Dr. Sripen introduces Alia and Benjarin for the presentation on HITAP experiences.
After the presentation, many questions were raised by our Zambia colleagues on the following subjects:
1. How are comparators being chosen? The most common treatment that is currently being used in practice is being used as a comparator.
2. Can rare cases be prioritized? Aside from the evidences, policy decision makers also take into account equity and ethical considerations. Choosing or not choosing the incorporation of treatments for rare cases depends on the decision maker. The most important aspect is that the decision maker must be able to give a valid justification if they do not act according to the evidence generated.
3. How are the thresholds being set? The WHO recommends that the threshold is 1 to 3x the GDP. However, depending on the context in that particular country, the policy decision makers have to decide which threshold is feasible in their context. Thailand has chosen to set this threshold on 1x the GDP which equals 160.000 baht.
4. How can HTA be institutionalized? This depends partly on the context of that country. For instance, in Thailand we had both economic prosperity that contributed to excessive use of health technologies. However, during the economic recession, Thailand needed to prioritize health technologies.
5. How many staff does HITAP have? HITAP started with 5 staffs in 2006 and now we have 57 staff including admin.
6. How do you raise funds? HITAP receives funds from the NHSO, which is the grand user of HTA. Aside from the NHSO, HITAP receives a small amount of budget from the ministry of Health and receives funds by doing international projects.
7. Conducting economic evaluation takes a long time, how can the results be implemented timely? The involvement of policy decision makers in the HTA process will speed up the implementation process.
8. How does HITAP set the scope for their research? HITAP consult different stakeholders.
9. How can decisions be dealt with that is not in line with the evidences? HITAP does not deal with decisions because HITAP works according to the TOR agreements which encompasses determining the cost effectiveness. However, in the case of policy decision makers, they have to be transparent in their decision making, for instance, they need to explain to the public on foundations the decisions are being made. This can be for example ethical considerations. HITAP works in a transparent manner as it publishes all its results on the website.
10. Will there be a collaboration between HITAP and Zambia? No, in South Africa, there is an organization called PRICELESS that can support Zambia better than HITAP in terms of culture, and familiarity with African countries and also the distance between Zambia and Thailand is inconvenient.
During the meeting, it could be perceived that the country context of Zambia differs significantly with Thailand in terms of diseases that is rare in Thailand but very common in Zambia. Further, the HTA system in Zambia is still in a very early phase with ad hoc teams performing HTA’s. One of the problems in their HTA system is consistency, which is cost and time consuming and therefore not efficient. There is a need for a movement towards an HTA organization. The need for an evidence based system will benefit the population the most.