Evolution of Health Technology Assessment in Indonesia: Supply Landscape, Implementation, and Future Directions

Figures & data

Figure 1. Existing criteria and actors involved in the priority decisions of health technology in Indonesia.

Source: Author.

Table 1. HTA studies conducted by InaHTAC and HTA Agent* during 2015 to 2019 in Indonesia.

No	Year and Title	Type of Interventions
1	2015. Clinical effectiveness and economic evaluation of Hemodialysis (HD) and Continuous Ambulatory Peritoneal Dialysis (CAPD) for End-Stage Renal Disease Patients in Indonesia.	Procedure
2	2015. Effectiveness and Economic analysis of Sildenafil for Pulmonal Arterial Hypertension in Indonesia.	Drug
3	2016. Systematic Review of Clinical Effectiveness of Prostaglandin-E1 as Lifesaving Treatment for Infants with Patent Ductus Arteriosus.	Drug
4	2017. Economic Evaluation on Bevacizumab Addition into Chemotherapy regimen for Metastatic Colorectal Cancer.	Drug
5	2017. Economic Evaluation on Cetuximab Addition into Chemotherapy regimen for Metastatic Colorectal Cancer.	Drug
6	2017. Health Technology Assessment on Importance of Review Utilization as part of claim reimbursement: Case study of Nilotinib in Chronic Granulocytic Leukemia.	Drug
7	2017 Clinical Effectiveness and Price Analysis of Insulin Analogues Compared to Human Insulin as DMT2 Therapy.	Drug
8	2018. Clinical and Economic Effectiveness of Rituximab and Chemotherapy Combination (CHOP) in Non-Hodgkins Lymphoma (NHL).	Drug
9	2018. Economic Evaluation of Trastuzumab Addition to Chemotherapy in Metastatic Breast Cancer (MBC) HER2-Positive.	Drug
10	2018. Economic Evaluation and Utilization Review of Lapatinib-Capesitabin Compared to Capesitabin in Metastatic Breast Cancer with HER2+ failed with Trastuzumab.	Drug
11	2019. Economic Evaluation of Phacoemulsification Vs Extracapsular Cataract Extraction in Cataract Patients	Procedure
12	2019. Economic Evaluation of Stent Installation through Percutaneous Coronary Intervention Procedures among Patients with Acute Coronary Syndrome and Stable Angina Pectoris in Indonesia	Procedure
13	2019. Analysis of utilization patients and costs of delivery with Caesar Sectio (SC) in Indonesia	Procedure
14	2019. Cost-Effectiveness Analysis of Fibrinolytic Therapy in Patients with Acute Myocardial Infarction with ST Segment Elevation	Procedure

*HTA agents are institutions designated by the InaHTA Committee to conduct the assessment process. They must have qualified personnel (a multidisciplinary research team, including experts in pharmacoeconomics, modeling, epidemiology, health economics, and other relevant fields) and a proven track record of performing satisfactory HTA studies.

Table 2. The utilization and costs of selected interventions assessed in HTA studies, 2015–2019.

Name of interventions	Year
	2017	2018	2019	2020	2021
A. Utilizations (# of tablets)
Bevacizumab	8.068	8.905	3.163	0	0
Cetuximab	3.616	4.039	1.396	16	9
Rituximab	12.172	12.725	12.548	8.083	8.261
Trastuzumab (Originator)	0	0	0	1.292	807
Trastuzumab (Biosimilar)	6.464	2.509	1.973	1.622	4.994
B. Claim costs (IDR, in millions)
Bevacizumab	25.530	28.179	10.009	0	0
Cetuximab	8.500	9.495	3.282	38	21
Rituximab	28.613	49.289	48.604	31.309	31.998
Trastuzumab (originator)	0	0	0	9.086	5.675
Trastuzumab (biosimilar)	37.081	14.393	11.318	9.305	28.649

Data on both utilizations and costs were taken from the JKN claim dataset, provided by BPJS Health.

Table 3. Identified HTA related-challenges, their consequences and future directions.

[1]	[2]	[3]
HTA Challenges	Consequences	Future Directions
Lack of HTA infrastructure, including local data on costs, clinical information and health outcomes	Unable to cope with the increasing demand for HTA HTA recommendations are neglected, delayed in policy actions or rejected. There is a higher likelihood of political activities performed by the pharmaceutical industry.	Develop a strong and independent HTA body Placing the HTA body at the border between research and policy formulation domains Explicit legislation linking HTA recommendations and decision-making, including using HTA for licensing, inclusion in the benefits package, and price negotiations. Broadening the scope of HTA studies A step-wise approach to address inadequate HTA resources, as follows: Capacity-building activities, academic research, and the production of public goods Exclusively finance HTA activities and allocate sufficient funding Create a stand-alone organizational connected to the health care system. Develop HTA infrastructures to increase the role of local data and the extended use of local patient registries linked to payers’ databases. Strengthened international collaboration. (6) Determining fixed CETs for the Indonesian context.
Lack of financial and human resources with enough technical capacity
Inadequate involvement of stakeholders in the HTA process
Transferability and lack of RWD to provide RWE
Less autonomy of the current HTA Agency
Inadequate overall HTA resources (personnel, financial, organizational structure, infrastructures, networking and decision mechanisms).

Source: Author.

Figure 2. Proposed HTA Body to provide evidence adopted by actors for priority decisions in Indonesia.

Source: Author.