Historical development of HTA in Thailand,and conducive factors and key components
for HTA development in Asia
Yot Teerawattananon M.D., Ph.D.
HITAP, Thailand Ministry of Public HealthInternational Decision Support Initiative (iDSI)School of Public Health, University of Singapore

Country and organizational profiles• Population: 67 millions• Health expenditure: 5% of GDP (Public70%)• Health serviced dominated by public
facilities with strong primary healthcare
infrastructure• Establishment of the Universal Healthcare
Scheme in 2002

Thai UHC started with an ad hoc benefit package design
Starting with a very simple HBP
without expensive interventions

PD-first policy

Tantivess S, Werayingyong P, Chuengsaman P, Teerawattananon Y. Universal coverage of renal dialysis in Thailand: promise, progress, and prospects. BMJ. 2013 Jan 31;346: f462

Governance structures supporting the use of HTA to inform health benefit
package development in Thailand

NHSO Board chaired byHealth Minister

National Drug Committee
chaired by Prime Minister

Health Benefit Package
subcomNLEM subcom

Health Economic Working
Group(NHSO staff = secretariat)

Health Economic Working
Group(HITAP = secretariat)

Several groups ofstakeholdersHTA agencies

HealthProfessionals

Thailand’s NLEM development process
The working group for the Coordination & Consolidation of NLEM
gathered information and making recommendations to the Health Economics working Group (HEWG) regarding the list for
conducting economic evaluation studies

8 weeks
The Health Economics working Group (HEWG)

Criteria for
decision making- Announcing Non-profit organization for submitting an application to conduct economic evaluation
studies- Assigns Non-profit organization to conduct economic evaluation studies

Public institutes and non-profit organisation
perform the economic evaluation studies by complying with the national HTA guidelines

32 weeks

24 weeks

The Health Economics working Group (HEWG)

8 weeks
Feeds back toresearchers

Cost-effectiveness
Budget impact

Examines the quality of HTA studies by working group itself and external reviewers
according to the national HTA guidelines

The Health Economics working Group (HEWG)
Considering those economic evaluation studies and developing policy recommendation

4 weeks

the Price Negotiation
for NLEM Selection
Working Groupthe Coordination & Consolidation ofNLEM Selects medicines into the formulary andconsiders the need of price negotiation of medicines

Teerawattananon Y, Tritasavit N, Suchonwanich N, Kingkaew P. The use of economic evaluation for guiding the pharmaceutical reimbursement list inThailand. Z Evid Fortbild Qual Gesundhwes. 2014;108(7):397-404

System capacity
Urgent healthpolicyAlternativetreatment
Ethical issue
Political issue
ETC.

National List of Essential Medicines: Incremental costeffectiveness of medicines in ThailandBudget saving from HTA-informed policy decisions in Thailand
Indications

Original price(THB)

Reduced price(THB)

Potential saving(THB per year)

HIV4312375 million

Pegylate interferon alpha2a (180 mcg)

Hepatitis C

9,241

3,150

600 million

Oxaliplatin (injection 50mg/25 ml)

Colon cancer

8,000

2,500

152 million

Angiogenesis inhibitor

Macular disease

40,000(Ranibizumab)

1,000(Bevacizumab)

1,600 million

Medicine

Tenofovir

Teerawattananon Y and Tritasavit N. A learning experience from price negotiations for vaccines. Vaccine. 2015 May 7;33 Suppl 1:A11-2.
Teerawattananon Y, Tritasavit N, Suchonwanich N, Kingkaew P. The use of economic evaluation for guiding the pharmaceutical reimbursement list in Thailand. Z Evid Fortbild
Qual Gesundhwes. 2014;108(7):397-404

10Making health priority setting ‘socialnorm’
HTA becomes publicly defensible for decision making

11…the setting and updating of the benefit package in Thailand
is arguably best practice; it is one of the few upper middle
income countries in the region, and indeed in the world, tocarry out formal health technology assessments to set
priorities.
Bredenkamp C, Evans T, Lagrada L, Langenbrunner J, Nachuk S, Palu T. Emerging challenges inimplementing universal health coverage in Asia. Soc Sci Med. 2015;145:243–8

Health Intervention and Technology Assessmentin Support of Universal Health Coverage

Member States:• Use of HITA to inform UHC decisions and other policies• Integrating HITA into national frameworks: HS research, profession education, policy
development including UHC• Identify gaps & needs for capacity building → seeking technical support
WHO:• Fostering awareness among Member States (policymakers and stakeholders)• Exchange of information & experience• Technical support & capacity building• Collaborations/networks

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HITA activities in SERO
Development ofMCH voucher
scheme inMyanmar

Economicevaluation of PENand PCV in
BhutanDevelopment of
HBP for VSS inVietnam

Development of Free Drug
List in Nepal

Supporting theestablishment of
MTAB in India
Estimatingsocial costsof alcoholand tobacco
in Sri Lanka

Supporting
theinstitutional
ization of
HTA inIndonesia

Economic
evaluation of
PCV and HPV
vaccines in thePhilippines

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Conducive factors for HTA
development in Asia

Reading materials

http://www.hitap.net/en/news-document/documents
http://www.idsihealth.org/

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Theory of change: Better Evidence for Better Health

Betterprocess
Betterdecisions

BetterevidenceTechnical aspect

Better
HealthPolicy (political)
aspectAnnual
HTA/economic
evaluation training
workshop

Informal education
for nationalcommittees(since 2006)

HITAP on the job
training (Thailand
Research FundSenior ResearchScholar)

Researchdissemination

Human
resources

EQ5D local score

National
methodological
guidelines

Standard costingmenu

WTP per QALY
Healthresearch
infrastructureInclusivenessResearch
funding

Contestability

Policycommitment

BetterprocessHuman
resources

Healthresearch
infrastructure

Transparency

Betterdecisions

Betterevidence

Better
HealthEnforcement

Social norm