Health Technology Assessment for Universal Health Coverage Dr Shankar Prinja Additional Professor of Health Economics School of Public Health Post Graduate Institute of Medical Education and Research, Chandigarh UHC Day, 12 Dec 2017, Delhi

Outline HTA: Concept Institutionalization of HTA in India Illustration: HTA on Safety Engineered Syringes Way Forward

Health Technology Assessment (HTA) Multidisciplinary process that summarizes information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner. Its aim is to inform the formulation of safe, effective, health policies that are patient/population focused and cost-effective European network for Health Technology Assessment. Common Questions. What is Health Technology Assessment (HTA). Accessed Aug. 1, 2013 at: http://www.eunethta.eu/about-us/faq#t287n73

What does word Health Technology mean? Medical devices & Implants Drugs Health programs & platforms of care Diagnostics Health technology refers to any method that is used to promote health prevent, diagnose and treat diseases or improve rehabilitation and long-term care.

Scope of HTA Investment decisions Dis-investment decisions Whether to Invest in Newer Technologies Whether to Scale up Newer Technologies Discontinue the existing health technology/intervention Re-allocate/ reduce allocation to health technology/ intervention Courtesy: Dr Yot

How Does HTA guide UHC Strategic Purchasing? Better than some current technologies Health benefit per $1,000 Worse than all current technologies Threshold Health care expenditures Interventions ranked highest to lowest Other candidates (eg new technologies) Budget

How Does HTA guide UHC Strategic Purchasing? Health benefit per $1,000 New Threshold Threshold Health care expenditures Budget

How Does HTA guide UHC Strategic Purchasing? Health benefit per $1,000 Net health gain from using HITA Health care expenditures Budget

Status of HTA in India Medical Technology Assessment Board established in the Department of Health Research, Government of India Recommendatory body to the Ministry of Health and Family Welfare Evaluate new and existing health care interventions Guide India’s priority setting under UHC reforms Prinja S et al (2017). Health Technology Assessment for Policy Making in India: Current Scenario and Way Forward. Pharmacoeconomics Open. Published online 13 June 2017

MTAB Activities: Early Phase Setting the principles and scope of HTA Maximizing health Equity Reduce OOP expenditures Identifying the criteria for decision making Development of process guidelines Hub and spoke model: Secretariat & technical partner MTAB Resource Centre: PGI Chandigarh, others to be set up Technical Advisory Committee & Board

KEY PHASES OF THE HTA PROCESS Topic Selection Technical partner identification Proposal development Research and analysis Appraisal of the evidence Dissemination

Prinja S et al (2015). Applied Health Econ Health Policy.

Capacity Building for HTA Series of DHR funded training workshops planned 1st workshop held at Kerala Focus of building skills for HTA Online Courses followed by face to face training and sustained mentorship http://healtheconomics.pgisph.in/

Methodological Work at MTAB Developing a reference case for HTA in India Costing Database Developing Indian tariff values for EQ5D health states

Safety Engineered Syringes Auto-disable (AD) Syringes: Safety plunger breaks off or metal clip that locks the plunger with the full depression of plunger after a single use It contains fixed dosing mark Used in immunization sector Reuse prevention Syringes: Safety plunger breaks off or metal clip that locks the plunger or the needle retracts into the barrel after a single use It contains variable dosing marks Used in therapeutic sector

Safety Engineered Syringes Sharp Injury Prevention (SIP): A plastic needle shield slides over the needle after the injection is given which ensures that the needle cannot accidentally “stick” anyone else (i.e. healthcare workers (HCWs), waste handlers and the community) Syringe with both SIP + RUP feature SIP syringes include syringes with a feature that draws the needle up into the syringe barrel (retraction of needle) The retraction occurs automatically or manually

Cost-effectiveness of SES (RUP) ICER (INR, Societal Perspective) Life Year (Undiscounted) 911 Life Year (Discounted) 8,118 QALY (Undiscounted) 879 QALY (Discounted) 7,608

Cost-Effectiveness Acceptability Curve

Threshold Analysis RUP Syringe

Threshold Analysis (SIP+RUP)

Threshold Analysis (SIP) Cost-effective Dominant

Challenges Political economy Health financing scenario UHC needs more than just HTA Political commitment and allocations for HTA

Thanks Email: shankarprinja@gmail.com