Strategies to Improve Health Systems(cont...)

Establish a Regional Health Technology Assessment Institution to Improve the Comparative Effectiveness of Interventions for NCDs and other Conditions(cont...)

Third, the cost, especially the fixed cost, of establishing an institution to rate comparative effectiveness can be high. Also the number of drugs, devices, and procedures that need evaluation is huge. All this suggests there is an advantage in having a regional body rather than national institutions. South Asia has several different models to choose from.

The United Kingdom has one of the oldest and most respected bodies, the National Institute for Clinical Effectiveness. For policy decisions and resource allocation, it relies on synthesis and critical appraisal of available evidence, including cost-effectiveness, to develop practice guidelines that provide technical support to the country’s publicly fundd National Health Service.

It develops guidelines with professional organizations, but not with private industry. The government also funds audits of the implementation of guidelines and information gathering of emerging clinical innovations. In Germany, where there are multiple payers, the German Institute for Quality and Efficiency in Healthcare (IQWiG), a not-for-profit nongovernmental entity, collates and presents a structured assessment of comparative clinical effectiveness of different medical interventions to inform negotiations between insurers and professionals.

This entity has an advisory capacity only; final decisions are made by the Joint Federal Committee, which is made up of health care providers and insurance funds. There are also models from low- and middle-income countries that may be more relevant to countries in South Asia, and the most relevant is perhaps Brazil. Brazil has entered into an agreement with the

United Kingdom to use guidelines from the National Institute for Clinical Effectiveness as a starting point.

The Ministry of Science in Brazil then reviews the guidelines and proposes adaptations to the Brazilian context; Brazilian economists conduct cost analyses based on the costs in Brazil; the final presentation is then made to the decision maker, the MOH. The information presented to the minister of health includes these recommendations, physicians’ requests, and opinions of hospital managers and patient advocacy groups.

Once included in the benefits package, the drug or device is fully funded and available throughout the system.The rationale for regional collaboration to establish a comparative effective institution is that such a body is unsustainable in terms of resources or expertise for a single country, yet the outputs will provide critical guidance on policy development for prevention and treatment at the country level.