Németh Bertalan, Goettsch Wim, Kristensen Finn Børlum, Piniazhko Oresta, Huić Mirjana, Tesař Tomáš, Atanasijevic Dragana, Lipska Iga, Kaló Zoltán
Syreon Research Institute , Budapest, Hungary.
WHO CollaboratingUtrecht Centre for Pharmaceutical Policy, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University , Utrecht, The Netherlands.
Expert Rev Pharmacoecon Outcomes Res. 2020 Aug;20(4):321-330. doi: 10.1080/14737167.2020.1779061. Epub 2020 Jun 18.
Lower-income European countries have a worse health status and less funds for health care compared to Western Europe. Despite their limited human and financial capacities for conducting Health Technology Assessment (HTA), the need for evidence-based decision-making is growing. Two main approaches emerged as potential solutions: joint clinical assessments on the European level, and simplified procedures relying on the judgments of well-established HTA agencies of Western countries.
Based on considerations of transferability, the European Network for Health Technology Assessment (EUnetHTA) was built up to harmonize HTA methodologies across the European Union, and to develop an HTA Core Model by focusing on joint production of relative effectiveness assessment, which can be used as a basis for national value assessments. The second approach has been suggested in various forms without considering transferability issues.
Joint clinical assessments reduce duplication of efforts based on appropriate scientific rationale. On the other hand, recent examples show that relying on judgments of HTA agencies from wealthier countries with potentially different health-care priorities can lead to suboptimal allocation decisions. In the short term, some stakeholders may benefit from ignoring transferability, but it will ultimately lead to limited access in other disease areas.
与西欧相比,欧洲低收入国家的健康状况较差,医疗保健资金较少。尽管它们开展卫生技术评估(HTA)的人力和财力有限,但基于证据的决策需求却在不断增长。出现了两种主要方法作为潜在解决方案:欧洲层面的联合临床评估,以及依赖西方国家成熟HTA机构判断的简化程序。
基于可转移性的考虑,建立了欧洲卫生技术评估网络(EUnetHTA),以协调欧盟范围内的HTA方法,并通过专注于联合开展相对有效性评估来开发HTA核心模型,该模型可作为国家价值评估的基础。第二种方法以各种形式被提出,但未考虑可转移性问题。
基于适当的科学依据,联合临床评估可减少重复工作。另一方面,最近的例子表明,依赖医疗保健优先事项可能不同的较富裕国家HTA机构的判断可能导致分配决策欠佳。短期内,一些利益相关者可能会因忽视可转移性而受益,但最终会导致其他疾病领域的可及性受限。