Health Technology Assessment Post-Dengvaxia

While social health insurance financing as well as government budgets have increased, efforts to improve technical efficiency and curb medical inflation through HTA have lagged behind.

If there was an institutionalized capacity for health technology assessment (HTA), would the Dengvaxia scandal have been averted? This was going through my mind when the Department of Health (DOH) hosted stakeholders in a meeting at Century Park Hotel in Manila on November 16, 2018 aimed to revive HTA in the country.

HTA is the systematic evaluation of the properties, effects, and impacts of drugs, medical devices, and procedures. It is a multidisciplinary process to determine the social, economic, organizational, and ethical issues related to health interventions. In her opening remarks, Dr. Anna Melissa Guerrero of the DOH noted that there were already 64 countries with institutionalized HTA as well as 180 HTA organizations around the world.

DOH Usec. Rolando Domingo traced the history of local HTA initiatives, which I can only describe as spurts and busts, reflective of our “ningas-cogon” mentality. The Philippines is way behind in this area. While social health insurance financing as well as government budgets have increased, efforts to improve technical efficiency and curb medical inflation through HTA have lagged behind.

Dr. Somsak Chunharas of Thailand and Dr. Amandla Adler of the United Kingdom’s National Institute of Cost Effectiveness gave their respective countries’ experiences in HTA. Both speakers urged the quick institutionalization of HTA in the Philippines
DOH Sec. Francisco Duque asserted that to realize the benefits of HTA, the Sentro ng Pagsusuri ng Teknolohiyang Pangkalusugan (STEP) will be set up within the next two years, with an enabling legislation. He set two key targets: that by the end of 2020, 100 percent of all drugs for public financing shall have undergone the HTA process, and the country would have trained at least 20 HTA practitioners. DOH also intends to support HTA centers of excellence in local universities which will be outsourced to do the necessary cost-effectiveness or cost-benefit analyses.
All these should have been done, as they say, yesterday. In my view, the HTA authority should have the final say in the decision whether to use public funds for a particular drug or device, otherwise Dengvaxia Part II is just around the corner.

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About the Author
Mr. Oscar F. Picazo is a retired specialist in health systems, health economics, and social policy. He has worked in 24 countries for the World Bank, the United States Agency for International Development (USAID), and as an independent consultant. He returned to the Philippines in 2009 and became a senior research consultant for the Philippine Institute of Development Studies.
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