Health Technology Assessment
Introduction
HTA
  1. Health Technology Assessment (HTA) aims to assist the health authorities in making informed decision on the introduction of new health technologies through providing scientific evidences and analysis. HTA is a multidisciplinary process which involves analysis of comparative effectiveness, cost effectiveness, budget impact, etc. and takes into account the ethical, legal and social implications. The purpose of HTA is to evaluate potential impact and assist the authorities to make corresponding plans in advance so as to use the healthcare resources more efficiently.
The Current Status of HTA in Taiwan
  1. Since the implementation of the Taiwan NHI system in 1995, how to reduce the burden of drug costs and avoid unnecessary medical waste has always been an important priority for the authorities in charge of the NHI (formerly the DOH and the BNHI, now the MOHW and the NHIA). The authorities constantly face the challenge of meeting the public’s needs for healthcare with limited resources. Therefore, the authorities have to be cautious about making decisions on the reimbursement and payment for new items so as to keep the NHI system sustainable.
    In the early years of the NHI, HTA was not formally introduced for NHI listing while decisions were made simply by committee meetings of scholars and experts through the assessment of documents submitted by applicants. In 2000, the BNHI (now the NHIA) started to consider introducing the HTA system to support the NHI decision-making process, moving towards an objective and scientific-based approach. This was the beginning of HTA in Taiwan.
    At the end of 2000, the BNHI (now the NHIA) commissioned several scholars to carry out a project to study the implementation of HTA in Taiwan. In 2001, representatives of health authorities visited various HTA institutes in the Province of British Columbia in Canada and brought back valuable information and experiences to contribute to the establishment of the HTA system in Taiwan.
    In August 2007, the CDE established its HTA Working Group to produce HTA report for new drug listing applications upon the BNHI’s commission. Those HTA reports were used as reference to support the BNHI Drug Benefit Committee’s decision on drug reimbursement. At the end of 2007, the CDE Board of Directors resolved to adopt the proposal of establishing the “Division of Health Technology Assessment“ and the proposal was submitted to the DOH (now the MOHW) for acknowledgement. The Division of Health Technology Assessment was officially formed on April 1, 2008. It was in 2012, as the government was preparing for the implementation of the second generation of the National Health Insurance program, that Dr Chiu Wen-Ta, the former Minister of Health and Welfare, instructed the CDE to establish the Preparatory Office of the National Institute for Health Technology Assessment.
    In the past years, the CDE’s HTA services were mainly to support the NHI’s decisions on new drug listing. Since 2011, the HTA services have been gradually extended to new medical devices.  From 2007 to 2015, the CDE HTA team assisted the NHIA in assessing 283 new drugs, 61 breakthrough drugs, 19 medical devices, and 142 consultations with manufacturers. Since 2014, the tasks of CDE HTA have been further extended to medical services. The HTA team completed several pilot studies, for example, robot-assisted surgery and laser treatments for benign prostatic hyperplasia.
    The HTA team in Taiwan not only supports the NHIA’s reimbursement process, but also carry out policy analysis or research projects commissioned by other authorities. Since 2007, HTA has conducted more than 80 analysis or projects for the MOHW, the Taiwan Centers for Disease Control, the Health Promotion Administration and the Taiwan Blood Services Foundation. The topics range from reimbursement for rare disease treatments, public-funded vaccinations to community day-care centers for disables.
The Prospect of HTA in Taiwan
  1. The CDE established the Division of Health Technology Assessment in 2007 to continue its promotion of HTA in Taiwan. Since then, HTA, a scientific and evidence-based approach, has earned the acknowledgement of all stakeholders, including the NHIA, drug companies, healthcare providers and the general public.
  • Expanding the Scope of HTA

  1. In the initial stage, the role of the HTA team was primarily to assist the NHIA in performing new drug listing assessment. From 2011, the NHIA started to commission the HTA team to assess medical devices; however, it was mainly at the NHIA’s discretion to decide which application is subject to HTA. The researchers in the CDE carefully consider the nature of each case and assess the evidences on effectiveness, cost-effectiveness reports and/or budget impact estimates. The CDE sets an assessment timeline of 42 calendar days for each HTA case. The HTA team produces a complete HTA report and submits it to the NHIA for reference. In 2014, the HTA team starts to take on HTA cases of innovative medical services.
  • International Participation

  1. Members of the HTA team are enthusiastic about acquiring new knowledge and building up experiences and capability on health technology assessment. They play an active role in regional and international networks as well as professional organizations with a view to improving their knowledge of HTA and sharing their experiences. At present, the HTA team is involved in the international activities of the HTAsiaLink, the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), and the Health Technology Assessment International (HTAi). In 2012, Taiwan hosted the 5th Asia-Pacific Meeting of ISPOR, marking Taiwan’s involvement in international HTA affairs. Following that successful event, Taiwan hosted the 4th HTAsiaLink Annual Meeting Conference in 2015. The CDE HTA team actively participates in international cooperation activities. In addition, it serves on the Boards of Directors of both the International Network of Agencies for Health Technology Assessment (INAHTA) and Health Technology Assessment International (HTAi). The CDE HTA Director served on the INAHTA Board of Directors from 2016 to 2022, and has been reelected to the HTAi Board of Directors from 2020 to the present; furthermore, the member of the CDE HTA team recently joined the Board of Directors of HTAsiaLink.
  • Cultivating HTA Professionals

  1. The main purpose of HTA is to provide scientific proof, using concrete evidence to support the formation of health policies, and to perform medical resource allocation under the principles of fairness and justice. The CDE HTA team has learned that the bottleneck of constructing a sound HTA system lies in shortage of professional HTA talents. Therefore, cultivation of HTA talents is an important task. In a short time, CDE can only rely on continuous education on its own and invite specialists at home and abroad to have communications and exchanges in Taiwan in order for members of the HTA team to enhance and accumulate HTA experience. Over the years, the HTA team has met many HTA specialists by taking part in international conferences, and has invited these specialists in good time to visit Taiwan to conduct trainings. These training courses not only allow the policy authority to have an opportunity to understand foreign experience but also provide many drug suppliers with learning opportunities in the HTA methodology.
  • Patient Participation

  1. NHI 2.0 that launched in 2013 has specifically mentioned in Article 41 of the National Health Insurance Act that patient should be invited to voice their opinions in the Pharmaceutical Benefit and Reimbursement Standard (PBRS) meeting, which is the legal base for patients in Taiwan to participate in decision making process of insurance reimbursements.
    In 2015, NHIA established an online platform of “Patient Opinions for New Drugs and New Medical Devices”. Patients and advocacy groups can provide their opinions about the drugs and medical devices under review through the platform. All posts will be collected by CDE and presented in the PBRS meeting as references. From 2016, 2 patient representatives that have previously submitted inputs will be invited to present their opinions about re-appraisal reimbursement cases.
    Started June 2019, 2 representatives from registered patient groups are to be seated in the PBRS meeting during the reimbursement decision making.