1. 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

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

3. 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:

4. 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.

5. 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

6. 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

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

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

9. 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

10. 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

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

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

13. 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

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

15. 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

16. 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

17. 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

18. Cost-Effectiveness Acceptability Curve

19. Threshold Analysis RUP Syringe

20. Threshold Analysis (SIP+RUP)

21. Threshold Analysis (SIP)
Cost-effective
Dominant

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

23. Thanks