Health technology assessment in China: challenges and opportunities

Key Issues of Economic Evaluations for Health Technology Assessment in China: A Nationwide Expert Survey

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.

Mapping of health technology assessment in China: a comparative study between 2016 and 2021

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.

Factors Influencing the Institutionalization of Health Technology Assessment: A Scoping Literature Review

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.

The quality of published health economic evaluations on screening programs in China: a systematic review and quantitative appraisal

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.

Exploring the possible sources of fiscal space for health in India: insights from political regimes

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.

Development of health technology assessment in China: New challenges

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.