Advancing HTA in Latin America: The Policy Process of Setting up an HTA Agency in Colombia
| DOI | http://doi.org/10.1111/1758-5899.12333 |
| Published date | 01 March 2017 |
| Date | 01 March 2017 |
| Author | Hector E. Castro |
Advancing HTA in Latin America: The Policy
Process of Setting up an HTA Agency in
Colombia
Hector E. Castro
Former Executive Director of the HTA institute of Colombia (IETS)
Takemi Fellow at the T.H Chan Harvard School of Public Health
Abstract
This article describes the on-going policy process of establishing a health technology assessment (HTA) agency in Colombia.
The stated aim is to promote a systematic and transparent approach to evaluating new medical technologies in the country.
It oulines the strengths and limitations of this newly-adopted approach, and we discuss policy lessons and future challenges.
Health Technology Assessment (HTA) examines the conse-
quences of the application of health technologies and is
aimed at better informing decision makers. As such, HTA
has become an issue of great interest, although it has also
attracted controversy. Advocates of HTA argue that it helps
to promote the efficiency of resource-allocation, whilst critics
state HTA is simply a means to restrict access to new and
costly technologies (O’Donnell et al., 2009).
Over the past decades different countries have estab-
lished specialised HTA organisations aimed at better
informing health care policies and clinical practice. The
first technology assessment institution, although not exclu-
sively health related, was the Office for Technology
Assessment (OTA), established in the United States public
sector in 1972 with the aim of informing the US congress
of the advantages and disadvantages of newly developed
technologies. This early initiative became attractive to
other western countries that were similarly dealing with
imperfect and asymmetric information to make decisions.
Soon after Austria, Denmark, France, Germany, the United
Kingdom, the Netherlands, and Sweden created similar
institutions.
Early models of specialised HTA institutions were estab-
lished in 1987 in Sweden (Statens beredning f€
or medicinsk
utv€
ardering (SBU)) and in Canada (Conseil d’
evaluation des
technologies de la sant
e(CETS)) and Australia (Pharmaceuti-
cal Benefits Advisory Committee (PBAC)) in 1988. This latter
is recognised as the first HTA committee with binding
power over drug reimbursement policies in a public health
system; it is considered to be one of the earliest versions of
an HTA agency.
1
SBU is recognised as one of the co-foun-
ders of the International Network of Agencies for Health
Technology Assessment (INAHTA) in 1993, a non-profit
organisation that today includes more than 55 member
agencies from around 32 countries.
In 1999 the United Kingdom introduced the National Insti-
tute for Clinical Excellence, renamed later as the National
Institute for Health and Clinical Excellence, and more
recently as the National Institute for Health and Care Excel-
lence (NICE). NICE perhaps remains the most well-known
HTA organisation worldwide (Morrison and Batty, 2009). Its
clear ability to establish a transparent review process to
determine the clinical and cost effectiveness of health care
interventions for the National Health Service (NHS) in Eng-
land and Wales continues to attract interest across the
world.
HTA agencies have gained space in taxation-based and
social health insurance systems. For example, the Institute
for Quality and Efficiency in Health care (Institut f€
ur Qualit€
at
und Wirtschaftlichkeit im Gesundheitswesen (IQWiG)) was
established in Germany in 2004. In the US, the Oregon State
Drug Effectiveness Review Project (DERP) has applied princi-
ples of EBM to formulary decision making in the public sec-
tor since 2000. In 2010, PCORI (Patient Centered Outcomes
Research Institute), an independent organisation aimed at
helping patients, clinicians, purchasers and policy makers
make informed health decisions, was created. In fact, most
high-income countries utilise some form of HTA process or
agency to facilitate decision making and priority-setting
within their health systems (Bulfone et al., 2009; Castro,
2011, 2012).
Recent examples of HTA agencies in low- and middle-
income countries include: the National Agency for Health
Surveillance (ANVISA) established in 1999 and the Depart-
ment of Science and Technology (DECIT) (both in Brazil and
conducting HTA since the mid-2000s), as well as the Health
Global Policy (2017) 8:Suppl.2 doi: 10.1111/1758-5899.12333 ©2017 University of Durham and John Wiley & Sons, Ltd.
Global Policy Volume 8 . Supplement 2 . March 2017 97
Special Issue Article
To continue reading
Request your trial