Health technology assessment: a European collaboration

Abstract

A record number of more than 2900 professionals attended the 13th Annual European Congress of the International Society of Pharmacoeconomics and Outcomes Research. ‘Health technology assessment: a European collaboration’ was the main theme of the congress. The scientific program included several hot topics with either global relevance, from the policy or methodology point of view, or with a clear European focus. Participants also enjoyed the lively atmosphere of Prague.

A total of 2916 delegates attended the 13th Annual European Congress of the International Society of Pharmacoeconomics and Outcomes Research (ISPOR). Six years ago, the number of attendees of the ISPOR Annual European Congress did not even exceed 1000; however, the record-breaking number of attendees this year clearly justifies the need for such a congress in Europe, where academics, industry experts, consultants and decision makers can meet and explore potential solutions for mutual problems. It also indicates the appropriateness of the ISPOR mission to promote the science of health economics and outcomes research and facilitate the translation of this research into useful information for healthcare decision makers to ensure that society allocates scarce healthcare resources wisely, fairly and efficiently [101].

Several factors have contributed to the success of ISPOR meetings, including carefully selected main themes and plenary sessions, lively debates at issue panels, methodology workshops from introductory to highly sophisticated levels, healthcare decision-maker case studies presented by real decision makers, easy to access precongress short training courses and, last but not least, good quality research abstracts. In addition to the strong scientific program, well-selected locations of recent meetings, which is especially true for Prague, also attracted many participants.

Scientific program

The main theme of the congress ‘Health technology assessment: a European collaboration’ was discussed at three plenary sessions and several issue panels, workshops and decision-maker case study sessions. Several sessions were devoted to the pricing and reimbursement policy and technology assessment of oncology products, vaccines, orphan drugs, personalized medicines and medical devices. Risk-sharing methods and innovative pricing models were favorite themes of those sessions addressing the market access of innovative technologies. Pros and cons of different economic modeling techniques and decision rules were addressed repeatedly. Methodological and policy sessions related to the better use of real-world data, including registries, payers’ databases and observational studies that complement evidence from randomized clinical trials, attracted many participants. Relative effectiveness assessment, measurement of adherence, mapping utility scores and validation of quality-of-life (QoL) instruments were the most popular outcomes research topics of the conference. Ideas likely to shape the future of health technology assessment (HTA) were also discussed, such as different perspectives on cost/quality-adjusted life year threshold-driven coverage decisions and establishment of stronger connections between the evidence need of regulatory and reimbursement agencies.

Main theme: HTA in European collaboration

The main theme of the conference was discussed at three plenary sessions from different perspectives. The first plenary session investigated how the efficiency of HTA can be improved in Europe. Bengt Jönsson (Stockholm School of Economics, Sweden), in his opening presentation, emphasized the rationale behind a European perspective and concluded that development of HTA had become a success story in Europe in the last 25 years. Despite current limitations with full implementation of HTA, institutional and methodological development can improve the efficiency of this important tool [1]. Finn Borlum Kristensen (European network for Health Technology Assessment [EUnetHTA], Denmark), on behalf of the EUnetHTA Secretariat, presented the European network for HTA Joint Action Strategy and the Core Model to share responsibilities between central and local HTA agencies. Wim Goettsch (Health Care Insurance Board, The Netherlands) provided insights into the Relative Effectiveness Assessment (REA) Work Package to address the therapeutic added value of new pharmaceuticals. Conceptual methodological guidelines will be available in 2011, and rapid and full models for REA based on core HTA can be expected in 2012. Clare McGrath (Pfizer, UK), in an industry stakeholder perspective, emphasized the need for balancing affordability, access and innovation when developing principles and tools for successful pan-European assessment of innovative health technologies.

