The article “Value based healthcare and Health Technology Assessment for emerging market countries: joint efforts to overcome barriers,” authored by Maximillian Otte et al., was published in the Expert Review of Pharmacoeconomics & Outcomes Research in 2024. This paper synthesizes the findings from an educational forum held in Copenhagen, Denmark, on November 11, 2023, which brought together international healthcare experts, academia representatives, and public agency officials from both emerging and established market countries. The forum’s primary goal was to address the unique challenges faced by emerging markets in implementing Value-Based Healthcare (VBHC) and Health Technology Assessment (HTA).
The forum focused on four main objectives: increasing awareness of VBHC and HTA among decision-makers in emerging market countries, exploring current practices, identifying challenges and enablers, and proposing collaborative efforts between industry, academia, and public agencies. Participants from countries such as Malaysia, Egypt, Kuwait, South Korea, Taiwan, Saudi Arabia, Spain, Belgium, and the United Kingdom shared their insights. The discussions were structured around expert presentations and interactive roundtables, covering critical areas such as:
- Value-Based Healthcare (VBHC): The forum highlighted that VBHC, defined as outcomes that matter to people relative to the cost of achieving them, is not a new concept but has gained popularity. Value itself is multifaceted, encompassing economic sustainability, ethical considerations, best practices, and social equity, and is perceived differently by various stakeholders, with end-user value being key.
- Health Technology Assessment (HTA): HTA is presented as a multidisciplinary process using explicit methods to determine the value of health technologies across their lifecycle, aiming to inform decisions for equitable, efficient, and high-quality health systems. While many developed countries have systems to incorporate health technology value, many emerging countries lack such established systems. The need for iterative HTA throughout a technology’s lifecycle was emphasized, considering changes in clinical practice and evolving evidence.
- Real-World Evidence (RWE) in Biosimilars: RWE, defined as clinical evidence from data collected outside controlled research settings, emerged as crucial for understanding biosimilar value recognition and decision-making. While randomized controlled trials (RCTs) are the gold standard, RWE can complement them, especially for local substantive values and long-term results, despite being more susceptible to bias. The forum noted that while the importance of RWE is recognized, emerging market countries face challenges like socioeconomic disparities and resource constraints in implementing it for decision-making.
- Multi-Criteria Decision Analysis (MCDA) for Pharmaceutical Procurement: Recommendations were provided for using MCDA, particularly for off-patent (multisource) medicines. This approach allows for a comprehensive assessment of value by considering multiple criteria beyond just price, including product, manufacturer, service, and economic categories, thus addressing issues like disincentives for evidence generation. MCDA can move decision-making in emerging economies from ad hoc to algorithm-driven, improving consistency and transparency.
Overall, the forum identified key avenues for collaboration, including public–private partnerships (PPPs), joint capacity building, training initiatives, and continuous knowledge exchange within global networks. These efforts are deemed essential to adapt global VBHC and HTA frameworks to local decision contexts, ultimately improving the adoption and utilization of innovative health technologies and fostering more equitable, efficient, and higher-quality healthcare systems in emerging markets. Future tasks include building infrastructure for collecting real-world effectiveness data, upgrading decision-making systems to consider non-price criteria, and potentially implementing MCDA in pharmaceutical procurement.
References: Otte, M., Dauben, H. P., Ahn, J., Gutierrez Ibarluzea, I., Drummond, M., Simoens, S., Kaló, Z., & Suh, D.-C. (2024). Value based healthcare and Health Technology Assessment for emerging market countries: joint efforts to overcome barriers. Expert Review of Pharmacoeconomics & Outcomes Research, 24(9), 1061–1066. https://doi.org/10.1080/14737167.2024.2398482
