1283. [PMID: 36226906 DOI: 10.1080/14737167.2022.2131542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study seeks to assess the quality of HEEs reporting on screening programs over the last 20 years in China, to identify potential predictors of reporting quality. METHODS We performed a literature search of HEE studies published in PubMed, Embase, CNKI, and WANFANG from 2000 to 2021. The search terms included 'screening,' 'China,' 'CEA,' 'CBA,' 'CUA,' and all other names for health economic evaluation. Two reviewers independently extracted data and assessed the reporting quality using CHEERS checklist. A generalized linear regression analysis was used to identify the predictors of reporting quality. RESULTS 133 of 1,281 identified studies was included. The reporting quality scores showed an increasing trend and the mean score was 0.56. Some items were underreported, such as study perspective, discount rate, measurement of effectiveness, analytical methods, uncertainty, heterogeneity etc. Five factors (year of publication, journal type, first author's affiliation, economic evaluation type, specialty journals or not) predicted a higher score of reporting quality in the regression analyses (P < 0.05). CONCLUSIONS Overall, the quality of HEEs on screening programs in China showed an improving trend. Given the significance of reporting quality, it is advisable to report HEE results following standard evaluation guidelines to improve their transparency.
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Affiliation(s)
- Yu Xia
- School of Public Health, Fudan University, Shanghai, China.,National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Dai Lian
- School of Public Health, Fudan University, Shanghai, China.,National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yi Yang
- School of Public Health, Fudan University, Shanghai, China.,National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, Australia.,The George Institute for Global Health, UNSW Sydney, Kensingto, Australia
| | - Jian Ming
- School of Public Health, Fudan University, Shanghai, China.,National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yan Wei
- School of Public Health, Fudan University, Shanghai, China.,National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yingyao Chen
- School of Public Health, Fudan University, Shanghai, China.,National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
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Exploring the possible sources of fiscal space for health in India: insights from political regimes. Health Res Policy Syst 2022; 20:32. [PMID: 35331253 PMCID: PMC8943520 DOI: 10.1186/s12961-022-00831-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rising healthcare costs and poor access to health services have become a significant concern for policy-makers; therefore, efforts must be made to generate fiscal space through alternative revenue measures in resource-poor economies. This study attempts to identify possible sources of fiscal space for health in India across political regimes. METHODS The study followed a descriptive approach to examine the political commitment towards health sector development by estimating the trend of growth in fiscal space indicators over the political regimes from 1998-1999 to 2021-2022 using a dummy variable regression model. RESULTS We found four possible sources of fiscal space for health, which include (1) raising domestic revenue mobilization, (2) generating alternative revenue collection mechanisms, (3) prioritizing health through expenditure management and (4) effective utilization of central transfer. Fiscal space measures such as goods and services tax reform, collection of health-specific tax, higher excise duty on tobacco products, cooking gas subsidies to poor people, tax administration reform and direct beneficiary transfer of health services could be alternative revenue mobilization channels for fiscal space for health. CONCLUSION The study reveals that the central government has a political commitment to generating revenue through various fiscal policy reforms. Health has been prioritized over the period, but there is less evidence of health-related political commitment for an increased share of health expenditure to total budgetary allocation. During the last 2 years, however, the health budget has been prioritized due to the COVID-19 pandemic crisis despite slower economic growth in India. This study will be a policy document for fiscal space analysis from a political-economic perspective, and the role of the ministry of finance can be assessed through administrative data and documents.
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Health technology assessment in traditional Chinese medicine in China: current status, opportunities, and challenges. GLOBAL HEALTH JOURNAL 2019. [DOI: 10.1016/j.glohj.2019.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Chen Y, He Y, Chi X, Wei Y, Shi L. Development of health technology assessment in China: New challenges. Biosci Trends 2018; 12:102-108. [PMID: 29760354 DOI: 10.5582/bst.2018.01038] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health technology assessment (HTA) is a field of scientific policy research that adopts multidisciplinary approaches to conduct systematic evaluation of health technologies and inform decision making. Although achievements have been made by HTA activities among academics, providers, and policy makers, development of the field of HTA in China is fragmented and not yet formally integrated in health policy making processes. All stakeholders need to make more efforts to strengthen HTA knowledge translation and facilitate a decision making process that is based on evidence including HTA findings. This article reviews how the field of HTA has developed in China, analyzes what factors have been influencing China's HTA development, and proposes policy recommendations.
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Affiliation(s)
- Yingyao Chen
- Key Lab of Health Technology Assessment (Fudan University), National Health Commission.,World Health Organization Collaborating Centre for Health Technology Assessment and Management
| | - Yao He
- Key Lab of Health Technology Assessment (Fudan University), National Health Commission.,World Health Organization Collaborating Centre for Health Technology Assessment and Management
| | - Xunyouzhi Chi
- Key Lab of Health Technology Assessment (Fudan University), National Health Commission.,World Health Organization Collaborating Centre for Health Technology Assessment and Management
| | - Yan Wei
- Key Lab of Health Technology Assessment (Fudan University), National Health Commission.,World Health Organization Collaborating Centre for Health Technology Assessment and Management
| | - Lizheng Shi
- Health Systems Analytics Research Center, School of Public Health and Tropical Medicine, Tulane University
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