The second plenary session continued this topic of how to balance healthcare budgets and access to innovation when applying HTA, especially in the light of recent cost-reduction measures in several European countries. Jan Svihovec (Charles University, Czech Republic) presented the gap between the available and necessary budget to finance new technologies according to their real therapeutic value, with special focus on Central Eastern European countries. Michael Drummond (University of York, UK) argued that many of the current developments in HTA in Europe arose from payers’ and manufacturers’ joint needs to identify value. He indicated three main unresolved issues: the possibility for harmonization in payers’ and regulators’ requirements, the successful implementation of managed entry schemes and the uncertainties over anticipated value from innovation. In his industry perspective, Ansgar Hebborn (F Hoffmann-La Roche AG, Switzerland) presented current limitations with the accessibility of new medicines. Implementation of recommendations by the Highlevel Pharmaceutical Forum could lead European countries to better decision-making processes [102]. He also emphasized that international and local policy makers should understand the external impact of their pharmaceutical pricing policies to avoid impairing affordable access to pharmaceuticals in the global marketplace [2]. Lieven Annemans (University of Ghent, Belgium) summarized the recommendations from the Belgian EU Presidency to make innovative medicines accessible in the EU [103]. He emphasized the importance of using the same definitions and the need for valuable innovation. By referring back to the first plenary session he argued that duplications in HTA have to be avoided by reviewing roles and responsibilities and exchanging information more efficiently. Formal risk-sharing approaches related to uncertainty can reduce delays in patients’ accessibility to innovative medicines and facilitate faster data collection on clinical experience.

The third plenary session addressed the problems of countries with limited resources for technology assessment by presenting cases on how to build capacities without breaking the bank. Tomas Dolezal (Charles University, Czech Republic) introduced the topic by presenting the current status of applying HTA in the Czech Republic and similar middle-income countries. Elisabeth Breyer (Federal Institute for Quality in Health Care, Austria) presented lessons learned from Austria, and Ken Paterson (Scottish Medicines Consortium, UK) and Iga Lipska (Agency for Health Technology Assessment in Poland, Poland) provided their insights into fairly successful HTA implementation despite limited resources in Scotland and Poland.

Geographical expansion of health economics & outcomes research to Eastern Europe

Generally, for a European ISPOR congress, proposals and abstracts are selected by review committees that have either global relevance from the policy or methodology point of view or have clear European focus. As the number of trained professionals in the field of health economics and outcomes research is limited in Eastern European countries, presenters at previous European congresses were mainly from Western Europe or institutions with global policy and research projects.

Compared with Western European countries, the health status of the Eastern European population is worse and healthcare resources in Eastern Europe are more limited. As strategic pricing of new healthcare technologies are usually adjusted to large Western European countries, the European international price referencing of payers in richer countries further limits the accessibility of patients to innovative medicines in poorer countries. In general, financial and human resources for health economic data collection and HTA implementation are limited in Eastern Europe. In addition to differences in the availability of resources, the organizational aspects of healthcare delivery are also very different. Despite the relatively greater need for better allocation of scarce healthcare resources in the middle-income countries of Eastern Europe, solutions from more developed Western European countries may not be applicable in middle-income countries, which is especially true for smaller countries in the Adriatic or Baltic region with less than 5 million inhabitants. Therefore, it is essential to promote the translation of health economics and outcomes research into feasible solutions in middle-income Eastern European countries.

The contribution of ISPOR in achieving this objective is substantial. ISPOR has been very successful in establishing local chapters in Eastern European countries and these chapters usually organize national ISPOR conferences to discuss topics with local relevance. The selection of Prague as the location of the 2010 Annual European ISPOR meeting and the selection of Eastern European professionals to chair different review committees and sessions were also an acknowledgement of efforts in these countries. In Prague, as a consequence, increasingly more sessions were devoted to specific problems of low-income countries with limited resources, and the quality of sessions organized by Eastern European ISPOR members was significantly improved in comparison with previous meetings.

Conclusion

Participants also enjoyed the lively atmosphere of Prague, including the conference dinner at the spectacular Žofín Palace. The record-breaking number of attendees and high scores of anonymous post-congress evaluations proved the success of the 13th Annual European ISPOR Congress.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.