What was the Inquiry?
The Health Technology Assessment (HTA) Review examined Australia’s approach to HTA to determine what works well and what needs to improve to meet future challenges. The aim was to ensure Australians can continue to access effective, safe and affordable health technologies in an equitable and timely way.
About health technology assessment
A health technology assessment (HTA) involves a range of processes and mechanisms that use scientific evidence to assess health technologies for their quality, safety, efficacy, effectiveness and cost-effectiveness.
HTA informs Australian Government decisions to fund and subsidise health technologies through subsidy schemes and funding programs, such as the:
- Pharmaceutical Benefits Scheme
- Medicare Benefits Schedule
- National Immunisation Program
- Life Saving Drugs Program
- National Health Reform Agreements
- National Blood Authority
- National Diabetes Services Scheme.
Submission Extract
Dr Anita Lal and Associate Professor Zavarsek from Deakin Health Economic (DHE)’s Health Technology Assessment (HTA) steam both submitted responses to the review. Below is an extract from Dr Lal’s submission.
1.3. First Nations people’s involvement and consideration in HTA
First Nations people partnership in decision making.
3. Sponsor submissions to require consideration/assessment of the impact on health outcomes for First Nations peoples to enable meaningful informed decision-making.
Response:
Health equity and accessibility of healthcare are important considerations in HTA, to help ensure that decisions regarding the adoption of interventions do not increase health inequalities of First nations Australians. Current HTA method guidelines do not require the quantification of the health impacts on Aboriginal and Torres Strait Islander people. A standardised approach to systematically quantify health inequities for First Nations Australians would enable the comparison of the impact across different interventions and health conditions and could facilitate HTA adopting a more transparent and rigorous strategy to ensure that health inequalities between Indigenous and non-Indigenous Australians are not increased.
Distributional cost-effectiveness analysis (DCEA) is a method that can provide quantitative information about the overall equity impact of funding new health technologies and the trade-offs that may arise between equity and efficiency (health maximisation). DCEAs can quantify the distribution of expected health benefits of interventions by Indigenous and non-Indigenous status. This methodology enables an intervention to be classified as being “Win-Win” (both cost-effective and reduced health inequality), “Lose-Lose” (not cost-effective and increases health inequality), “Lose-Win” (not cost-effective but decreases health inequality) and “Win-Lose” (cost-effective but increases health inequality). This will aid decision-makers confronted with equity-efficiency trade-offs, such as assessing the funding viability for a new medicine that is “Lose-Win” to address health inequality or contemplating additional investment in the redesign of a public health prevention program that is “Win-Lose” to enhance uptake among First Nations people.
There are two important ways the quantification of the health equity impacts could be used to inform HTA funding deliberations to ensure health inequalities of First Nations Australians are not increased. Firstly, this data has the potential to substantiate the development of supplementary delivery recommendations aimed to increase uptake of cost-effective interventions amongst Indigenous Australians. It could influence decisions around novel technologies with an unequal benefit in Aboriginal populations, due to inequality in the utilisation and adherence to existing technologies, such as more accessible medication for Aboriginal people with diabetes with suboptimal blood sugar control. Secondly, it may play a pivotal role in influencing definitive recommendations, either in favour or against, particularly in scenarios where the marginal cost per quality-adjusted life year (QALY) gained closely approaches the relevant cost-effectiveness decision threshold. A considerable positive influence in lowering health inequality could sway a borderline decision from a ‘no’ to a ‘yes.’
A publicly accessible tool, the Health Equity Impact calculator was developed in the UK to assess socioeconomic health inequality impact. It uses built in prevalence look up tables to estimate the social distribution of the population, based on hospital episode statistics and s survey data for risk factors such as smoking. Inputs such as uptake and effectiveness can be varied by group. An Australian version could assess health equity impacts of Indigenous and non-Indigenous Australians and perform simple distributional cost-effectiveness analyses. We will begin to develop an Australian version in 2024. Indigenous experts and academics will be involved to make sure that the First Nations Australians health outcomes are accurately represented and that this tool is respectful to their cultural values and beliefs.
Download Dr Anita Lal’s full submission
What did the Review find?
The HTA Review concluded on 4 May 2024. The HTA Review Reference Committee held its final meeting on 2 May 2024 and provided its final report to the Minister for Health and Aged Care on 31 May 2024.
The final report was released in September 2024 along with a summary of recommendations and a full recommendations document. These documents supplement the full report by including a summary of the key recommendations and their aims.
The Pharmaceutical Benefits Advisory Committee (PBAC) and the Medical Services Advisory Committee (MSAC) have considered the final report of the HTA Review and provided their initial advice and reflections to the government.
The government has established an Implementation Advisory Group to develop a roadmap for sequencing the government’s response to the recommendations.
Read more about Deakin Health Economic (DHE)’s Health Technology Assessment (HTA) stream
